Borderline Personality Disorder: An Overview

by Simran Premjani 
February 19, 2022
Borderline Personality Disorder: An Overview

Neurosis can be described as individuals experiencing emotional distress while psychosis can be viewed as the distortion of reality. Dwelling on the border between neurosis and psychosis lies a condition called Borderline Personality Disorder (BPD). The condition consists of negative affective states that might cause disturbances in interpersonal relationships, feelings of emptiness, fears of abandonment, and susceptibility to suicidal thoughts. Based on these negative affective states and emotional dysregulation, people with BPD may suffer from deficits in reality testing and misinterpret the environment and motivations of others by either idealizing them or degrading them. This disorder is characterized by extraordinarily unstable behavior, affect, mood, and self-image. Individuals may lack a coherent identity and struggle to develop a stable sense of identity that may lead to distress as well as dysphoria. BPD may also include depression-like symptoms such as overall feelings of hollowness and loneliness.

The term ‘splitting’ is often used to describe their extremely fluctuating emotions. These fluctuations can also lead to performing behaviors like inflicting self-harm for control or attention. Since splitting, i.e., characterizing people, objects, beliefs, or situations as either all good or all bad and fear of abandonment are central to people with BPD, they often have extreme emotional viewpoints which may eventually lead to problems in interpersonal relationships. There is a tendency towards an intense and idealized form of dependence that does not last long. This overdependence later manifests into direct aggression towards loved ones. Mood swings are common and the person may rotate moods of anger, sadness, and numbness all in short succession. Due to intense emotions and impulsive behavior, individuals with BPD face difficulties in reaching their academic or personal potential.

People with this disorder may feel very insecure about themselves and can be dependent on others to help them feel better or less lonely. However, they also struggle with an inner conflict wherein they feel conflicted about their life goals and often question their own identity. At times the individual may feel that they are a burden, and believe that they cannot be loved because of their disorder. This leads to the compulsive need to be constantly validated by family and friends, which can effectively ruin relationships. As a result, their feelings escalate in intensity and they become more demanding and impulsive. These individuals can become hyper-sensitive and can be triggered by comments that are hurtful to a very little extent. Their reaction is physiological, wherein they can feel anger pulsating throughout their body. The individual may also feel extreme hatred towards people when their feelings are not reciprocated. This makes it harder for these individuals to control their emotions. They may apply a ‘black and white’ dichotomy towards people and their experiences.

BPD symptoms have been associated with biological factors like heritability, abnormalities in hormones, neurotransmitters involved in regulating sensitivity to pain, abnormalities in areas of the brain that are involved in emotional regulation such as the amygdala and prefrontal complex. These biological factors may increase susceptibility to BPD. Psychological processes such as abnormalities in emotional functioning and regulation, avoidance of situations and feelings that bring discomfort, inability to regulate anger, and low distress tolerance combined with biological factors may translate into BPD symptoms. Along with that, early childhood experiences like trauma, history of psychiatric disorders at home, abuse, insecure attachment styles, etc., may also play a crucial role in the development of BPD symptoms.

BPD is highly stigmatized in mental health settings because it is seen as a chronic disorder that is untreatable. This stigma and misconception lead to an underdiagnosis of BPD. In reality, evidence shows that symptoms of BPD improve over time and early interventions are quite beneficial (M. C. Zanarini, 2014). One of the important long-term goals of the intervention is to attain and maintain functional recovery for people with this disorder.

Evidence suggests that psychotherapy is effective in minimizing symptoms of BPD (National Collaborating Centre for Mental Health, 2009). Psychotherapeutic approaches like Dialectical Behavior Therapy (DBT) and transference-focused psychotherapy are evidence-based treatments that have a significant impact in managing symptoms and attaining functionality for people with BPD. A single session of psychoeducation about the diagnosis can also be effective and beneficial, wherein the therapist shares information with the clients and their families about the nature, symptoms, underlying psychological structures, symptoms, and behavior associated with borderline personality. Psychoeducation has emerged as an evidence-based and effective intervention that has helped in managing symptoms of many disorders.

Psychotherapeutic approaches that focus on helping the individual become aware of their emotions, and help them to control impulsive and intense behaviors such as self-harm and distress reactions have been successful in managing symptoms. These goal-directed approaches help the person identify and analyze their problem to develop healthy and effective solutions. Therapy also helps the individual develop self-management and interpersonal skills. One of the treatment approaches can be through integrating psychotherapy, family interventions, and pharmacological treatment to achieve a more holistic treatment. However, BPD can lead to difficulties in maintaining the relationship with the therapist. In such situations, an outside perspective of a consulting therapist can be beneficial to the treatment process.


Simran Premjani

Clinical Associate Psychology,


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