Borderline Personality Disorder (BPD) is often mistaken to be a very visible, over-the-top condition where the person has violent rage outbursts and is dysfunctional. However, BPD is actually a subtle condition that often goes undetected and therefore untreated. Global statistics reveal that:
- Eighty to 90 per cent of BPD patients have a history of physical or sexual abuse
- The highest suicide attempts are by people in their 20s and mortality rates increased in their 30s
- Although statistics show that more women are diagnosed with BPD (gender ratio is 3:1), research finds this is true of clinical samples and not community samples, which means more women seek help than men.
NINE SYMPTOMS OF BPD
- Frantic efforts to avoid real or imagined abandonment. Loved ones being unavailable for even short periods of time leads to rage, outbursts and erratic behaviour.
- A pattern of unstable interpersonal relationships. Partners come across as either devils or angels but nothing in between.
- Unstable self-image leading to frequently changing jobs, partners, ethics, religion and even sexual preference to find a sense of identity.
- Impulsivity in at least two areas (spending, sex, substance abuse, reckless driving, binge eating).
- Recurrent suicidal behaviour, gestures, threats, self-mutilation.
- Mood instability leading to dysphoria (dissatisfaction with life), irritability, or anxiety usually lasting only a few hours.
- Chronic feelings of emptiness.
- Inappropriate, intense anger.
- Paranoid ideation or severe dissociative symptoms. People with BPD report feeling mistrustful and suspicious of others. When under stress, they have an experience known as dissociation where they feel spacey, floaty or report out-of-body experiences.
MANAGEMENT OF BPD
BPD is a mental illness, not a character flaw or a ‘personality issue’. Therefore, treatment with a trained therapist is a crucial step to recovery. Effective therapies include cognitive behaviour therapy, dialectical behaviour therapy, eye movement desensitisation and reprocessing (EMDR), often used in combination with medications for mood management. However, therapy is only part of the entire treatment. Recovering from BPD takes time, patience and hard work by the person. Here are some strategies:
Self soothing: I encourage clients to create a ‘soothing kit’, with objects to represent the 5 senses as an emergency tool for intense emotions (for instance, a ziplock bag with a perfume, velvet cloth, mint, a bell)
Mindfulness: For people with BPD, the PFC or Pre-Frontal Cortex (part of the brain that helps us pay attention to tasks) doesn’t function optimally, making them restless and agitated with low attention spans. Mindfulness practices such as grounding, sensory orientation, journaling increases activity in the PFC.
Managing self-harm: Snapping a rubber-band on the wrist, holding ice cubes in the hand, drawing a line with a red marker, are helpful substitutes when urge to do self-harm comes up.
Distress Management: The “TIP” is a good strategy:
T: Temperature change with cold water. Putting face in a cold bowl of water or holding a cold ice pack activates the “dive” response, where the heart slows down and blood flow is activated to the brain and heart. This skill helps regulate emotions.
I: Intense exercise like jogging for a few minutes helps expend the body’s stored energy and calms it down.
P: Paced breathing. Tense muscles while breathing in. Breathe out while saying the word ‘relax’ — let go of the tension and notice the difference in your body
Get Support: Family and friends need to adopt an attitude of unconditional support. As Kiera Van Gilder writes in The Buddha and the Borderline, “The difference between being told ‘There’s no reason to feel that way’ and ‘I can understand you feel that way’ is the difference between taunting a rabid squirrel and giving it a tranquiliser”.
Spirituality: Finding an anchor in the form of a guru, guide, or religion helps the recovery process. Many people with BPD find teachings from Buddhism helpful in the development of the ‘wise mind’.
This post originally appeared in Mumbai Mirror.