The scene takes place at a very nice restaurant. Teresa is arguing with a friend. When the friend becomes insulting, Teresa responds with rage. She begins a tirade while pounding the table with her fist and finally flips the table over. Several men rush to her side. She shoves one away, but allows another to comfort her. She then calms down and they end their conversation with a kiss.
In a post interview Teresa seems unaware of the intensity of her emotional outburst. She doesn’t realize she shoved her male friend. She is also out of touch with her table guests’ reactions of shock and confusion and, in fact, believes her husband found her behavior sexy. As she reflects on the experience she doesn’t appear embarrassed or remorseful about what occurred that evening. In her opinion it was justified.
This type of emotional vacillation, black-and-white thinking, and disruptive behavior is typical of Borderline Personality Disorder (BPD).
Other behaviors include:
- Seems angry or very sad without any apparent reason
- Leaves loved ones feeling confused
- Engages in risky behaviors, such as risky sex, gambling, drug usage or binge drinking, eating disorder, or self-injury
- Can have problems with the law, may drive recklessly, or behave aggressively and belligerently
- Often seems overwhelmed and extremely stressed by daily living
- Simple decisions may seem challenging to make
- There are topics that are too touchy to discuss
- As previously mentioned, thinks in extreme “black and white” terms or “all or nothing,” for example, if you don’t do something for her, then you were never a real friend
- Seems to be perpetually a victim of other’s bad behaviors—seems to lack common sense and exposes self to undue risk without much awareness of it
- Sometimes is hypersensitive—more bothered by bright lights, loud noises, or strong odors
- Easily distrustful and suspicious of others
- Seems frightened to be on his or her own
- Also seems to go from one crisis to the next. Everything is big and overwhelming
- Has a different view of the world. Other’s perception of a situation is drastically different from his or her viewpoint
- Often circadian rhythm is off—sleeps during the day and is awake during the night
- Causes others to feel aggravated, powerless, and overwhelmed by his or her demands, moodiness, and constant drama
- Often experiences a sense of “emptiness” or lacks a strong sense of a cohesive self.
- Frequently is very hard on self, experiences shame which can erupt in to self-injurious behavior, such as cutting or suicide
The exact cause is still unknown. Until recently, bad parenting has been blamed. It has also been speculated that early childhood trauma may play a role in the development of BPD since children who experience severe trauma, particularly sexual abuse, seem to have higher rates of the condition.
Recent advances in neurobiology, however, suggest there are strong biological indicators. Research on several different fronts indicates that those with BPD have irregularities in areas of the brain that control executive functioning. These neurological regions affect how people manage emotional stimulation, maintain impulse control, experience and regulate pain, interpret and remember daily events, deal with anxiety, develop insight, and execute decisions. Those with BPD seem to have innate biological differences. This may seem like bad news since conventional wisdom is that developed brains don’t grow or change. This understanding, however, has been disproven. It is now known that the brain is capable of developing new neuronal pathways, regardless of age, thanks to Eric Kandel’s work in neurogenesis. Such growth doesn’t happen spontaneously, it take constant practice to learn new and different way to handle stressful situations.
How can someone with BPD improve their overall level of functioning? In the next article I will discuss the latest available treatments that offer hope for those with BPD and their families.
A special thank you to Valerie Porr for the comprehensive information on BPD in her recent book, Overcoming Borderline Personality Disorder: A Family Guide for Healing and Change.
Porr, Valerie, Overcoming Borderline Personality Disorder: A Family Guide for Healing and Change. M.A. : Oxford University Press, 2010.