Personality Disorders: Borderline and Beyond (Part 1 of 2)

What are personality disorders?

Are these just ‘faults’ or ‘flaws’ in someone’s personality?

And, if personality is something that’s largely formed by the time we’re adults, does this mean that personality disorders can’t be treated?

You may have heard of borderline personality disorder, narcissistic personality disorder, obsessive-compulsive disorder (OCD) or many others in the category. The use of these terms, along with their diagnoses, has been on the increase these days. Yet they are still somewhat misunderstood.

Today we’re going to look at one of these disorders, Borderline Personality Disorder, as Part One in a continuing series, delving deeper into its origins, symptoms, myths and examples. We’ll also look at various options for treatment, which itself is cutting to the chase on that front – yes, there is treatment available. If you or someone you know are affected by one of these personality disorders, there’s reason for hope and optimism.

Personality Disorders, Defined

The American Psychological Association defines personality disorders as “a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.” The APA has identified 10 essential personality disorders. Perhaps most noteworthy among these are:

• Borderline Personality Disorder
• Narcissistic Personality Disorder&
• Obsessive-Compulsive Personality Disorder

Typically, a diagnosis is given when two or more of the following patterns are presented:

• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior

These disorders more commonly are seen in adulthood or late teens. It’s less common to see these in childhood or early teens. What’s important about these disorders is that they cause distress and can be terribly prohibitive towards one’s ability to function.

At Capital Choice Counselling here in Ottawa, we have several therapists and counsellors who are trained and experienced in treating a variety of personality disorders. We firmly believe, as does the psychological and mental health community at large, that while there is no magic “cure,” effective treatment is possible to restore or implement a functional life. People who’ve gone without treatment or even diagnosis who have moderate to severe afflictions of one or more of these disorders are likely suffering in silence. If that’s you or someone you know, read on to discover what you could be dealing with and how to go about treatment.

Borderline Personality Disorder

If the term “borderline” sounds to you like a catch-all word to describe someone who’s on the edge of psychosis, you’re not alone. That’s a misconception, though. Borderline Personality Disorder (BPD), as defined by the National Institute of Mental Health, is “marked by an ongoing pattern of varying moods, self-image, and behavior.” Sufferes of BPD often exhibit “impulsive actions and problems in relationships,” and many experience “intense episodes of anger, depression, and anxiety that can last from a few hours to days.”

There are nine criteria for the diagnosis of borderline personality disorder. One only needs five of the nine (a majority) to be considered likely for diagnosis. Note that one should never self-diagnose just by reading information online or elsewhere. The following criteria are to be seen as guidelines for BPD and used as an impetus or spark to seek professional help.

• Fear of – and frantic efforts to avoid – abandonment
• Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
• Markedly and persistently unstable self-image or sense of self 
• Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating)
• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
• Affective instability due to a marked reactivity of mood (e.g., intense episodic depression, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
• Chronic feelings of emptiness
• Inappropriate, intense rage or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
• Transient, stress-related paranoid ideation or severe dissociative symptoms

Sound familiar? Someone you know? Perhaps even… you?

Before jumping to conclusions, any one of these symptoms can be present on their own and are not directly correlated or unique to BPD. With two or three symptoms, one should still look at other possibilities (with professional assistance, of course). At four symptoms, the possibility of borderline-like disorder starts to go up. Five or more, and you or your loved one would be wise to seek professional help and begin treating this affliction.

The many ways in which those with Borderline Personality Disorder struggle

People with borderline personality disorder are not on the edge of going “crazy” or “psychotic.” They do, however, have significant struggles in life. Their ability to function as adults in society is impacted by some or many of the borderline traits set out above, particularly when it comes to relationships and careers. You can imagine (and more than imagine, if you have BPD) what a challenge it could be for someone with abandonment and/or anger issues, for example, to sustain a friendship, let alone a romantic relationship. And on the job, impulsiveness and lack of self-awareness or self-worth are ingredients for disaster.

Making matters worse, BPD sufferers often feel disconnected from their own reality. It’s difficult for them to see the future ramifications of their decisions and actions, which stem from an inability to ‘see’ or ‘feel’ in many situations. On the other hand, people with borderline personality also tend to swing quickly and violently from one emotion to the next. Their emotions in a given situation are often seen or perceived by others as “irrational” or “exaggerated.”

Achieving happiness or even satisfaction is extremely difficult for those suffering with BPD. They’re more likely to feel empty, seem bored, and constantly taking actions that might not be in their best interest. Some with BPD are suicidal, either outwardly (cutting/mutilating themselves, and/or making threats of suicide) or feeling suicidal without necessarily expressing it.

But even without outwardly suicidal gestures, their actions can be seen as a call for help… if properly identified. Someone engaging in dangerously impulsive behaviour –  such as substance abuse, binge eating or drinking, reckless driving or spending, or impulsive and unsafe sex – is doing so for a reason.

How to Receive a Diagnosis and Get Treatment

If you have a friend or family member in such a situation, talk to them. Let them know you’re there. Avoid making judgments; go out of your way to make it clear you’re on their side and you want them to get better.

If this is you… would you like to get better? Maybe you’re not sure how? Or perhaps you firmly believe this is who you are, that it’s in your source code and destiny.

While it’s true that these traits are well ingrained in an adult who’s been borderline for years if not decades, that doesn’t mean that treatment isn’t possible.

Quite the contrary.

Psychotherapy is the best option – and a very viable one – in the treatment of borderline personality disorder. Therapy or counselling helps the patient learn and build coping skills, regulate their emotions, and achieve better levels of functionality that ultimately lead to improvements in areas such as careers and relationships.

Get in touch with Capital Choice Counselling in Ottawa today to set up an initial assessment session with one of our counsellors. Take the first step towards healing, recovery and success.

And stay tuned for our second part in this series on personality disorders.