To be diagnosed with BPD, you need to have 5 out of 9 traits. At least, that’s what you’re told. The folks who decided on the 5/9 criteria left out crucial information on their decision-making process — that the number is completely arbitrary.
And so begins this deep dive of what we’ve got wrong about BPD, what we know but don’t seem to be telling anyone and what we can do to remedy this. Buckle up.
What We Got Terribly Wrong
1. We called it Borderline Personality Disorder
Back in the primitive days of Psychology, Emil Kraepelin — a famous German Psychiatrist — produced a definitive map of mental illness. It was decided that there was simply Neurosis or Psychosis, and everything lay between these polarities. To put it even more explicitly: you had the remarkable choice of Paranoia or Schizophrenia.
Borderline Personality was smack-bang in the middle, hence “Borderline”, people who experienced both Neurotic and Psychotic symptoms. They were undefinable by the current system. So instead of changing the system, we decided you lay on the edges.
2. We declared it untreatable
Of course we did. Your symptomatology began its definition exiled to the border, and as psychological diagnoses continued, we slapped a “personality disorder” label onto it.
Culturally, your personality is a fixed snapshot of who you are at your core. If someone was asked to describe me, for instance, they might say I am relatively shy, socially diplomatic, occasionally funny and (hopefully) kind. Those not so fond of me might even describe me as weak, impulsive and naive. And I would agree with all of those traits. Our personalities also come from our upbringing, religious, sexual and political slants.
So if you were told you had a personality disorder, you’ be forgiven for thinking that not only did this make you inherently flawed, but that there was no hope of changing who you are.
This is simply not so. As difficult as it may be to write this sentence simply — your personality is not your personality disorder.
3. We claimed only women get it
Classic, classic psychology. We could talk for hours about how a lack of orgasms was the cause of hysteria. But let’s not, because that is absolute bollocks. And whilst we have buried a significant amount of sexist psychology over the last 50 years, everyone knows this still isn’t an equal playing field.
BPD is no exception. The alternative label of Emotionally-Unstable Personality Disorder (EUPD) aimed blindly and directly at women who could not maintain their moods. Those mad women and their…*looks at notes* emotions.
All genders have emotions. All genders can experience childhood adversity. All genders can be diagnosed with BPD.
What We Know But Aren’t Saying
1. BPD is undeniably linked to Childhood Adversity
A recent paper by Porter et al., 2019, titled “Childhood Adversity and BPD: a Meta-Analysis” looked at 42 studies with over 5000 participants. Patients with BPD were 13 times as likely to report childhood adversity, in particular abuse and neglect, than both other clinical samples and the general population.
To put this in perspective. The medication your GP gives you for your physical ailments, be it a bacterial infection, cancer or high-blood pressure has, on average, a 60% chance of working for you. Out of 100 people, the medication given will have an effect on 60 of them, but for 40 of them — nothing. This is accepted to be good enough to authorise the use of all of the medications you are exposed to.
Studies on BPD have found that, on average, between 75–95% of sufferers report being abused or neglected in childhood. Out of 100 people with BPD, 75 of them will have suffered some form of childhood adversity. Yet a lot of mental health professionals still refuse to take this into consideration when it comes to diagnosing, treating (or even refusing to treat) Borderline Personality Disorder.
2. DBT isn’t a miracle cure
DBT or Dialectical Behaviour Therapy is a type of cognitive therapy designed by psychologist Marsha Linehan in the 1980’s. Having a diagnosis of BPD herself, Marsha developed this treatment with the aim of reducing black-and-white thinking, decreasing distorted thoughts and improving healthy social relationships and boundaries. By instilling better coping mechanisms for stress and helping to regulate emotions, it has received plenty of praise from practitioners and sufferers alike.
But it doesn’t work all the time. Linehan herself gave a talk, during which she expressed how much more effective it was when administered to people who were not suicidal. She went as far as to not recommend it at all for those who were having thoughts about suicide and self-harm as it seemed to worsen their symptoms. A theory that hasn’t been disseminated throughout the mental health world, let alone researched in any depth.
What We Can Do
1. Fund more research & Communicate our findings
We need more money to do more research into BPD. Yes, Emma, I hear you say. We need more money to do more research into everything; cancer, climate change, extremism, auto-immune disorders.
Yes, yes we do. Research is a fundamental pillar of progress. Good, honest research practices must be implemented more strictly. Scientists should stop lying about their work to get into high-level journals. High-levels journals should stop charging so much to give access to much-needed information.
- As an aside, if there’s a paper you would like to read, it’s worth contacting the researcher directly. They will often send you a copy for free.
There is so much research to be done, and so many curious minds who want the opportunity to bring their ideas to life. BPD researchers are no exception. This is a debilitating, frustrating and frightening disorder. It is prevalent in the prison system and in forensic psychiatric care. We need to understand more. We need to communicate that more.
2. Work harder to reduce childhood adversity
Like the stories about hostile, parasitic takeovers — if you kill the queen, the hive becomes inactive. I’m not saying the sole reason for BPD is childhood adversity. But with such impressive odds (see above) the reduction of abuse and neglect in our formative years could dramatically reduce not only the development of Borderline and other psychological disorders, but also the suffering of flipping children.
Take it from me, you don’t want to be an adult with a tumultous childhood. And sure, shit happens. But where are we* when it does? Because that’s what matters.
*We are the adults. Ideally trauma-informed, trained and with at least half a crap to give the most vulnerable people in our communities.
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Borderline Personality Disorder remains a terrible diagnosis to receive. The stigma that it is untreatable, an inherent flaw in your personality remains to this day.
This simply isn’t the case, and we owe those who suffer with these paralysing, life-changing symptoms an explanation.
Then we need to work together to do better.