What is BPD?

First, we must know what therapists and doctors are basing their diagnosis off of. In the clinical world, mental health diagnosis can only be made if clients meet certain criteria as listed in the Diagnostic Statistical Manual for Mental Health Disorders (Also known as the DSM) 

Personality Disorders are organized in “Clusters” to differentiate underlying foundational characteristics. There are 3 Clusters – Cluster A, Cluster B, and Cluster C. Borderline Personality Disorder falls under the “Cluster B Category” but this is a major point of contention for me, because the core wounds that condition BPD behaviors are not the same as those that shape NPD or ASPD. (More on that, later.)

In the DSM, BPD is defined by the following:

Borderline Personality Disorder is defined by “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by meeting FIVE or more of the following criteria:

1. Frantic efforts to avoid real or imagined abandonment

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation (also known as Splitting)

3. Identity disturbance: markedly and persistently unstable self-image or sense of self 

4. Impulsivity in at least 2 areas that are potentially self-damaging, for example, spending, substance abuse, reckless driving, sex, or binge eating 

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 

6. Affective instability due to a marked reactivity of mood, for example, intense episodic dysphoria, anxiety, or irritability, usually lasting a few hours and rarely more than a few days 

7. Chronic feelings of emptiness

8. Inappropriate, intense anger or difficulty controlling anger, for example, frequent displays of temper, constant anger, or recurrent physical fights

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.”

source: https://www.ncbi.nlm.nih.gov/books/NBK430883/

In informal and non-clinical language, people with BPD can be described like this:

People with BPD fear being abandoned by the people they love most. This symptom comes with extreme anxiety and fear, is often trauma-related, and a result of previous abusive or toxic relationships and childhood experiences where they actually WERE abandoned or betrayed by the person they trusted the most. Although this is a distressing symptom, it shows that people with BPD genuinely love and care in relationships and have the ability to form connections that they value and cherish.

People with BPD struggle in relationships, often being described as “rollercoaster relationships” with extreme highs and lows. People with BPD are at high risk for being in abusive or toxic relationships, and struggle with leaving them (due to the fear of abandonment or other factors) and before therapy/treatment, they may struggle with identifying healthy vs. toxic partners because of their trauma/abuse history. If a person with BPD attaches to someone who is toxic or abusive for them, it will result in a hot/cold relationship because the person they need the most is also the person harming them the most. It makes sense when you think about it. 

People with BPD struggle with knowing who they really are. Because of the extreme emotional dysregulation they experience, and difficulty forming healthy relationships, people with BPD lack a stable point of reference for their identity, often times resulting from deep levels of self hate and not truly accepting themselves for who they are, so they often try to “be someone else” to escape the pain, which only causes more confusion and increases the risk for being in the wrong relationships with people who don’t actually love them (or know them). This symptom also results from unbalanced self-blame, blaming themselves for every bad thing that has ever happened to them and wanting to “be someone else” because of it. Trauma/abuse is a major reason this happens. 

People with BPD struggle with impulsivity. These impulsive behaviors are usually due to strong emotional reactions, like impulsively acting out of anger, often doing things that they regret or cause irreparable harm to themselves and their relationships. Impulsivity can also be a symptom for people who constantly seek thrills, as a way to fill the void of emptiness and search for something that will give them a “high” to escape from their pain (this can be impulsive spending, high risk activities, substance abuse, etc.)

People with BPD suffer from intense emotional pain and may have suicidal thoughts and self-injurious behaviors (like cutting, hitting themselves, burning themselves, etc). These can become medical emergencies, and are often the result of a long-standing pattern of self sabotage and hopelessness. People with BPD need help building a life worth living, including finding healthy environments full of people who care about them, a job that they feel gives them purpose, and healthy self care and self soothing skills to deal with life’s challenges without feeling like the only relief is to hurt themselves or end their life. 

People with BPD are highly sensitive individuals that feel very big emotions. This is often mistaken for being “manipulative or attention-seeking” (NOT TRUE!!!) but research SHOWS that people with BPD have neurological differences that explain why they feel so sensitive and emotional all the time: 

Research on Borderline Personality Disorder (BPD) and the amygdala shows that while many studies report a reduction in amygdala volume, some indicate that an enlarged or hyperactive amygdala—often linked to comorbid, treatment-resistant depression—contributes to extreme emotional instability. This overactive amygdala drives the intense, long-lasting emotions, fear of abandonment, and high sensitivity to interpersonal stress characteristic of BPD. 

Key Findings on BPD and Amygdala Structure/Function:

• Hyperactivity and Volume: Although some studies found smaller volumes, others have shown increased gray matter concentration (GMC) in the amygdala, suggesting it may be larger or more active in certain BPD profiles.

• Comorbidity Factor: Amygdala enlargement is particularly associated with BPD patients who also suffer from major depression (MDD).

• Emotional Processing: The amygdala in BPD individuals overreacts to emotional stimuli (e.g., neutral or fearful faces), often resulting in a mismatch between actual situations and perceived threats.

• Reduced Top-Down Control: BPD is characterized by a decreased connection between the prefrontal cortex (which regulates emotion) and the amygdala (which generates emotion), leading to poor impulse control.

• Treatment Impact: Studies show that therapeutic interventions, such as Dialectical Behavior Therapy (DBT), can help normalize this amygdalar emotion space. 

Implications:
The enhanced amygdala activity is believed to cause the "high sensitivity" to environmental cues, making patients feel intense emotions for longer periods. The combination of an overactive amygdala and reduced prefrontal regulation creates a "perfect storm" for the emotional volatility seen in BPD. 

People with BPD struggle with chronic feelings of emptiness. This is due to all the aforementioned, with the severity of the previous symptoms described, it’s no wonder they feel empty in life when all seems meaningless and hopeless. People with BPD need help discovering who they truly are and loving and accepting themselves so they can find purpose and meaning in life. This also includes staying AWAY from toxic individuals and abusive relationships which will only increase the feelings of emptiness and loneliness in their life. 

People with BPD struggle with anger. Repressed anger and rage is actually a form of Grief. When a person with BPD has racked up a number of negative experiences in their life, and no one to truly help them work through it, all of that pain gets buried underneath and turns into repressed anger. This may cause explosive outbursts during conflicts with loved ones, often seeming “inappropriate” because the anger is a build-up from ALL trauma that has accumulated. People with BPD need a healthy outlet for their anger, and a safe place to work through their trauma so they go through the entire grieving process, and get to the underlying hurt/pain that anger is built off of, and eventually come to a place of acceptance and forgiveness. 

People with BPD struggle with paranoia, understandably paranoid that any new relationship or experience is going to “turn out” like the past. They may be paranoid of being cheated on, abandoned, gossiped out, made fun of, lied to, or any number of traumatic experiences especially if there is a long history of abuse. These paranoid thoughts can become extremely delusional under high and severe stress, may go into states of “magical thinking”, and in extreme cases lead to psychosis. This is one of the more serious symptoms that may require medical intervention or be due to abusing drugs, alcohol, or sleep deprivation. 

What are common problems people with BPD face?

Not every person with BPD deals with ALL of the symptoms. Some may struggle with one or two of the above-mentioned, but in order to be “formally diagnosed” a person must struggle with at least FIVE of the issues talked about above. 

But even ONE of these symptoms, when out-of-control, can impact any and all major areas of their life. 

Because these symptoms MUST be severe enough to cause dysfunction in their daily life, people with BPD struggle with the following:

1. Relationships: Making and forming relationships or friendships  

2. Career: Getting a job, or keeping a job

3. Money: Managing their finances and spending habits 

4. Lifestyle: Having a healthy lifestyle including sleep, diet, exercise, and sobriety 

5. Future Planning: Saving for their future/retirement, planning ahead, achieving goals in life like family or major purchases like a home, building a business 

6. Self Concept: Loving themselves, having confidence, healthy self esteem, and self acceptance 

If any of the symptoms remain out of control for extended periods of time, these can lead to major life-altering events like divorce, trouble with the law, homelessness, lead to addiction, and in severe unfortunate cases, actually lead to death/suicide. Of course we want to prevent these things, provide support for people who want to improve their life, and help their friends/family too who may love them and care about them and DON’T want to see them living a bad life, either. People with BPD need HOPE that healing is possible, even if their life is a mess, even if there’s many things that need “fixing” and that they are not monsters who “deserve” to live a terrible life. 

Healing is 100% possible with effort and dedication, a good coach and therapy team, and a supportive community who can help them when they are struggling and provide a safe place for them to land. This cannot be achieved overnight, and cannot be the responsibility of just ONE person either – but as a community, if we all help each other, we can build hope and inspiration for those who are lost and need help. That is why social media communities can actually save lives, why content can help someone step off of the ledge if they realize they’re not alone, and why supportive services like therapy and coaching should be easily accessible. This is why we here at Emotional Care Academy are doing what we do, to help change the world one life and one piece of content at a time.