Borderline Personality Disorder (BPD) is a very challenging and complex disorder to treat. Dr. Blaise Aguirre, a recognized child and adolescent researcher of BPD, states that about 11% of clients with the disorder end up in outpatient settings, while about 20% are in inpatient settings with a comorbid diagnosis. For example, someone with BPD may also have severe depression, anxiety, or ADHD.
This article will provide a brief overview of BPD symptoms to look for. You will also have access to my audio discussion on this topic.
Most people who struggle with BPD tend to struggle with controlling their emotions which can lead to a loss of multiple relationships including employment or future opportunities. Even more, multiple hospitalizations can also steal one’s life. It sometimes takes a very long time to receive the diagnosis of borderline personality disorder. It may also take many doctors or therapists to nail down the symptoms and understand their nature.
In 2013, while completing an internship in my counseling psychology program, I treated a client who had been hospitalized 13 times over a years time which resulted in a loss of friends, her job, her education, and her grip on life. She began to lose touch with parts of her reality, her relationships, and her direction in life. It wasn’t until she began actively using her coping skills, regulating her emotions, and relying on community and family supports that she improved and was able to stay out of the hospital for a longer period of time. Unfortunately, she ended up leaving the state with her fiance which resulted in undue stress that led to 3-4 more hospitalizations.
Thankfully, she returned to the state where I practiced and saw me for a few sessions. I administered mood questionnaires and scales to track her fluctuations, reviewed her history, requested hospital records, spoke with family, and obtained records from her school (when she was in high school). I put all of the information together and was able to arrive at the diagnosis of borderline personality disorder. Sadly, I didn’t see this the first time around but I wasn’t the only one who missed it.
Some of the most telling signs of borderline personality disorder are:
- Disproportionate anger or reactivity: Anger is typically disproportionate to the trigger and may seem exaggerated or “blown out of proportion.”
- Emotional lability or changeable moods: Moods may range from day to day or even hour to hour sometimes. Labile moods may include instant anger or explosive reactions.
- Low self-esteem, low confidence, or challenges with body image: Some individuals with BPD may struggle with their self-concept and view themselves in negative ways. Self-esteem is often contingent upon how others treat them.
- Relational instability or challenges maintaining healthy relationships: Relationships are often unstable, stormy, and emotional. The individual suffering from BPD may become verbally, emotionally, or even physically abusive to others.
- Self-harm including chronic suicidal thoughts/attempts: Some individuals may engage in cutting themselves to ease the pain or distract themselves from emotional pain. They may cut themselves in an attempt to “communicate” their pain or even gain attention they feel they are not getting. For most individuals, however, cutting occurs as a way to mask the real pain.
Barriers to receiving the diagnosis and proper treatment
Some clients are highly functional and may not suffer from intense or severe symptoms. Some individuals suffering from BPD may only experience impulsivity, irrational anger, or moodiness but never end up in the hospital more than once or engage in severe self-injurious behaviors. I’ve learned over time that depression or anxiety can make BPD worse as well. Primary diagnoses (i.e., depression, anxiety, psychotic behaviors, etc) can become a barrier to the diagnosis of BPD. If symptoms of depression, anxiety, or psychosis are so robust that other symptoms fade into the background, a diagnosis of BPD may not occur until the primary symptoms dissipate. Another barrier to the diagnosis is age and gender.
Males tend to be overlooked when it comes to a diagnosis of BPD and adolescents are often not diagnosed until they become adults. Because BPD has been “classified” in the past as a “women’s only” diagnosis, males are misdiagnosed with intermittent explosive disorder or anger management challenges, ADHD/ADD, or bipolar disorder. Research is beginning to include males in their search for answers with BPD.
Listen to my audio review of what you should look for if you suspect you or someone you know has borderline personality disorder.