Borderline personality disorder (BPD) is a mental illness characterized by intense and unstable emotions, impulsive behavior, unstable self-image, and unstable or toxic relationships. People with BPD often have difficulty regulating their emotions, leading to rapid mood swings, anger, anxiety, and depression.

Patients with BPD may also suffer from the following:

• Fear of abandonment
• Chronic feelings of emptiness
• Self-harm
• Substance abuse and addiction
• Difficulty maintaining stable relationships
• Paranoia and dissociation

BPD is poorly understood, but research suggests genetic, environmental, and neurobiological factors may cause it.

Are There Four Stages/Types of BPD?

There are no universally accepted stages or types of borderline personality disorder (BPD), and the progression of symptoms can vary widely from person to person. Some mental health professionals have proposed elegant models of BPD that describe a stage or sub-type based on common patterns of symptoms and behaviors.

For example, Theodore Millon, an expert in personality disorders, puts forth one such model. The four sub-types of BPD, according to his model, are:

Discouraged Borderline: this subtype, which also goes by the name high functioning BPD or quiet BPD, can manifest in several ways in their relationships. While in these relationships, the BPD patient can function quite normally. However, when the relationship ends, their life can crumble. They may also fear the possibility of the end of the relationship, causing strain and, ultimately, a self-fulfilling prophecy. Patients with this subtype of BPD are typically depressed and avoid specific interactions and circumstances. They are often submissive and can be codependent, especially in romantic relationships.

Impulsive Borderline: this subtype of borderline personality disorder often manifests in chaotic behavior not backed by deep thought or reflection. The impulsive borderline’s behavior may cause physical or emotional harm to themselves or others. They are often superficial but charismatic and exciting to be with. Often, these behavior stem from earlier chaos in the family setting where they had to act out to stand out. They may have difficulty dealing with aging, especially if they were praised for their looks or abilities as a child.

Petulant borderline: often manifesting in passive-aggressive behavior, the petulant borderline patient can be seen as pessimistic or negative, impatient, and irritable. Many were insecure and abused emotionally or physically as children, which ultimately left them feeling depressed and inadequate as adults. These patients often experience irrational and overwhelming anger but feel terrible guilt and remorse once they return to baseline.

Self-Destructive Borderline: as the name suggests, self-destructive borderlines often turn their emotions and anger inwards. While they hope to be independent, they are usually submissive and compliant in their relationships. These patients are at a greater risk for self-harm, including suicide.

It is important to note that these stages are not definitive or universally applicable. Some patients will not fall into any subtypes mentioned above, while others may fall into one or more subtypes. Only a proper diagnosis from a qualified mental health professional can effectively address any of the borderline personality disorder subtypes mentioned above.

Do People with BPD Suffer?

People with borderline personality disorder (BPD) can experience significant emotional suffering, including anxiety, anger, and depression. Individuals with BPD may also experience feelings of emptiness, worthlessness, and a sense of being disconnected from themselves or others.

The symptoms of BPD can make it difficult for individuals to maintain stable relationships, hold down a job or pursue education, and engage in daily activities. The high emotional intensity and impulsivity associated with BPD can also lead to risky or self-destructive behavior, such as self-harm, substance abuse, or suicide attempts.

Can People with BPD Experience Love?

Yes, people with borderline personality disorder (BPD) can and do experience love. However, their love experience may differ from those without BPD due to the intense emotions and fear of abandonment associated with the disorder.

Individuals with BPD may struggle with maintaining stable relationships due to their fear of abandonment and tendency to idealize or devalue their partners, leading to conflicts or arguments.

Therapy, such as dialectical behavior therapy (DBT), can help individuals with BPD develop skills for managing their emotions and communicating effectively with their significant others or loved ones. Support from loved ones and a solid social support network can also be beneficial in managing symptoms and promoting recovery.

Bipolar disorder versus Borderline Personality Disorder

Bipolar disorder and borderline personality disorder (BPD) are two different mental illnesses that are often confused due to some similarities in symptoms. A borderline personality disorder diagnosis can also be confounded by the fact that most people with BPD suffer from Co-occurring mental illnesses. It is estimated that over 80% suffer from major depressive disorder, and 90% or more have anxiety. This also extends to substance abuse, with a study assessing that 2/3 of those with BPD also abused alcohol, pills, or drugs.

There are some critical differences between these two similar disorders:

• Mood swings: Both disorders involve mood swings, but the patterns and duration of the mood swings can be distinct. In bipolar disorder, mood swings tend to occur in episodes that last for days or weeks, while in BPD, mood swings may occur more frequently and last for shorter periods, even just a few minutes.
• Emotional instability: Both disorders involve emotional instability, but in BPD, emotional instability is typically more intense and can lead to impulsive behavior, anger, and anxiety.
• Impulsivity: Impulsivity is a common symptom of both disorders, but in BPD, impulsivity may be directed towards self-destructive behavior, such as self-harm or substance abuse.
• Self-image: Individuals with BPD often have an unstable sense of self and may struggle with feelings of emptiness or identity disturbance, while individuals with bipolar disorder typically have a stable sense of self.
• Treatment: Bipolar disorder is typically treated with medication, such as mood stabilizers or antipsychotics, while BPD generally is treated with therapy, such as dialectical behavior therapy or schema-focused therapy.

It is important to note that bipolar disorder and BPD can both be serious mental illnesses that require proper diagnosis and treatment from a qualified mental health professional. If you suspect that you or a loved one may be experiencing symptoms of either disorder, it is essential to seek professional help.

Treatment for Borderline Personality Disorders

Getting treatment for patients with BPD can be difficult. Like with many mental illnesses, the family often initiates the intervention or pushes for treatment. However, BPD is an often-misunderstood disease that the patient and those around them may not fully comprehend. It is not uncommon for BPD patients to be misdiagnosed, and when treatment is ineffective, patients and their families give up, resigning themselves to “reality.” The actual disorder remains undiagnosed and effective care may never be sought. We see, all too often, families that are fractured due to BPD, with some members believing that the patient has malicious intent or may be trying to manipulate their emotions and feelings. All of this occurs while the patient suffers from this severe disease. Some estimates put the suicide rate in BPD patients at up to 10%.

Getting effective treatment from professionals that understand and have significant experience in managing BPD is critical to stemming the damage and starting to heal, both on an individual level and as a family. There are several effective treatments for borderline personality disorder (BPD), including:

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral therapy that teaches the skills to manage emotions and behaviors. DBT is often the first-line treatment for BPD, effectively reducing suicidal behavior, self-harm, and hospitalizations. DBT, of course, is not a substitute for emergency or crisis care.

Schema-Focused Therapy is a type of therapy that helps individuals identify and change negative patterns of thought and behavior that contribute to their BPD symptoms. It can be helpful for people with BPD who have experienced trauma or have difficulty regulating their emotions.

Mentalization-Based Therapy (MBT) is a type of therapy that focuses on improving an individual’s ability to understand their thoughts and feelings, as well as the thoughts and feelings of others. It can be helpful for individuals with BPD who have difficulty maintaining stable relationships.

Certain medications, such as antidepressants and antipsychotics, may help manage symptoms of BPD, such as depression, anxiety, or impulsivity.

It is important to note that BPD treatment is a long-term process that requires ongoing support and management, and there are no guarantees of success. Treatment may involve a combination of different therapies and medications, depending on the individual’s needs. The family also plays a significant role in making treatment for BPD more effective. Family programs like the one at The Sylvia Brafman Mental Health Center start by educating the patient and their family on how to approach this lifelong fight with compassion and open hearts and minds.

How To Support Your Loved One

If you have a family member or loved one with borderline personality disorder (BPD), you have been suffering just as they have. It can be difficult, to say the least, to set aside the emotional trauma that this disease has caused. However, it’s essential to know that you can help them manage their symptoms and improve their quality of life:

• Educate yourself: Learn as much as you can about BPD. Doing so allows you to better understand your family member’s experience and how to support them. You can start by reading books and articles or attending support groups for families and loved ones of individuals with BPD. This education and understanding of the disease will also help you cope with what will undoubtedly be ups and downs over the coming months and years.
• Encourage professional treatment: Encourage your family member to seek professional help from a qualified mental health professional, such as a therapist or psychiatrist. Offer to help them find a provider, schedule appointments, or accompany them to appointments if needed. You’ve probably tried this before but have not succeeded. If you believe you’ve hit a wall, contact a mental health professional to see if they can assist and intervene.
• Be patient: BPD can cause intense and unpredictable emotions, which can seem impossible for family members to manage. Try to be patient and understanding with your family member, even when their behavior or feelings may be challenging. Remember, this is a disease. They, too, are suffering and don’t want to live this way just as much as you.
• Practice effective communication: Effective communication is vital in maintaining a healthy relationship with any individual, let alone someone with BPD. Use first-person statements to express your thoughts and feelings, listen actively, and avoid blaming or criticizing your family member.
• Establish healthy boundaries: Healthy boundaries protect your well-being. Set limits on what you can do to help and communicate these boundaries clearly without anger or frustration.

Supporting anyone with a mental illness, especially borderline personality disorder, can be very challenging for the caregiver or loved one. Don’t underestimate the effect your loved ones’ disease can have on you; don’t feel that seeing a mental health professional yourself is a sign of weakness. As we say, letting go and admitting that you need help is often the first step toward true healing and long-term mental wellness.

The Sylvia Brafman Mental Health Center’s clinicians have devoted their lives to helping others identify and treat even the most difficult mental illnesses. If you need professional help and support in managing borderline personality in a friend or a loved one, we encourage you to contact us and speak to one of our admission specialists. From there, we can help your loved one get the care they need to cope with BPD.