- BPD is a personality disorder marked by an unstable self-image and difficulty regulating emotions.
- Emotional outbursts and other BPD symptoms happen as a way of coping with extreme inner turmoil.
- With professional support, people with BPD can learn to better navigate distress and discomfort.
Borderline personality disorder (BPD) arguably remains one of the most stigmatized mental health conditions — even within the mental health community.
In fact, evidence suggests many healthcare professionals may feel more reluctant to work with people who have BPD than people living with other mental health conditions.
Helene D’Jay, a licensed professional counselor and Executive Director of Young Adult Services for Newport Healthcare, has treated BPD for over 10 years. She says this condition — which affects about 1.6% of the population — often gets a bad rap simply because it’s misunderstood.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), BPD describes a pattern of unstable self-image, moods, and relationships.
People with BPD often have trouble controlling their anger or regulating their other emotions, which can inherently put them at odds with others, even those trying to help like friends, family members, romantic partners, doctors, and therapists.
But it’s important to keep in mind that for people living with BPD, many of these behaviors actually serve as efforts to avoid abandonment or cope with chronic feelings of fear, loneliness, and emptiness.
Below, D’Jay clears up some common myths about the causes, symptoms, and outlook for BPD.
Myth #1: People with BPD act out for attention
If you know someone with BPD, you may find yourself perplexed or even frustrated by their occasional angry outbursts, drastic shifts in mood, and other unpredictable and intense emotional reactions.
However, D’Jay notes that contrary to how this may seem, people with BPD don’t behave this way simply to get attention.
“People with BPD are responding in the only way that makes sense to them and have developed these behaviors as a way to survive the emotional turmoil they are forced to endure on a daily basis,” she says.
BPD is characterized by a deep fear of abandonment and rejection — real or imagined — by loved ones.
So, you may not think much of it when you have to cancel your plans, run late to meet up, or forget to reply to a text for a few days. But to someone with BPD, this signals a threat, which may prompt an emotional outburst.
Myth #2: Only women develop BPD
Research shows that the ratio of women to men with BPD is 3:1 in clinical settings — but in the general population, there’s no difference in BPD rates between men and women. This suggests women may simply be more likely to seek a diagnosis.
It’s also worth noting that experts have identified sexual abuse as a major risk factor for BPD — and 82% of all sexual abuse and assault survivors under 18 are female.
D’Jay says BPD can also involve different symptoms in men and women:
- Women tend to report more internalizing symptoms like anxious or obsessive thoughts.
- Men tend to report more externalizing symptoms like explosive anger and reckless driving.
Professionals may not diagnose men with BPD as often because their typical symptoms are less commonly known, D’Jay says.
The DSM-5 even acknowledges that when it comes to BPD, gender-related factors rooted in social stereotypes may complicate diagnosis.
Yet, in one study where researchers asked participants to rate the severity of their BPD symptoms, men actually reported higher scores than women.
Myth #3: BPD can’t be treated
BPD has a reputation for being difficult to treat because people with this condition may tend to shut down quickly or lash out at suggestions from therapists.
However, studies suggest BPD is just as treatable as major depression. Furthermore, according to the DSM-5, only about half of people with BPD still meet the diagnostic criteria 10 years after treatment.
Once people with BPD can learn skills to challenge unhelpful thought patterns and better regulate their emotions, D’Jay says it’s entirely possible for them to live fulfilling lives.
According to D’Jay, the gold standard treatment for BPD is generally dialectical behavioral therapy (DBT). This approach aims to help people build self-esteem, tolerate distressing situations, manage and regulate their emotions, and learn new communication skills for relationships.
Myth #4: Only adults have BPD
While the majority of BPD diagnoses happen in adulthood, D’Jay says younger people can also develop BPD.
In fact, experts can diagnose BPD in adolescents as young as 11: About 8.3% of boys and 11.5% of girls between the ages of 11-14 have moderate BPD.
All that said, D’Jay notes that many professionals may hesitate to diagnose BPD before the age of 18, since personality and identity continue to take shape during the teenage years.
Commonly, teens and adolescents may deal with abrupt shifts in mood and other BPD-like symptoms as a result of:
- Natural hormonal fluctuations
- Stress and anxiety related to social pressures and entering adulthood
Myth #5: Only people with childhood trauma have BPD
In one study, researchers found that over 71% of people with BPD experienced abuse, neglect, and other trauma in childhood — and people with BPD are 13.9 times more likely to report childhood trauma than people who don’t have this condition.
However, D’Jay says not everyone with BPD has a history of childhood trauma, and not everyone who experiences childhood trauma will go on to develop BPD.
Evidence also points to abnormalities in regions of the brain that control emotions as another potential link. D’Jay says, though, that researchers have yet to determine whether these abnormalities cause BPD, or BPD causes the abnormalities.
According to the DSM-5, genetics can play a role, too. In fact, BPD is about five times more common among people with first-degree biological relatives — like a parent or sibling — who have the condition than in the general population.
Myth #6: People with BPD can’t have relationships
People with BPD can swing from showing loved ones intense adoration and affection one minute to intense anger and hatred very quickly, D’Jay says — a symptom known as “splitting.”
Maintaining a relationship with someone who has BPD may at times feel like a rollercoaster, due to the emotional volatility that characterizes the condition.
Still, D’Jay says that with treatment, people with BPD can certainly learn to manage their emotions and communicate with others more effectively, which can help them form more stable relationships.
Maintaining healthy relationships can require effort from both sides, according to D’Jay.
By enabling people with BPD to withstand and regulate extreme emotions, DBT can help foster the behavioral changes necessary to improve relationships.
Indeed, evidence suggests that DBT can help reduce suicidal thoughts, self-harm, depression, and anxiety in people with BPD.
BPD is a widely misunderstood personality disorder marked by an unstable self-image, moods, and relationships. Many of the symptoms and behaviors associated with BPD, like splitting and angry outbursts, are rooted in a deep fear of abandonment — not an effort to get attention from others.
“It’s important to understand that people with BPD are not purposefully trying to manipulate people, or destroy relationships,” D’Jay says.
“They are trying to survive and interact in the only way they know how, and with help and support, many can go on to lead full and meaningful lives with healthy connections,” D’Jay says.