The BPD Person or the Person with BPD?

Much has been written about the Borderline Personality Disorder (BPD). BPD is also frequently portrayed in popular media.

For those of us old enough to recall the 1987 thriller Fatal Attraction, it is hard to forget Alex Forrest, the character that was, among other things, struggling with BPD. Glenn Close’s powerful portrayal of this character probably had quite a few men (and women) hoping they don’t know anyone like that. Oscar-worthy performance aside, the character of Alex Forrest, while perhaps meant to be terrifying to viewers on some level, was someone genuinely struggling with emotion dysregulation and a somewhat unstable and fractured sense of self.

Having said that, in recent times, while there may be more open discussions on mental health and mental illness, pop culture has also seen glamourizations of such mental conditions, not least of all, of personality disorders like BPD. Regardless of whether this was the intended effect, the messaging can be confusing, especially for those who are impressionable.

As I was drafting this particular piece, I figured that because so much has been written (and will continue to be written) about BPD, because as a subject of study it is fascinating, I figured I will take a slightly different spin on the discussion of BPD.

From the perspective of those with BPD or BPD traits (the latter refers to a person who displays some of the traits of the personality disorder), their fear of being abandoned is very real and very urgent, especially when they get into an intimate relationship. The fear of being abandoned by an intimate partner can ironically lead to the end of the relationship, because in trying to manage the fear, the person with BPD tends to cling to the partner and bombard them with demands of reassurance of their love and commitment to the person with BPD. As one can imagine, these demands become extremely draining for the partner, and over time the end of the relationship is inevitable. Sadly, the person with BPD then starts to believe that intimate partners will indeed abandon them and that therefore, they have good reason to insist on their assurance-seeking behaviours. This becomes a self-fulfilling prophecy.

Unfortunately, when such events transpire, the person with BPD is often unable to tolerate the distress and becomes very emotionally dysregulated. Self-harm may become their coping mechanism.

What I have described above is one scenario that is rather common amongst those who struggle with BPD and their loved ones. This is also usually the scenario that brings them to my clinic.

Over the years of being a therapist for my clients with BPD, one thing that always stood out for me was the response my clients had when they were diagnosed with BPD (and this can be self-diagnosis at times given the amount of information and questionnaires readily available online). For some, this was something to be ashamed of, something that they felt made them “abnormal”. There were others who wore the diagnosis proudly and felt that this was what made them unique. As you can see, both responses are arguably two sides of the same coin.

Whatever it is, what is interesting to me is how readily my clients started to identify themselves as BPD. I have had some clients who walked in for their first session with me, smiled and said, “So, I am BPD….” There is nothing wrong with that. Well, unless this identification is harming the client. And I do think that is the case with these clients who start to feel that they are BPD, rather than they have BPD. A subtle but pivotal difference. You can argue that this is a case of semantics. As a counselling psychologist, I would argue that how we speak about something affects how we think about it and what we do about it.

Whatever treatment modality a mental healthcare professional chooses to use in providing therapy for someone with BPD, I think one of the most effective techniques is establishing boundaries. Those who struggle with BPD may come across as being over-friendly with people, and this may sometimes border on inappropriate behaviour. They may also communicate with their family and/or friends in ways that may seem disrespectful of the other person’s personal space, i.e. that person’s boundaries. Incessant WhatsApp messaging in the middle of the night or asking overly personal questions in social or professional situations are examples of the difficulty in maintaining boundaries. When family and/or friends of those who struggle with BPD come to me, exhausted and at their wits’ end about managing the constant need for reassurance from the person with BPD, my suggestion is always to establish and maintain compassionate boundaries.

I like to use the analogy of a cushioned fence as a boundary. When we maintain a boundary by saying something like, “I am sorry you feel unloved, but I do care for you, and I do not want to keep talking about this same issue”, this is not an electric fence that is meant to burn the person who tries to get “in” to our personal space. Each time we maintain the boundary by calmly and firmly telling the person that the behaviour they are displaying is being triggered by the BPD and not what they would usually do, that is a cushion which helps them bounce off without getting hurt. Over time, they learn that this is a boundary that cannot be crossed at will and that they will retain the partner’s or friend’s love by respecting the boundary rather than pushing it.

This, in turn, also helps the person struggling with BPD to learn to establish boundaries for themselves. The lack of boundaries for themselves can be a reason for their fractured identity which usually does indicate a fragile self-esteem, and thus, a difficulty in practicing self-respect.

Perhaps equally importantly, the boundary is also a way I separate the condition from the person and therefore encourage the person with BPD to manage the condition rather than be managed by the condition. This again helps in nurturing a healthy self-esteem and a stable sense of identity. An identity which represents the whole person and not just one aspect which is the BPD.

In closing, I want to take this opportunity to dedicate this piece of writing to all my clients who have struggled (and are still struggling) with BPD and who are slowly, but surely, learning to manage it. You have truly taught me how to see BPD and to constantly find ways to help you and those like you, embrace their true selves. I will always be grateful to all of you for that invaluable lesson. And I hope you know that I always believe in you.