Why We Need More Conversation About Borderline Personality Disorder

Posted: July 17, 2017
Why We Need More Conversation About Borderline Personality Disorder

A disorder that affects nearly two percent of the population and 10 percent of psychiatric patients is strikingly absent from common conversation. Borderline personality disorder (BPD) is nearly as common as schizophrenia and obsessive-compulsive disorder (OCD) combined, yet the stories of people with BPD are much more difficult to come by. Changing that could help BPD patients get the support they need—especially considering that the vast majority struggle primarily with relationships at work or school rather than home and may have trouble holding down a job as a result.

With the right support and treatment, it is possible for BPD patients to recover. “When I started working in the field, to give someone the diagnosis of borderline personality disorder was equivalent to saying they were chronic and untreatable,” says 2012 Young Investigator Grantee Bradford Reich, M.D., of McLean Hospital and Harvard Medical School. “We now know that’s no longer true.” In a recent webinar, he offers a glimpse into what life is like for BPD patients.

Border dispute

One of the difficulties of living with BPD is that “it’s not a valid diagnosis in the eyes of some people,” according to Reich. Part of the issue is that BPD “rarely occurs in a pure form,” says Reich, instead tending to occur in patients who already have a psychiatric disorder such as bipolar disorder.

When the concept of BPD first arose back in the 1930s and 1940s, it was thought as a disorder between psychosis and neurosis, hence the name “borderline.” While BPD is a serious mental illness that can profoundly affect patients’ lives, they tend not to lose touch with reality to the point of psychosis and hallucinations unless they are very stressed out. Among the key symptoms is a pattern of intense, unstable interpersonal relationships. Sometimes within just seconds, says Reich, patients can “alternate between feeling very good about people and very bad about people.” They are also prone to impulsive behaviors such as self-injury, feelings of abandonment, and issues with recognizing their own identity.

Rocky relationships at work

Healthy relationships are a challenge for BPD patients, and research shows that is particularly true at work and school, where understanding of the unique challenges of BPD may be lacking. For many BPD patients, vocational success is a major obstacle to recovery. In one study, 90 percent of patients achieved remission within 10 years. Out of those who did not achieve healthy relationships, however, 98 percent did not do so because of issues at work or school rather than in their personal life. This observation “actually makes sense to me,” says Reich, “because I think that when you know someone, they may be much more tolerant of your instability than a workplace, a boss, someone who doesn’t know you as well.” 

Many treatments, from medication to mindfulness

It’s critical that people with BPD or those close to them recognize that there’s an issue and seek help, because a number of successful treatments have been developed over the last several decades. Certain medications first used to treat other illnesses, such as seizures and depression, can help moderate BPD symptoms, though Reich notes that these options are “really not curative” and can have significant side effects like weight gain.

Behavioral therapies are another effective option. One of the most widely-used therapies in this category is dialectical behavior therapy, which employs mindfulness—the capacity to observe and describe oneself in a way that is non-judgmental—as a way to work through the difficulties a patient faces. Several other psychotherapies are available, and Reich says that it’s “not clear that any one of these treatments is more effective than the others—they all seem to work!”

By Andrea Alfano