Myths about Borderline Personality Disorder

Myths and Truths about BPD

Many people contact me wondering if they may have Borderline Personality Disorder (BPD). When you see BPD traits in yourself or in a family member or friend, it is normal to worry about the stigma that can come along with this diagnosis.

Luckily our understanding of BPD is changing and the diagnosis holds less stigma among mental health professionals than it has in the past. However, most people’s information about mental health in general, and BPD specifically, are based on portrayals in television and films. These presentations can perpetuate false myths about the people who are living and coping with this diagnosis. It is important to dispel these myths with accurate information so that you can have hope and build motivation to pursue the treatment that can help you improve your situation.

I will discuss 7 common myths about BPD below and work to dispel them with facts based on research and my experience as a psychologist specializing in BPD treatment.

1. BPD is very rare.

This myth stems from the false belief that individuals with BPD are extremely sick and unable to function outside of institutions. Since hospitals are not full, people tend to think that BPD is very rare. In fact, BPD it is one of the more common mental health diagnoses, affecting 2% of the general population.  Due to the pain and impairment that is caused by BPD symptoms, an even higher proportion of people seeking mental health treatment (both in hospitals and in psychotherapy offices) have BPD.  The diagnosis of BPD is more common than schizophrenia and bipolar disorder, and it is likely still under diagnosed due to the stigma that can accompany the diagnosis. In my experience, most people who have BPD, or BPD traits, function well in an outpatient treatment setting and are never hospitalized.

2. BPD is only seen in women.

The diagnosis of BPD is more prevalent in women. 70% of individuals diagnosed with BPD are women, but the disorder clearly does exist in men too (30%).  BPD is likely under diagnosed in men, maybe due to the lingering impact of this myth.  Even more concerning is the potential that this myth could make it more difficult for men with BPD to find effective treatment.

3. People with BPD are manipulative and “just want attention.”

I do not like to conceptualize people with BPD as manipulative or attention seeking.  They are doing the best they can but lack important skills for regulation of their emotional responses and behaviors and for communication with others. As a therapist, it is important to remember that people with BPD are feeling intense pain (maybe they even feel pain more quickly, more often and more intensely than the average person). At the same time, it is important that we do not lose sight of the ineffectiveness of many behaviors related to BPD and their real impact on the patient and other people in the patient’s life. In therapy, we acknowledge that patients are doing the best they can, but that they also need to work very hard every day to do better.

4. BPD is untreatable.

It can be very frustrating to be confronted by medical professionals who still see BPD as untreatable.  Personality disorders are by their nature complex and entrenched patterns of thinking and behavior, and for this reason some people assume that they cannot change. In my experience, this is simply not true. There are several treatment approaches (including, by not limited to, DBT) that have been empirically proven to decrease BPD symptoms.  Effective treatment always includes psychotherapy and often includes medication. Most importantly, the patient and therapist need to build an effective treatment relationship in which a balance can be found between trust and validation and pushing to face difficult truths and make important changes.  Over time, with effective therapy, people resolve the underlying issues that lead to BPD symptoms and can get to a place where they no longer have the diagnosis because their ability to cope is so good that they do not experience the symptoms any longer.

5. People with BPD are trying to kill themselves anytime they self-harm.

There are two types of self-harm behavior that we see in individuals with BPD.  Sometimes individuals feel overwhelmed and suicidal. It is important to take these feelings seriously and to intervene to protect their safety if possible.  We find that with time the impulse to kill oneself does pass, and keeping someone safe until the immediate urge to commit suicide passes is important.

A second type of self-harm can be an important part of some patients’ experience and can lead to confusion for people who don’t understand what is going on in these cases. Sometimes people with BPD harm themselves by cutting, burning, or other means when they do not feel suicidal and do not want to die. The reasons for this self-harm are complex and can vary based on the individual. Often self-harm is related to the desire to escape from other painful experiences, to change emotional experiences that feel intolerable in the moment, to convert emotional pain to physical damage that can feel more valid, or to communicate feelings for which no words are available.  Even though these events are not in an attempt to kill oneself, they can be very dangerous, leading to serious injury or even to death in some cases.  For this reason they must be addressed and resolved in the course of effective BPD treatment.  Also, the thinking patterns and feelings about oneself that lead to self-harm can be resolved and more effective and healthy skills for coping with painful emotions can be built in therapy.

6. People with BPD are dangerous to others.

I suspect that this myth comes directly from portrayals of individuals with BPD in the media.  In my experience, people with BPD are no more dangerous than other individuals.  Potentially their impulsivity and emotional intensity could lead to dangerous behavior. But I find that my patients are much more likely to direct this anger at themselves (especially when we are talking about physically dangerous actions) than they are to externalize their anger and harm others.

7. Parents are to blame for BPD.

This myth is likely related to old fashioned thinking that used to dominate our theories about BPD (and really all of mental health). BPD does appear to be more prevalent in people who experienced childhood abuse, but many patients with BPD have not experienced trauma of any sort. As we increase our understanding of mental health and mental illness, we seen more and more complexity in the causation of all diagnoses. Our understanding of the cause of BPD continues to develop each year, but right now it appears that risk for the development of BPD is related to complex genetic predispositions and a range of environmental factors, just as is true for most mental health diagnoses.

8. It is hopeless to try to have a relationship with someone who has BPD.

This is not true. Certainly it can be a challenge to love someone with BPD due to their lack of skills and potentially related difficulties including trouble with trust, fear of abandonment, and challenges with communication. Individuals with BPD can be emotionally charismatic because they also tend to feel positive emotions intensely, and they can be very passionate, loyal and loving.

No one should stay in a relationship with someone who is not good for them.  People with BPD (or any emotional disorder) need to work on the issues that make relationships difficult for them. But it is important to remember that just being diagnosed with BPD (or seeing the traits of BPD in your partner) does not mean you will be unable to have a healthy relationship.  Symptoms of BPD tend to improve over time. And, especially with effective BPD treatment, patients can change relationship patterns and can lead happy and productive lives.

I hope I was able to dispel some common myths about Borderline Personality Disorder, and that with more accurate information, you will be better able to understand your experiences and get support when you need it.  If you would like to talk further about your situation, please feel free to give me a call at 404.668.9893

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