Borderline Personality Disorder (BPD) is characterized by
difficulties regulating emotions. According to the National Alliance on Mental
Illness (NAMI), patients with BPD, emotions are felt intensely and for extended
periods of time with difficulty returning to a stable baseline after an
emotionally triggering event. These factors can often lead to impulsivity, poor
self-image, stormy relationships and intense responses to stressors. Struggles
with self-regulation can result in dangerous behavior such as self-harm (i.e.
cutting). It is estimated that 1.4% of US adults experiences BPD. While
majority of patients are women (75%), recent studies have shown that men may be
equally affected; however, they are commonly misdiagnosed with PTSD or depression.
According to the Diagnostic and Statistical Manual (DSM),
patients with BPD exhibit frantic efforts to avoid real or imagined abandonment
by friends or family. They may have dissociative feelings, thoughts or identity.
They may lash out with inappropriate, intense or uncontrollable anger, often
followed by shame or guilt. Patients will often have unstable personal
relationships and alternate between extreme idealization (i.e. being “so in
love”) and devaluation (i.e. hatred). Patients can have distorted and unstable
self-image affecting their moods, values, opinions, goals and relationships. They
sometimes engage in impulsive behaviors with possible dangerous outcomes. For
example, excessive spending, unsafe sex, substance abuse and reckless driving. Patients
may self-harm or threaten to self-harm including cutting, suicidal threats or
attempts. Patients may also experience periods of intense depression with
irritability and/or anxiety which can last hours or days. They may also
experience chronic feelings of boredom or emptiness. The causes for BPD are not
fully understood; however, the consensus is a combination of three factors.
First, genetics. While there is no specific gene or gene profile which points
to BPD, having a close family member with the disorder may place an individual
at a higher risk. Second, environmental factors. Experience a traumatic event
or events, such as physical or sexual abuse or neglect and/or separation from
parents, may contribute to the risk factor. Third, improper brain function.
Portions of the brain that control emotions and decision-making/judgement may
not communicate at optimal levels in patients with BPD. There is currently no
definitive testing for BPD. A patient is usually diagnosed after a
comprehensive clinical interview, reviewing medical records and interviews with
family and friends, if necessary.
There are a few treatments available for BPD. First,
medications. Mood stabilizers and antidepressants have shown results with
controlling mood swings and dysphoria. Low doses of antipsychotic medications
may also help with symptoms like disorganized thoughts. Second, Dialectical
Behavioral Therapy (DBT). DBT is influenced by the philosophical perspective of
balancing opposites and designed for the development of new skills to manage
painful emotions and decrease conflicts in relationships (Psychology Today). It
promotes balance and avoiding black or white, all-or-nothing thinking. It also
promotes a both-and rather and an either-or approach. It works in
four key areas: 1) mindfulness (improving the ability to accept and be present
in the current moment), 2) distress tolerance (increasing tolerance of negative
emotions rather than trying to escape it), 3) emotion regulation (strategies to
manage and change intense emotions that cause problems), and 4) interpersonal
effectiveness (communication that is assertive, maintains self-respect and
strengthens relationships). DBT typically consists of individual and group
therapy sessions but not necessary to be done concurrently. Third, Cognitive
Behavioral Therapy (CBT). CBT is a “talk therapy” designed to help patients
become more aware of inaccurate or negative thinking so that challenging
situations can be seen more clearly, and responses can be more effective (Mayo Clinic).
Exposure therapy can also be used with CBT as it would require patients to
confront situations, they would usually avoid in order to learn the appropriate
responses. Patients learn to better manage stressful life situations. Lastly,
short-term hospitalization may be necessary in times of extreme stress and/or
impulsive or suicidal behaviors in ensure safety.
Most often, movies, TV and other forms of popular culture
can misrepresent a person with a mental illness; however, sometimes they get it
right. According to Dr David Allen (2013), there is a movie that portray a
person with BPD accurately as well as understanding “the family relationship
patterns” that he believes are the primary risk factors. Thirteen (2003),
co-written and starring Nikki Reed, nails the family dynamics of people with
BPD. Reportedly semi-autobiographical, Thirteen is the story of
13-year-old Tracy (played by Rachel Evan Wood) a junior high school student in
Los Angeles, feels abandoned by her divorced, alcoholic mother, begins dabbling
in substance abuse, sex, and crime after being befriended by a troubled
classmate, Evie (played by Nikki Reed). Another movie that portrays BPD is Eternal
Sunshine of the Spotless Mind (2004). While her diagnosis is never revealed
in the film, the character, Clementine “Clem” Kruczynski (played by Kate
Winslet) is a good representation of BPD’s impulsivity, substance abuse,
emotional intensity, and idealization and devaluation (Virzi, 2017). A case was
made for the character of Anakin Skywalker, from the Star War films Episode II Attack
of the Clones (2002) and Episode III The Revenge of the Sith (2005),
as an example of BPD (Virzi, 2017). Played by Hayden Christensen, Anakin has
preoccupations and fears of abandonment and loss. He has sensitivity to
potential slights, bursts of extreme anger, and paranoid ideation (Virzi,
2017). I can certainly see how Anakin could be an example of an person with
BPD.
In conclusion, Borderline Personality Disorder is an
inability to regulate emotions and can be exhibit extreme emotions from love to
anger. While no specific cause is known, it is thought to be genetic,
environmental, and/or improper brain function. A combination of therapy,
medications and hospital stays are common treatments for BPD. Popular culture
often misrepresents individuals with mental illness in their stories; however,
a few movies have been shown as good examples of patients with BPD and their
families. The films, Thirteen and Eternal Sunshine of the Spotless
Mind, and the Star Wars character, Anakin Skywalker, are good
representations of individuals with BPD.
References
Allen, David M. (July 22, 2013). Borderline Personality
Disorder in the Movies. Psychology Today. https://www.psychologytoday.com/us/blog/matter-personality/201307/borderline-personality-disorder-in-the-movies.
Retrieved March 3, 2020.
Mayo Clinic. Cognitive Behavioral Therapy. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610.
Retrieved March 4, 2020.
NAMI (National Alliance on Mental Illness). Borderline
Personality Disorder. https://www.nami.org/learn-more/mental-health-conditions/borderline-personality-disorder.
Retrieved March 1, 2020.
Psychology Today. Dialectical Behavioral Therapy. https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy.
Retrieved March 2, 2020.
Virzi, Juliette (November 20, 2017). 10 Movies That Got
BPD Symptoms (Mostly) Right. The Mighty. https://themighty.com/2017/11/movies-borderline-personality-disorder-bpd/.
Retrieved March 3, 2020.
Thank you!
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