What is Borderline Personality Disorder (BPD)?

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.