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At the edge of a "disordered" personality?

Updated: Aug 3, 2022

The label, "borderline personality disorder" (BPD) is simply inscrutable. It describes nothing about this mental illness and it sounds quite pejorative to say that someone's personality is "disordered" and at the "borderline." So, how can we explain the experience of having BPD in terms that are as descriptive, nonjudgmental, and empathic as possible?

Before exploring the answers, it is important to clarify that not all persons with BPD have the same experience. It is a spectrum from being a highly sensitive and slightly impulsive person with a loving family and a successful career to having a history of addiction and suicide attempts, unemployed and without friends. Every human being is unique and there are many expressions of this illness. There is no one characteristic that everyone with BPD has.

The experience of suffering BPD revolves around intense and even unbearable emotional pain. Persons with this disorder tend to be emotionally vulnerable and sensitive and have extremely intense reactions. An emotional reaction may arise suddenly and last for hours. The combination of emotional vulnerability and intensity that does not pass quickly can make emotions intolerable. Some people live from one dramatic crisis to another, while others avoid potential triggers and minimize their contact with the world.

For many persons with BPD, a common underlying emotion is chronic shame. Shame is the emotion that arises when there is the possibility, real or imagined, of humiliation, disrespect, or rejection. "The mother of all emotions," it might be the first emotion we experience upon birth. Babies will not survive without immediate soothing, firm touch, soft voices, and heart beat sounds, in addition to food, and they need many years of such caretaking. We might say that shame is the central nervous system's response to the possibility of death by rejection or abandonment. It is also the emotion most associated with dissociation, that is, not being conscious of one's own experience, feelings, or perception.

Shame is not, however, the only unstable intense emotional experience for persons with BPD. Fear, anxiety, anger, irritation, sadness, guilt, envy, jealousy, and any other emotion may be easily triggered and intensely experienced. Many emotional experiences are often intolerable for a person with BPD. Clinicians and researchers have proposed changing the name from borderline personality disorder to "emotional regulation disorder," a more descriptive name.

Humans are first and foremost emotional beings. This is supported in the science of psychology. Emotions drive thoughts and behaviors, especially when they heat up instantly. When we are intensely sad, we only think of sad thoughts and tend to isolate or avoid doing things. When we are enraged, we can only think of all the cruel or unfair things that happened to us and we tend to attack, judge, or complain about others. We can understand what it is like to have our emotions running the whole show because it has happened to all of us.

Emotional regulation may be confusing for a person who meets criteria for BPD. They don't know how they are going to feel, why they reacted, or how they can control it. Emotions are closely linked to wants, cravings, desires, and volition, all of which are known as conations. Emotional dysregulation and conative dysregulation are inseparable. These will also underlie instability in thoughts or cognition, including uncontrollable obsessive or easily distracted styles of thinking. Emotional volatility can drive impulsive behaviors and actions that offer immediate relief to emotional suffering, but create long term problems. Ultimately all this instability in emotions, desires, thoughts, and behaviors may lead to a confusing sense of self or an unstable identity.

Marsha Linehan, the creator of dialectical behavior therapy who also suffered from BPD, compares the emotional sensitivity of BPD to someone with third degree burns. Just a light touch on the skin can trigger intense pain that does not go away when the touch ends. Physical and emotional pain are processed in the same place in the brain so this analogy is quite appropriate.

We would not poke a person with severe skin burns and then expect them to just stop being so dramatic. It would be understandable if their reaction was an accusation or verbal attack, if they had long monologues of complaints and blame, or if they did not want you to leave them alone in their pain. Accepting that a person is biologically unable to regulate their intense emotional pain -- and that drives instability in conation, cognition, behavior, and identity -- is a major step toward helping another more effectively and also improving self-care.

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