A couple of seasons ago when Crazy Ex-Girlfriend’s main character – Rebecca Bloom – was diagnosed with Borderline Personality Disorder (BPD), I watched the next few episodes with my hands practically over my eyes, clinically curious but also really cautious about how the show would portray her and BPD.
While the treatment of Rebecca’s character and her diagnosis was ultimately relatively well-handled (MIC even asked for my feedback on this), I was initially worried as the plot unfolded that the show, far from treating Rebecca and her character’s diagnosis with empathy and grounded clinical information, would only reify and sensationalize the largely negative stereotypes surrounding BPD.
I was worried about this because, BPD, while an actual clinical diagnosis, has become somewhat of a pop psychology pejorative term in recent years: “Oh! She’s so borderline you wouldn’t believe it!” or “That’s so borderline!”
It’s become a term that’s used to describe generally bad or erratic behavior that, in reality, may or may not bear a resemblance to BPD at all.
It’s become a term that both laypeople and even clinicians have strong, and sometimes negative reactions to making those with BPD who seek treatment or disclose their diagnosis often highly susceptible to criticism and prejudice.
And, frankly, I have such a hard time with this.
I think BPD and those that struggle with it have a poor reputation that doesn’t help either them or the clinical community attempting to help them.
BPD has become a term that’s often misunderstood and misaligned, and so my hope in today’s post is to provide a little psychoeducation about what BPD actually is and offer a reframe about how we can think of this diagnosis as a wider community, both clinical and lay alike, to cultivate more empathy, compassion, and, ultimately, support around this.
What exactly *is* Borderline Personality Disorder?
Borderline Personality Disorder (BPD) is a mental health condition defined by the Diagnostic and Statistical Manual of Mental Disorders (the bedrock clinical manual of the mental health field). If you’re interested in reading the full criterion of the disorder, you can do so here.
But, essentially, BPD, is a mental health condition characterized by emotional lability (an inability to regulate one’s emotions), an unstable sense of self, challenges forming and sustaining relationships, and a tendency towards erratic, often self-harming, behaviors and impulses.
BPD is quite common. It’s estimated that 1.6% of the adult U.S. population has BPD, but that number may be as high as 5.9% and of those diagnosed, nearly 75% are women.
So, if the diagnosis is so common and so impactful, we have to ask the question: in what context would it come to pass that someone would develop BPD?
In my opinion, this can be answered in three words: complex relational trauma.
A compassionate reframe.
Borderline Personality Disorder is, in my clinical opinion, a trauma disorder. More specifically, a relational trauma disorder.
What do I mean by this?
Overwhelmingly, BPD patients have a history of childhood trauma.
And, even though trauma is not used as one of the diagnostic criteria of BPD, I personally think we have to bear in mind the impact that complex relational traumatic experiences can have on a child.
Complex relational trauma is a series of experiences that takes place over time in the context of caretaking or authority relationships.
The experiences of trauma can be anything that undermines the integrity, well-being and personhood of the individual who experiences it and what makes it traumatic is that it subjectively overwhelms the person’s ability to stay present and to cope.
As I’ve written about before, the impacts of complex relational trauma can be vast and impactful on the individual who experiences it.
Now, this doesn’t necessarily mean that an individual who experiences complex relational trauma in childhood will develop BPD, but it does mean that when someone is diagnosed with BPD, we can and should be curious about their childhood history of traumatic experiences and how this has shaped their responses to the world.
What do I mean by this?
Well, let’s imagine a little girl was frequently locked into her closet for hours at a time by her mother whenever the mom got angry or overwhelmed. Forced to hold in her pee or go without food or drink until her mom let her out.
Or let’s imagine a little boy repeatedly shamed by his father and berated for not being manly or sporty enough in front of his father’s golf buddies.
Imagine a child whose parent would make them get out of the car and walk miles home in the dark on the highway or side streets if they talked back to the adult driving the car.
Or let’s imagine a kid who would hear her mother’s footsteps stomping up the stairs and would feel fear in her body because she knew her mother was going to scream at her for something she did or didn’t do.
Imagine the fear, anguish, shame, and relational insecurity these children would experience in such scenarios.
I mean really imagine it. Imagine how horrible and powerless these children must have felt.
Now imagine that moments like these leave an impact on children.
They can leave a psychological mark in the form of maladaptive attempts to cope with their own feelings and with the relationships in their lives.
These kinds of experiences are like emotional lacerations, like proverbial paper cuts on the body.
Now let’s also imagine that life is like a bathtub of lemon juice – sour at times and capable of stinging you even at the best of times. And that’s if you don’t have an open wound on your body!
But what if you had a body full of paper cuts and had to sit in that same bathtub? Can you imagine how much that would hurt?!
You’d scream, try to pull yourself out of the tub, thrash around, and, at best, be really uncomfortable and in pain.
I’m taking liberties with this metaphor but, in a way, someone who had a sustained history of emotional lacerations, someone who deals with BPD, is like someone with a proverbial body of papercuts sitting in a bathtub full of lemon juice.
Why this reframe is important.
Simply put, life and the attendant relationship stress it holds can feel less tolerable and more painful if you have a history of emotional lacerations, a history of complex relational trauma that is unhealed.
And, for someone struggling in this way, it can make sense that they would respond to life and to relationships with behaviors and in ways that can look dysfunctional from the outside but are, in fact, attempts to make themselves feel better in themselves and in relationship.
To circle back to Crazy Ex-Girlfriend, think about the huge lengths the main character would go to secure the affection of her love interest, or the risky behavior she exhibited when she felt rejected, sad, or abandoned.
On the one hand we can look at her actions and call her “crazy” as the title of the show suggests, or, in bearing in mind her history of childhood relational trauma (which she certainly did have), we can imagine that the responses were appropriate reactions (meaning a response that makes sense given the circumstances of her past) and, in a way, made sense for her to do in her frantic attempts to avoid emotional pain.
By holding a reframe and lens of Borderline Personality Disorder as a product of a childhood trauma and the actions of someone with BPD being context-appropriate responses, we can hopefully have more compassion for those who deal with BPD or, if we see ourselves in this diagnosis, for us.
A personality disorder implies something wrong with individual rather than the result of individual’s past which they cannot and could not help at the time.
My hope in inviting you and all of us – clinicians and laypeople alike – to see BPD as a condition rooted in trauma is that the diagnosis itself will be further destigmatized and more attention will be paid to what, unfortunately, is at the root of so much mental health challenge: childhood abuse and neglect.
Relationship wounds, but it can also heal.
In closing, I will say that one of the biggest things I’ve learned personally and professionally making my way through this world and in my work as a therapist is this: relationship can wound, and it can also heal.
Now, what I mean by this is that, if you have a history of complex relational trauma and if you see some or all of the criteria and symptoms of BPD in yourself, this does not mean that you are broken or “unfixable” in any way.
Your history has impacted you, yes, but just because that is your history does not mean it has to be your future.
We know that Dialectical Behavioral Therapy is an evidence-based form of clinical treatment shown to have great success in treating BPD and, I truly believe this, if we are able to find and heal in the context of a safe, consistent, caring and attuned relationship (whether this is through therapy or otherwise), you can experience relationship as helping heal the wounds that you may have one time experiences in relationship.
In other words, it’s possible to heal those paper cuts and have an easier time tolerating sitting in that proverbial bathtub of lemon juice.
So please, be kind to yourself and to those you may know, love, live with, work with or treat if they or you deal with BPD.
Remember, as you can, the reframe that BPD is a relational trauma disorder and that the person with BPD and their actions make sense in the context of their past.
In doing so, we may all further help destigmatize BPD and create more compassion for ourselves and each other.
Until next time, take very good care of yourself.