Borderline Personality Disorder and Trauma

How Can a Personality Be Disordered?

One way of thinking of our personalities is that we tend to have certain patterns of how we think, feel, and behave. For example, if you value your independence, then you are likely to focus on opportunities for autonomy and push against efforts to confine you. There may be some people you allow yourself to depend on more than others, but your desire for independence is a pattern that is readily observable by you and others whether you're at home, work, or out with friends.

When we talk about personality disorders, we talk about patterns of thinking, feeling, and behaving that are so rigid in such a wide range of settings that they really get in our way of simply functioning on a day-to-day basis. These patterns typically go back to adolescence or early adulthood.

Valuing autonomy across different situations is not so unusual. However, if this was so rigid a pattern that since you were a teenager you found yourself not enjoying or wanting close relationships, and as a result you were unable to maintain a social support system or hold down a job requiring social interactions - we'd likely think of that as disordered and want to think of ways to help you soften those patterns and grow past them.

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a personality disorder that frequently comes up in my practice because it is often connected with trauma. Some clients come in because they were diagnosed with BPD. Others have never heard of the condition, but it becomes apparent during sessions that it describes their experiences. Still others come to therapy because they're trying to make sense of their relationship with parent or partner who has BPD.

BPD can look different for different people, but according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) it includes some combination of at least five of the below symptoms:

  1. Frequently making frantic efforts to avoid real or imagined abandonment

  2. Having intense, unstable relationships with a tendency to shift between extremes of idealizing and devaluing

  3. Having self-perception, values, and hopes that shift dramatically depending on external influences

  4. Feeling empty

  5. Having extreme mood swings

  6. Being so impulsive that it causes real problems, such as through drug or alcohol abuse or binge eating or spending

  7. Experiencing intense, inappropriate anger that is difficult to control

  8. Repeatedly engaging in self-harm or suicidal threats or behaviors

  9. Periodically feeling paranoid or dissociating

If you or the person you are concerned about does not have five symptoms of BPD or the symptoms are relatively mild, it may be more accurate to say you or your loved one has some BPD characteristics.

BPD and Trauma

To explain how I see the link between trauma and BPD development, I'll use the example of a child whose parent was emotionally abusive. However, similar patterns could emerge in the cases of childhood physical abuse, sexual abuse, domestic violence, or any of the numerous ways we humans hurt one another. At its core, I see BPD as often developing out of a betrayal of trust.

If we bring to mind the image of a child whose parent is demeaning or cruel, we can imagine that this child was taught to expect others to mistreat them and ignore their needs. We might experience that child to grow up being terrified of being (1) abandoned at any moment.

They may (2) have a difficult time developing stable relationships because they are almost constantly on alert for the potential of cruelty, just as they are often on the lookout for the long wished for experience of being cherished and understood.

A person who was emotionally abused may have a hard time (3) defining who they are and have a tendency to try to people please, and then feel resentful about that. Without a trusted, well attuned parent to help us develop our identity, we may very well often carry around a (4) feeling emptiness.

Not having a soothing, stabilizing parent to teach how to calm down or manage emotions may lead to (5) mood swings and (6) impulsive efforts to simply feel better in anyway possible. Difficult to (7) control anger would also make sense when you're carrying around the legacy of your own parent's cruelty.

Being raised to expect that others will dismiss or insult your feelings may lead to a need to go to (8) extremes to feel that others hear you or that you can acknowledge the depths of your own pain.

Finally the intensity of being hurt, being afraid, and feeling disconnected from your self can have moments of such extreme (9) that you feel as if you are temporarily losing connection to reality.

Sometimes the traumatic experience or experiences that lead to developing BPD may not seem extreme. Check out my post on little "t" traumas to explore ways in which seemingly benign hurts can be build up to become something much worse.

Treating BPD

BPD does not have to control a person's life. It is a difficult journey to begin to change self-perceptions, expectations of others, and strategies for managing emotions. However, therapy that helps you heal from these traumatic experiences and encourages you to grow past them can provide a sense of validation and hope.

I also often include elements of Dialectical Behavior Therapy (DBT) in treatment. DBT was developed specifically to help people with BPD become more mindful, improve their relationships, manage their emotions, and get through stressful moments without making things worse for themselves.

Often times things become so drastic and so painful because you carry around an internalized expectation that you and the people around you will only take your pain seriously if you are at the height of distress. Helping you to communicate your needs to yourself and others more effectively, can shortcut this process and save you and the people you care about a lot of distress.

Thoughts or questions? Reach out and let's talk.