What is Borderline Personality Disorder?
According to the National Education Alliance for Borderline Personality Disorder, "Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to manage emotions effectively.”
BPD may be manifested through the individual's intense fear of abandonment, intense mood swings, anger or rage toward caregivers or partners, suicidal thinking, self-harming behaviors, and sometimes paranoia. Symptom severity may make it difficult for individuals to work toward meaningful academic, vocational, and relational goals. Most often, BPD is diagnosed by using the criteria established by the DSM-5.
Generally, BPD is most often diagnosed in adolescents and young adults. There are strong indications and evidence that the disorder will become more manageable as the individual progresses through adulthood.
What Causes Borderline Personality Disorder?
This is one of the areas in which the psychiatric community is unclear. It's really difficult to pin down exactly what causes someone to be diagnosed with BPD. With that said, there are two schools of thought.
First, there is evidence that some (and potentially all) components of BPD are tied to genetics. Just like we see a genetic component when it comes to physical illnesses, diagnoses such as depression, anxiety, or bipolar disorder may also be linked by family history.
Second, it would appear that many people are more vulnerable to having the diagnosis if they grew up in what we think of as an invalidating environment for some children and teens. An invalidating environment may we one where trauma or neglect takes place. Sometimes emotionally-sensitive children don’t feel like they fit in with the rest of the family and we might also consider that to be an invalidating environment.
Of course, parents don’t set out to “cause” BPD or create a family where trauma is likely to occur. I encourage families to be careful and not assign blame or judgment to themselves or others when someone in the family has been diagnosed with BPD.
As a therapist intensively-trained in dialectical behavior therapy, I believe in the assumption that all people are doing the best that they can. That includes individuals with the diagnosis of BPD and their family members.
All behavior is caused. —Marsha Linehan, PhD, creator of dialectical behavior therapy
What are "Triggers" for Someone with Borderline Personality Disorder?
The word “trigger” seems to bring with it so many negatives connotations. When I’m working with clients and their families, I almost always use the word “catalyst” as a substitute for “triggers.” When we think about some of the behaviors associated with BPD, the word catalyst refers to the events or actions that cause the problematic thoughts, emotions, or behaviors.
Here’s an example:
Kate is an emotionally-sensitive 19 year-old who is away at college for her freshman year. She has several roommates she met on her first day on campus. Like most freshman, Kate is eager to make friends and wants to be liked by her peers. She also fears rejection.
One of Kate’s roommates decides in the first couple of days that she doesn’t like Kate and behaves in a way that is polite and, yet, cool toward her. Because of this rejection, Kate feels a mixture of shame, sadness, and guilt. She’s had the thought, “There’s something wrong with me.” Less than a week later Kate calls her family in tears and says that no one at college likes her and that she wants to come home.
In this particular case, the catalyst for wanting to leave school is the perceived rejection. The thoughts and emotions that surround the event cause the behavior.
One of the most important keys to recovery is understanding how particular emotions, thoughts, or events serve as catalysts for BPD symptoms and behaviors.
It's important to note that the catalysts for a person's behaviors will vary from one individual to the next. There is no one-size-fits-all position here. With that said, some catalysts are more common than others. That list includes the following:
the perception of being abandoned
having one’s feelings hurt
any form of rejection (even from a stranger)
the loss of an important relationship
being fired from a job or removed from a group
memories of a traumatic event
While there are many other events and actions that can cause a moment of intense emotional dysregulation, the fact remains that the fear of exclusion, rejection, and abandonment seem to be most prevalent. When the individual feels they have been abandoned or shunned, it's common for them to react emotionally. Sometimes a person will strike out in anger at the source of the rejection or abandonment. This might also occur when people feel invalidated or dismissed. When that anger turns inward, self-sabotaging behaviors, alcohol use, drug abuse, self-harm, and suicide become real possibilities.
What's most concerning about one's catalysts is the idea a catalyst might not be a significant event in the eyes of a person who is not suffering from BPD. Here is a list of seemingly innocent catalysts that can drive a someone to BPD toward behaviors that invariably hurt them or others:
not getting a return phone call when requested
not getting an invitation to a party
the lack of a response to a simple question
not being called on in a classroom
not being included in a decision making process
being ignored, criticized, or judged
Anything that makes the individual feel they are being disregarded could serve as a catalyst for behaviors that are incongruent with that person’s goals and values. Identifying patterns can help everyone cope in ways that are more effective.
Can You (or Should You) Remove “Triggers”?
It’s probably not possible to identify and then remove all potential triggers—or catalysts—for ineffective behaviors. We don’t need to always shield or protect someone we love from upsetting events or difficult situations since these moments are often an important part of experiencing life as it is. Some people even find that tough situations help them to grow and build our emotional resilience. (I also believe this!)
A healthy (and compassionate) response is to help someone cope with the events that are upsetting. People with BPD can learn to soothe themselves and to understand their maladaptive patterns to approaching problems.
Helping the Individual Who Has Borderline Personality Disorder
Collaboration is key. Telling someone what to do or demanding change in a moment of emotional dysregulation will almost always cause more harm.
What people with BPD are missing is the ability to cope with the catalysts that drive their inappropriate behaviors. If they can learn to recognize and cope with their catalysts, they stand a fighting chance of leading a normal life.
The first thing you can do to help your loved one is to make sure they get a proper diagnosis and understanding about that with which they are dealing. With work with a well-qualified therapist, they can learn new coping skills or ways to understand their thoughts and emotions.
Here are some basic things your loved one can do to help offset the pain and anxiety they might face when feeling rejected or abandoned:
Listen to some relaxing music
Watch a funny movie
Relax in a warm bath
Read or listen to a book
Seek help when things get really rough
What’s important for you to know is that you don’t need to solve all of your family member’s problems and you don’t need to try to say or do the “perfect” thing. You quiet presence is sometimes all that’s necessary in order to help your family member get through a difficult moment.
Think about what has worked for your family in the past. Is there something you could plan to do in the future to help you both?
If you are someone who loves an individual with BPD, please check out my course for family members and friends.