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Borderline Personality Disorder

personality disorder
16th February, 2023

Borderline Personality Disorder – prison of your mind

“I’m so good in the beginning, but in the end, I always seem to destroy everything, including myself.”[1]

A depiction of extreme idealization and devaluation common in BPD
Devaluation in Edvard Munch’s Salome (1903). Idealization and devaluation of others in personal relations is a common trait in BPD.

Borderline Personality Disorder is characterized by intense fear of abandonment, chronic feelings of emptiness, distressing level of body image issues, self harm, intense mood swings and impulsivity. BPD has a significant burden of comorbidities including depression, psychoactive substance use, short lived, circumscribed, psychotic symptoms, paranoid ideations, intense dissociative episodes. Around 70-75% of patients with BPD have history of deliberate self harm. [2,3]

In the Diagnostic and Statistical Manual (DSM-V)[4] diagnosis of BPD is based on (1) a pervasive pattern of instability of interpersonal relationship, self-image, and affects and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts

To read a full list of criteria please refer to DSM-V (BPD)

International Classification of Diseases (ICD) by WHO has a slightly different nomenclature for Borderline Personality Disorder. Under the Code F60.3 it prefers to call it Emotionally unstable Personality Disorder and distinguishes two types:5


  1. The Impulsive Type characterized predominantly by emotional instability and lack of impulse control, and
  2. Borderline type characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behavior, including suicide gestures and attempts.
People with Borderline personality disorder (BPD) are like people with third-degree burns, over 90% of their bodies lacking emotional skin as described by Marsha Linhan. They feel agony at the slightest touch or movement. Borderline Personality Disorder (BPD) is a chronic psychiatric disorder, characterized by difficulties regulating emotion, causing loss of emotional control leading to increased impulsivity, affecting how a person feels about themselves and negatively impacting their relationship with others. People living with BPD often have an intense fear of instability and abandonment. As a result, they have problems being alone. 

According to the National Health Service (NHS) comprehensive public-health service under government administration, established by the National Health Service Act of 1946, There’s no single cause of borderline personality disorder (BPD) and it’s likely to be caused by a combination of factors. Several environmental factors seem to be widespread among people with BPD. There is strong evidence to support a link between distressing childhood experiences, particularly involving caregivers, and the development of BPD. Being a victim of emotional, physical, or sexual abuse, being exposed to long-term fear or distress as a child, being neglected by one or both parents, or growing up with another family member who had a serious mental health condition, such as bipolar disorder or a drink or drug misuse problem might lead to BPD. Not everyone with BPD has had these types of childhood experiences, although many have. And not everyone who has these types of experiences will have BPD. It is likely that a combination of factors, rather than a single cause, is responsible for most cases of borderline personality disorder. Studies have shown that a variation in a gene that controls the way the brain uses serotonin (a natural chemical in the brain) may be related to BPD, affirming BPD to be genetic and showing that BPD tends to run in families. 

Surveys have estimated the prevalence of borderline personality disorder to be 1.6% in the general population and 20% in the inpatient psychiatric population. It’s estimated that 5.9% of the adult U.S. population has BPD, and Nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD. Borderline personality disorder (BPD) can be hard to diagnose because the symptoms of this disorder overlap with many other conditions, such as bipolar disorder, depression, PTSD, or anxiety hence, most people are commonly misdiagnosed with PTSD or depression. 

People with BPD are considered among the most challenging groups of patients to work with in therapy, requiring a high level of skill and training for the psychiatrists, therapists, and nurses involved in their treatment. Majority of the psychiatric staff report finding individuals with BPD moderately to extremely difficult to work with, more difficult than other client groups. Sometimes, it can pose challenges in the recovery process and many dropouts are common. Because it is a serious and vulnerable condition, it is seen that many of these individuals are neglected, misdiagnosed, misinformed, and treated in a manner that aggravates the symptoms.

In countries such as Nepal, there are different levels of expertise in the mental health service providers. Even individuals who are trained for only a short period with virtually no patient exposure and proper supervision are involved in the mental health service delivery. Because of these and other reasons we come across reports of this group of clients being misdiagnosed, misinformed, provided treatment that only aggravates the condition, and even abused, harassed, and mistreated. It is important to note that since individuals with BPD are emotionally vulnerable and tend to form a strong bond with mental health service providers, it is especially important that they do not fall into the wrong hand.  

Healthcare providers should practice utmost caution in that they are not contributing to the stigma of a BPD as a diagnosis or in any way sensationalizing it since this can often result in the perpetuation of BPD features. Efforts are ongoing to improve public and staff attitudes toward people with BPD. One of the problems that have plagued the treatment of BPD and reduced its potential to be effective is the fact many therapists overlook the disorder and instead focus on its comorbid conditions, such as depression, anxiety, eating disorders or substance abuse.

“The borderline personality disorder is the engine driving the patient’s difficulties,” Hoffman explained. “And if that is not addressed, then it’s less likely that the other co-occurring disorders will remit.”

Despite the obstacles and challenges, recovering from BPD is possible, even likely, based on the stats mentioned earlier. The patient has to realize, though, that even with medication, recovery is a long term process that requires hard work and patience. As Friedel wrote in “Borderline Personality Disorder Demystified,” “patience and persistence are crucial to your success, and these behaviors are usually not strong points in people with BPD. However, they can be developed, especially with the proper help, and as you achieve small and large successes, failures become less common.” 

Those with BPD have a deficit in their ability to perform certain high-level cognitive tasks, such as regulation of affect and impulse control. They incorporate the brains of people close to them to so-to-speak supplement their brains when performing these tasks. Using an external object or person as part of one’s cognitive apparatus demands nearly constant proximity and an exceptionally intimate informational bond. This would account for the BPD sufferer’s panic and despair in the face of abandonment–when abandonment means losing one’s mind, it could seem worth any effort or risk to avoid such a loss. Further application of extended mind theory to other psychiatric phenomena is also considered.


1. Kiera Van Gelder, The Buddha and the Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior         Therapy, Buddhism, and Online Dating
2. Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline                patients [published erratum appears in Arch Gen Psychiatry 1994 May;51(5):422]. Arch Gen Psychiatry. 1993 Dec. 50(12):971-4
3. Linehan MM, Tutek DA, Heard HL, Armstrong HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal         borderline patients. Am J Psychiatry. 1994 Dec. 151(12):1771-6
4. Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2022 Oct 25]. In: StatPearls [Internet]. Treasure Island      (FL): StatPearls Publishing; 2022 Jan-. Available from:
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Arlington, VA:                  American Psychiatric Association; 2013. 663-6.
5, World Health Organization. World Health Organization; [cited 2023Feb18]. Available from:

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