Category: Bipolar Disorder

According to the National Institute of Mental Health (NIMH), Borderline Personality Disorder, or BPD, is a serious mental illness which is characterized by “unstable moods, behavior, and relationships.” BPD was first listed as a mental illness in 1980 in the Diagnostic and Statistical Manual for Mental Disorders, Third Edition. Since then, it has been estimated that approximately 1.6% of the U.S. population has been diagnosed with BPD. Interestingly, 75% of diagnosed patients tend to be women, but newer research suggests that there may be just as many men as women who suffer from BPD. Previously, according to the National Alliance on Mental Illness (NAMI), men with BPD may have been misdiagnosed as suffering from PTSD or depression.

Many individuals who suffer from BPD experience difficulty in regulating their emotions or thoughts or may be inclined towards impulsive or reckless behavior. They may also have difficulty maintaining stable relationships with other people because the fluctuate between idealization and devaluation. This behavior is also known as “splitting” since they seem to switch between one emotional extreme and another.

Treating Borderline Personality Disorder with Therapy

Unfortunately, the exact causes of BPD are still under debate, but many scientists agree that genetics and environmental factors play a huge influence. That being said, there are ways to address and treat BPD to make life a little easier for individuals struggling with the disorder. Mindfulness therapy can be a huge help because it can encourage slowing down and grounding oneself to become more self-aware and recognize how certain impulsive urges can potentially be harmful. Describing the sometimes overwhelming nature of BPD, Dr. Blaise Aguirre, assistant professor of psychiatry at Harvard Medical School states: “For people who struggle with impulsivity,  the often-dangerous consequence of impulsive behaviors, can, over time can lead to a sense that there is nothing to do, and that it is your destiny to have bad things happen to you. By definition, impulsivity is acting on an urge instead of thinking about the action and consequence.”

Thus, the key to overcoming the potentially dangerous impulsive urges that accompany BPD is through practicing mindfulness. Previously, we’ve addressed how mindfulness therapy can help overcome depression and anxiety, but it is also particularly useful for BPD. Dr. Blaise Aguirre explains the effectiveness of mindfulness therapy on BPD as follows: “The practice of mindfulness in targeting impulsivity is mostly about working with urges rather than reacting. The goal is to avoid acting on strong urges and to become familiar with what happens to your emotions and thoughts in these moments. Then, by knowing your mind, being able to slow down and choosing a different course of action.”

Because mindfulness therapy can be enormously helpful in combating the impulsivity of BPD, let’s look at 3 techniques one can employ help build a resistance to some of the symptoms:

1. Staying Still

For the most part, many of us can identify the impulsive behaviors which get us into trouble. As you develop an awareness of your thoughts and behavior, the realization may arise that in certain situations perhaps the best course of action is none at all. Dr. Aguirre advises that individuals with BPD identify a potentially self-destructive behavior that one is prone to doing when alone and make a commitment that the next time the urge arises to engage in that behavior the individual will instead practice not moving. The challenge here, then, is to essentially commit to resistance. Dr. Aguirre explains: “nothing lasts forever even when things feel like they will. For some people the urge will pass in a short while and for others, it could take quite a bit longer! As you sit or lie down, focus your attention on your breath, and notice the urges, labeling the urge as an urge.” He suggests that over time, intentionally doing nothing will result in reducing overall impulsivity.

2. Learning to Focus

There are times in life when we might be faced with certain situations which may trigger impulsive actions. For example, in situations when we feel emotionally provoked – such as when we receive an upsetting message from someone – might feel more inclined to react impulsively due to our innate emotional response. Acting upon these impulses can lead to instantaneous regret, just as we might regret sending an angry text message or snapping at someone versus telling them how we actually feel. The first step is to identify a situation when an impulsive behavior occurred, then, if and when this situation presents itself again, practice identifying the emotions at play which motivate the urge to act on a behavior which may provide short-term relief but long-term regret. Dr. Aguirre suggests: “ As you notice the intensity of the anger begin to heighten, and the urge to act becomes stronger, shift your attention to your toes.” Why toes? It’s a way of shifting one’s attention from the impulsive urges to something more sensational. While often neglected, feet, toes, and even posture can be a means of redirecting one’s attention from a harmful urge to a far more benign source.

3. Practicing Resistance

As we’ve already explored, an important part of using mindfulness to combat the impulsiveness of BPD is to practice resistance. This can be done in a number of ways, but another useful method of teaching oneself how to resist urges is to sit down and try to resist the urge to swallow. What does this mean? Swallowing saliva can be one of the most basic urges we have, which makes it a prime target for practicing urge resistance. Set a timer for one to two minutes and begin. As we resist this urge, we will begin to notice it intensify. Addressing this, Dr. Aguirre states: “You don’t have to give in to the urge. When the timer rings, swallow! What this practice teaches is that you might have an urge (in this case to swallow) but you don’t have act in the moment of the urge. You have the choice of controlling when, or if, you will act.” This resistance can then be applied to other instances of urges motivated by BPD.

By learning mindfulness and practicing these techniques, individuals struggling with BPD can learn to better take charge of their impulses and be in control of themselves, rather than allowing BPD to do so instead. The key is, as always, to practice, and self-control will follow.

To schedule an appointment with one our therapists, please contact our office directly @ 800-378-9354.

According to the National Institute of Mental Health, or NIMH, it is estimated that around 9.1% of the U.S. adult  population have been diagnosed with some kind of personality disorder within the past 12 months. This amounts to a total of approximately 29.3 million people. The exact rates of prevalence for the severity of these personality disorders is unknown, as is whether or not they persist for  the entirety of the individual’s lifetime. Furthermore, there is no currently reported average age of onset, making predicting whether or not one’s age is a contributing factor to the likelihood of developing a personality disorder difficult, to say the least.

What is known, however, is that of the estimated 29.3 million people diagnosed with some form of personality disorder, 39% seek treatment. But even then, NIMH reports that “ Even though the majority of cases were seen by a psychiatrist or other mental health professional, respondents were more likely to receive treatment from general medical providers than mental health specialists.” This statistic is especially worrisome considering the fact that personality disorders rarely occur alone. In fact, researchers have found that “people with personality disorders are very likely to have co-occurring major mental disorders, including anxiety disorders (e.g., panic disorder, post-traumatic stress disorder), mood disorders (e.g., depression, bipolar disorder), impulse control disorders (e.g., attention deficit hyperactivity disorder), and substance abuse or dependence.”

Personality Disorder Defined

But what exactly is a personality disorder? The study of human personalities have been a topic of interest since ancient Greece. Greek philosophers created a number of personality “types” within which individuals could be classified. It wasn’t long after that Greek physician Hippocrates declared that our personalities could be categorized into one of four temperaments: sanguine, choleric, melancholic, and phlegmatic, which are derived from one of four kinds of fluids found in the body. Thus, an individual found to embody one temperament more than the other was believed to have a kind of chemical imbalance that needed to be rectified.

Such beliefs and methods of categorization acted as the foundation for what later became modern psychological theories. These days, the Diagnostic and Statistical Manual of Mental Disorders is considered by many in the medical community to be the definitive volume of existing mental and personality disorders. In it, a personality disorder is described as being something that can be diagnosed if there are noticeable impairments in the self and how we function interpersonally, in addition to one or more pathological personality traits. Oxford psychiatrist  Dr. Neel Burton explains that these features must also be “(1) relatively stable across time and consistent across situations, (2) not better understood as normative for the individual’s developmental stage or socio-cultural environment, and (3) not solely due to the direct effects of a substance or general medical condition.”

The Three Clusters

Personality disorders can usually be categorized into one of three clusters, labelled A, B, and C. Each cluster contains 3 or 4 of the total 10 presently identified personality disorders.

Cluster A

The first cluster, known as cluster A, encompasses personality disorders whose characteristics are described as odd or eccentric behaviors. This cluster includes Paranoid Personality Disorder (PD), Schizoid PD, and Schizotypal PD. The personality disorders within this cluster are dominated by distorted thinking which can culminate in the individual behaving in a manner that is considered socially awkward or even socially withdrawing themselves. Those with Paranoid PD are highly suspicious and distrustful of others, making it hard for them to establish or maintain relationships. Those with Schizoid PD are frequently socially and emotionally detached, thus giving the impression of being “cold” or “aloof”. These individuals will prefer to act alone and therefore may be inexperienced with responding to certain social cues or reciprocating certain expressions or gestures, like a nod of agreement or a smile. The final disorder within this category, Schizotypal PD is characterized by an acute discomfort in social situations and having a reduced capacity for close relationships. Unlike Schizoid PD, however, those with Schizotypal PD will likely demonstrate eccentric behavior or experience perceptual or cognitive distortions. This can include seeing things no one can see or claiming to have experienced things that conflict with reality – such as being able to read minds or being fearful that their own mind is being read.

Cluster B

The second cluster, cluster B, contains personality disorders best defined by dramatic, emotional, and erratic behavior. Within this cluster are Borderline PD, Narcissistic PD, Histrionic PD, and Antisocial PD. To begin with, Borderline PD is one of the most widely studied personality disorders. It is characterized by individuals experiencing intense, unstable emotions and moods that can quickly shift. Consequently, they may have a difficult time calming themselves once they’ve become upset. These individuals are also more prone to emotional outbursts and impulsive behavior, which can lead to substance abuse, binging, self-injury, or engaging in risky sexual behavior. Their perception of the world tends to be polarized, applying harsh judgments to themselves and others. The second personality disorder within this cluster, Narcissistic PD, occurs when individuals struggle with their own sense of self-worth by believing themselves to deserve special treatment and entitlement. In order to compensate for a fragile sense of self esteem, those with Narcissistic PD act as though they are better than or more special than others, and can be devastated when they are told that they are normal just like anyone else. In a similar vein, those with Histrionic PD feel the need to be the center of attention at all times, demonstrating excessive emotionality to achieve this goal. Situations where they are not the center of attention make them uncomfortable, which likely stems from a fear of being alone. The last disorder in this cluster, Antisocial PD, is characterized by a pervasive disregard for the rights of other people which frequently manifests as hostility or aggression. Individuals with Antisocial PD can often behave in a manner that is deceitful or manipulative, lacking the ability to feel remorse for any harm they cause others. Those with Antisocial PD are most likely unable to either sympathize or empathize with others, making forming relationships incredibly difficult.

Cluster C

The third and final group, cluster C, is characterized by anxious and fearful behavior. Disorders within this cluster include Avoidant PD, Dependent PD, and the more well known Obsessive-Compulsive PD. Those who are diagnosed with Avoidant PD experience pervasive social inhibition and struggle with feelings of inadequacy. Because of this, they are often hypersensitive to negative evaluation, which motivates them to avoid social situations. This leads to underdeveloped social skills because they constantly believe that they are not good enough or that others don’t like them. Consequently, they are perceived as distant and shy when in reality social interaction can trigger feelings of discomfort and anxiety. Individuals with Dependent PD often experience a strong need to be taken care of by others. This is likely due to a fear of abandonment and losing support. Due to these fears, those with Dependent PD may behave in  a manner that is described as being “clingy”. They are also more likely to submit to the desires of others to avoid conflict rather than stand up for themselves as an individual. The final and most well-established personality disorder within this cluster is Obsessive-Compulsive PD, or OCD. This disorder is characterized by a preoccupation with rules, regulations, and orderliness. This can lead to an excessive drive for perfection, even at the risk of neglecting themselves or their relationships with others. This can also cause them to be unable to complete projects because they are so intensely focused on the details rather than focusing on the project as whole. Such compulsion towards perfection can come across as stubbornness or rigidity to those who are unaware of the disorder or the extent of its effects.

Help is Available for Those Who Need It

While any individual can demonstrate some of these characteristics, to be diagnosed with a personality disorder they must  experience significant impairment as a result. However, because of the subjectivity with which one may define the words “normal” or “abnormal” with regards to behavior, diagnosing these disorders reliably can be difficult. That being said, upon diagnosis, there are a number of resources and treatment options available to individuals struggling with personality disorders.