I received a question from one of my followers, “Can you offer any insight as to why there is so much shame attached to BPD? Is it worse than other mental health issues?” I thank this follower for her request, because it gave me the idea for the post, which I believe offers insight and information that are often overlooked.
When I was in graduate school, I remember sitting in my psychopathology class and learning about BPD. I recall my professor explaining, that many therapists avoid working with clients’ with BPD. He explained the reason for this being, that many clinicians find it difficult to make progress with BPD clients, due to their symptoms such as instability, impulsivity, splitting, difficulty trusting others, etc. My professor provided an example of an experience he had working with a client with BPD. He explained that the client would present anger outbursts almost every session, during which she would black out due to the extreme anger. He reported having difficulty building rapport with his client due to her anger, which she displaced onto the therapist. He also mentioned the inconsistency of attending sessions. I would like to make it clear that this is not my personal opinion, but a story that was shared with me, and information given by one of my professors.
Is BPD worse than other mental disorders?
There is no evidence based answer to this question. Every case of Borderline Personality Disorder is different. People with BPD may experience a wide range of symptoms, while others with a more mild form of the condition present less severe symptoms. It comes down to the individual, and factors contributing to the disorder such as family, relationships, childhood, environmental factors, social factors etc.
Although this is not conclusive, there are factors associated with BPD that may make it seem more severe than other disorders. What we do know is that individuals with BPD frequently suffer from co-occuring mental disorders (the diagnosis often comes with additional diagnosis). It is common for a clinician to misdiagnosed a client with BPD with the comorbid disorder, which is unfortunate because than they are unable to receive proper treatment. In order to treat BPD with co-occuring disorders the most effectively, Both BPD and the comorbid disorders must be treated.
Disorders that most commonly occur with borderline personality disorder include:
1.Mood Disorders (depression, bipolar disorder): Many people with BPD experience mood swings. They may experience sudden, extreme shifts in mood, for example going from upbeat, happy, euphoric to angry, irritable etc. Some individuals meet criteria for major depressive disorder as well as BPD. The symptoms of Major Depressive Disorder (MDD) include sadness and/or emptiness most of the day, nearly everyday, low energy, difficulty concentrating and making decisions, thoughts of suicide, sleep and appetite disturbance, agitation, as well as feelings of helplessness, guilt and worthlessness. BPD individuals struggle frequently struggle with establishing a sense of self, and feeling inherently bad. The symptoms associated with both BPD and MDD overlap, and frequently lead to co-occuring diagnosis.
2. Substance Use Disorders-Individuals with BPD are often more likely to use substances. The overuse of substances, addiction, and problems with substance abuse can render a diagnosis of substance use disorder, co-occuring with BPD.
3. Post traumatic Stress Disorder-A high percentage of individuals with BPD also suffer from Posttraumatic Stress Disorder (PTSD). Many individuals with BPD have suffered from early childhood trauma such as sexual and or physical abuse. PTSD is triggered by traumatic experiences, and can develop at any stage of life. The maladaptive coping skills that often occur with BPD diagnosis often develop as a way of coping with trauma.
4. Eating Disorders (most commonly bulimia)eating disorders are common in individuals with BPD. Anorexia and Bulimia primarily being the two found most commonly associated with BPD. Childhood trauma predisposes individuals to these eating disorders, similarly to how it predisposes people to BPD. The impulsive, self-destructive tendencies associated with BPD may make them more vulnerable to developing an eating disorder.
5. Attention Deficit Hyperactivity disorder(ADHD) frequently co-occurs in borderline individuals affects approximately one out of four diagnosed. Similar to BPD, ADHD symptoms include impulsivity.
6. Anxiety Disorders-Anxiety Disorder and Panic Disorder are also co-occuring disorders that many BPD individuals suffer with. Some may be vulnerable due to childhood trauma, chaotic environments, and conflicts. Children raised in chaotic environments are more likely to develop anxiety disorders.
7.Other Personality Disorders-Research has indicated that many individuals diagnosed with BPD either have co-occuring other personality disorders or features of other personality disorders.
Overall, a diagnosis of BPD often comes with other co-occuring disorders. I believe the main reason behind this is because BPD is a complex disorder, with a wide range of symptoms, which overlap with many symptoms associated with other disorders. Symptoms associated with BPD are similar to a few disorders all wrapped into one. So inclusion, I can not say for certainty that BPD is more severe than other disorders, but if asked my opinion given all of the co-occuring disorders that come with the diagnosis I do believe it is a disorder harder to cope with, treat and manage than most.
Why is there so much shame attached to BPD?
Given the nature of the disorder, and the features of other disorders, and co-occuring disorders that often come with a BPD diagnosis, individuals with the disorder frequently experience shame and guilt over many of these symptoms. Many other features of the disorder also cause individuals with BPD to feel shame. For example, splitting, a common phenomena that people with BPD experience, can make the individual view themselves as bad, worthless, etc. Many individuals with BPD also have experienced trauma, many having suffered from physical and or sexual abuse, which causes them to feel shame, and sometimes even blame themselves for the abusers behaviors. Overall, there is a lot of shame associated with the disorder because of the symptoms and criteria that come with it. On top of that, there is the stigma placed on the disorder, which causes even more shame.
BPD is a complex disorder, extremely difficulty to manage, but overcoming the symptoms is definitely possible, and typically in most cases of BPD around the persons early 30’s
symptoms begin to lessen in severity. Progress is possible, and it is a challenge, but many individuals suffering do get better. It is a long journey, but it is worth it. WIth treatment such as individual therapy, DBT, group therapy, medication management etc. BPD is manageable and there is so much potential for suffers to overcome it.