Borderline Personality Disorder

I wanted to write a post on Borderline Personality Disorder (BPD/EUPD) given how it seems to be grossly misunderstood and mistreated in traditional healthcare practices and, having worked with a number of individuals with the condition, I wanted to offer my own thoughts and perspectives.

It can be very difficult to understand BPD without having awareness of the lack of whole object relations and object constancy that tends to define the disorder. For those who are unfamiliar with this, lack of whole object relations is what leads to the ‘splitting’ or ‘black and white thinking’ so common in the disorder. It can be impossible for a person with BPD to see a person’s good and bad sides at the same time, and so when there is conflict or disagreements, it is easy for them to ‘split’, making the other ‘all bad’, leading to extreme distress, loneliness and confusion.

Object constancy is the ability to remember things that are not currently in one’s present awareness, such as a partner’s previous supportive or positive behaviour, or actions or situations that do exist (such as a person’s success at work), which can be completely wiped out and forgotten in moments of intense emotion, which also characterises the disorder.

This lack of healthy whole object relations and object constancy leads to a fragmented or unstable sense of self. The person with BPD often does not experience themself as a ‘whole’ object, and split themselves into ‘all good’ or ‘all bad’. This is changeable and can contribute to the extreme mood swings also present in the disorder.

A healthy sense of self is something that is usually formed in childhood, and when someone grows up with caregivers who are shaming, dismissive or not emotionally attuned to a child’s reality (particularly when the child is especially sensitive), it can cause them to ‘split’, effectively freezing their ‘true self’ in time, and growing up with an adaptive, rigid self. Because this rigid self is created to ‘fit in’, it is rarely representative of the child’s authentic self (which feels ‘wrong’ or ‘shameful’ to the child). Over time, they may come to identify with this ‘false self’, which is unstable and as such cannot hold two conflicting realities (good and bad) at the same time. Yet change is difficult because this adapted self is how a person comes to see themselves, and is challenging to shake from its position of ‘authority’ given how necessary it felt in early childhood.

So, is there a ‘cure’ for BPD? I would have to say yes. It is possible to develop whole object relations and object constancy as an adult, as well as integrated, healthy relationships with others. It is possible to learn to regulate and manage one’s emotions, and feel secure and stable despite the threat of abandonment or insecurity in one’s external environment.

Therapy can provide a template for a new relationship, one which the client may internalise. The ‘cure’ is about developing a positive relationship with oneself - coming to recover and accept one’s true self, recognising the need for the split in childhood, but seeing this is no longer necessary now. Doing this in the safety of loving relationships is vital, as the child-like self will feel very vulnerable, and need reassurance and support during the growth period.

An analogy might be cutting back weeds that have overtaken and outgrown the space in which a flower may have bloomed. It takes time to give the sapling enough space to grow again, but when this space is here, support and structure is needed. It is very easy for old habits to take root again, and so it is a combined effort of therapy and positive relationships in one’s life to do the work.

Yet the work is possible. And, like all flowers, it’s the ones that grow in the sh*t that can often appear the most beautiful.

I would love to see a broader conversation in psychotherapy around this process. There is so much stigma around BPD, which, I believe, comes from a lack of understanding in how to heal it. It can be easier to dismiss or write it off as untreatable. I do hope this will change.