The Emmy-winning CW show Crazy Ex-Girlfriend points out a falsehood right in its title: the idea that sometimes people are just crazy, a catch-all term that oversimplifies complex issues. That attitude reflects a lack of understanding and, sometimes, compassion.
In real life, that stereotypical “crazy” can manifest in very real and defined mental health issues. A condition often misunderstood in this way is borderline personality disorder, or BPD. It is rare – affecting maybe 2% of adults – and can be difficult to treat due to stereotypes and stigma surrounding it.
But understanding it is important, and gives insight into the subtleties of human behavior.
Borderline personality disorder is characterized by unstable and unpredictable emotions, often leading to reckless behavior and a fear of abandonment. Its causes are uncertain; though some genetic links and physical causes have been studied, the general consensus is that childhood trauma plays a large factor.
BPD is much more prevalent in females, with three times as many diagnoses as males; nearly 10% of sufferers commit suicide.
The easiest way to characterize BPD symptoms is general unpredictability. BPD sufferers think in extremes: someone loves you unconditionally or hates you completely, people will be with you forever or leave you immediately. This can manifest in overreactions, particularly when criticized or in stressful situations.
BPD sufferers may also exhibit rash decision making and unsafe behavior such as sexual promiscuity, drug use and rage. It can also affect both physical and mental self-image, which correlates with other behaviors such as self-harm and eating disorders.
It may be easiest to imagine BPD as a constant wavering between euphoria and absolute sorrow. Imagine the happiest and saddest times in your life; now imagine those feelings being considered your normal happiness or sadness. This may explain how a BPD sufferer sees the world.
Dealing with BPD in a Loved One
Interpersonal relationships with a BPD sufferer can be very difficult. Children of parents with BPD may feel a need to constantly please the parent, for fear of triggering an extreme reaction; partners of sufferers may find it hard to express their concerns or criticize their partner.
While medications can treat issues that come with BPD – depression, anxiety and the like – they cannot treat the illness itself. Because of its multifaceted nature, psychotherapy, in particular Dialectical Behavioral Therapy, is the most effective treatment. DBT focuses on teaching sufferers to become more self-aware and particular skills to manage their own behavior patterns.