Behind Diagnosis: The Inner Experience of Borderline Personality Disorder

Author: Anushka Dasgupta

SUMMARY 

Borderline Personality Disorder (BPD) is a mental health disorder characterized by intense emotional dysregulation, unstable relationships, impulsive behaviors and a strong fear of abandonment. Most often rooted in early emotional experiences, trauma or biological vulnerability, borderline personality disorder influences how a person views himself or herself and relates to others. Nonetheless, with all these difficulties, borderline personality disorder can be treated. With techniques such as dialectical behavior therapy, a person can be able to regulate his/her emotions and even develop long-term resilience. 

KEY DEFINITIONS

Borderline personality disorder is a mental health condition that affects the way people feel about themselves and others, making it hard to function in everyday life. It includes a pattern of unstable, intense relationships, as well as impulsiveness and an unhealthy way of seeing themselves. (Mayo Clinic Staff, 2024).

Emotional dysregulation is an inability to manage your emotional states, such as unable to control feelings of sadness, anxiety, or anger. (Verywell Mind, 2020)

Fear of abandonment is the overwhelming worry that people close to you will leave. It can be deeply rooted in a traumatic experience you had as a child or a distressing relationship in adulthood.  (Johns Hopkins Medicine, 2025).

Impulsivity is broadly defined as actions that are poorly conceived, prematurely expressed, unnecessarily risky and inappropriate to the situation. (Verywell Mind, 2008).

Dialectical Behaviour Therapy is a stage-based psychotherapy that integrates principles of behavioural therapy, cognitive behaviour therapy, and mindfulness. It emphasizes a dialectic between accepting one’s current reality and actively working toward behavioural change, with a core focus on emotion regulation and distress tolerance. It was developed by clinical psychologist Marsha Linehan and is effective for individuals with borderline personality disorder (American Psychological Association, n.d.).

CASE

27-year-old Lisa feels "she's too much". When her boyfriend went for an office party and couldn’t update her because his phone was switched off, Lisa began to think…"What if he leaves me for someone else? What about me, then? I'll be all alone by myself for lifetime." Her fear of being left out sometimes makes her spend excessively on him just for the sake of trying to "save the relationship" and on other days, she just pushes him away to protect herself from future hurt.

THE CLINICAL PICTURE OF BPD

Borderline Personality Disorder can be understood through three core clusters: 

A. Interpersonal instability

-Fear of abandonment

- A pattern of unstable and intense interpersonal relationships, characterized between extremes of idealization and devaluation of others

B. Identity & emotional regulation

- Unstable sense of self

- Marked mood reactivity

- Chronic feelings of emptiness

C. Behavioral dysregulation

- Impulsivity in at least two areas, spending, sex, substance use, reckless driving or binge eating 

- Recurrent suicidal behavior, gestures threats or self-mutilating behavior

(American Psychiatric Association, DSM-5-TR)

EARLY WARNING INDICATORS 

• BPD commonly begins in adolescence, making early identification critical for improving long-term outcomes. (Winsper et al., 2016).

• Longitudinal research suggests that early childhood traits such as impulsivity and emotional dysregulation may signal higher likelihood of developing BPD features in adolescence or early adulthood. (Stepp et al., 2014)

• Signs such as early emotional dysregulation, impulsive behaviours, and self-injury in youth can precede the full expression of borderline personality characteristics. (Kaess et al., 2014).

Thus, understanding these early indicators is vital for awareness, screening and early intervention efforts.

WHAT IS BORDERLINE PERSONALITY DISORDER? 

Borderline personality disorder is a mental health condition that can be understood in terms of emotional instability in relationships and in one's sense of self. In other words, a person with borderline personality would be living the life of a tide that rushes in and out, in rapid shifts. 

HOW BPD FEELS FROM INSIDE

Living with BPD involves navigating intense emotional experiences, often with limited resources. Emotions arrive suddenly, feel strong and take time to settle. There's a push and pull dynamic that operates within their lives - closeness promises safety at the risk of losing the other person, distance hurts deeply because it strengthens fear of abandonment. The question that we ask ourselves, "Who am I?", the identity of a person living with BPD gets fragmented to such an extent that they feel emotionally unstable with the shifts in internal states and relationships. The act of repetitive cuts seen in their hands, excessive spending or reckless driving; these behaviors are often judged as being irrational or too much, but for someone with BPD, these behaviors are an attempt to express their unbearable emotional pain.  

Each phase is like the pain that is embedded deep inside and wounds engraved deep within....

CAUSES 

Borderline Personality Disorder is best understood through a ‘biopsychosocial’ model, where biological vulnerabilities interact with psychological traits and adverse social-environmental experiences across development that shapes the course of the disorder.

Linehan’s biosocial model explains this interaction by proposing that BPD develops through the combination of biological vulnerability and a childhood context where emotional experiences are often invalidated, dismissed or inconsistent in nature (Linehan, 1993).

Biological factors further act as precursors to the development of the disorder. Twin studies indicate a significant genetic contribution, ranging from 40% to 60%. Neurobiological research has implied that there is reduced serotonergic functioning in individuals with BPD, which thereby reflects in impulsive-aggressive behaviours and self-harm. 

Overall, borderline personality disorder emerges from the complex interaction of genetic predispositions, psychological processes and environmental influences, rather than being attributable to a single cause. 

TREATMENT 

Treatment of BPD primarily focuses on psychotherapy, first-line treatment being Dialectical Behaviour Therapy (DBT), developed by Marsha Linehan. It is an evidence-based approach developed for emotional dysregulation and impulsive behaviour. It prioritises on decreasing suicidal and self-injurious behaviour, conflicts within relationships and helps to develop a stable sense of self, inculcating acceptance with change (Linehan et.al. 1993, 2006). Mental health practitioners often combine psychotherapy along with medications to enhance effectiveness, primarily targeting symptoms.

Beyond therapy, the development of skills becomes important in dealing with daily-life hurdles. This can be understood by noticing emotions right before they start to build up. Then there is practicing how to handle emotions and feelings by processing and building the habit of pausing before acting on strong impulses. Further, building routines and self-care practices like regular habits for taking care of oneself, helps a lot in keeping steady. I think routines keep things from falling apart. All in all, these skills will help individuals gradually feel more in control of their lives. 

Role of support systems becomes essential in the lives of BPD, as they provide security and predictability. Gunderson (2001) emphasized on the importance of interpersonal relationships that play an important role in the course of borderline personality. He stated that those with BPD are extremely sensitive to feelings of rejection or abandonment within relationships. Having a supportive environment that is structured and consistent in how people interact act as protective factors contributing towards the reduction of symptoms and better overall functioning.         

Recovery takes time, it’s a gradual process and a two-way street. That means both the client and therapist have to put in effort together. Just as physical injuries like bruises or accidents take time to heal, mental health also requires patience and steady care.

Therapists need to build the recovery capital for the client, that is therapists play a key role in strengthening a client’s belief that stability is possible through structure, self-awareness and continued support.

CLOSING REFLECTION

Returning to the case of Lisa, it does not seem so irrational anymore, but rather a normal reaction to intense emotional pain and fear of being abandoned. Sometimes that feeling of instability, it just stems from wanting real connections and feeling emotionally safe. Having those borderline traits does not lock someone into struggling all the time. With early recognition and proper support, it is possible to build healthier ways of managing emotions and creating better relationships with others. 

REFERENCES

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). Author.

• American Psychological Association. (n.d.). Dialectical behaviour therapy. APA Dictionary of Psychology. https://dictionary.apa.org/dialectical-behavior-therapy

• Gunderson, J. G. (2001). Borderline personality disorder: A clinical guide. American Journal of Psychiatry, 158(3), 493–494. https://doi.org/10.1176/appi.ajp.158.3.493

• Kaess, M., Brunner, R., & Chanen, A. (2014). Borderline personality disorder in adolescence. Pediatrics, 134(4), 782–793. https://doi.org/10.1542/peds.2013-3677

• Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

• Mayo Clinic Staff. (2024). Borderline personality disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237

• Stepp, S. D., Lazarus, S. A., & Byrd, A. L. (2014). A systematic review of risk factors prospectively associated with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 5(1), 1–16. https://doi.org/10.1037/per0000036

• Verywell Mind. (2008). Impulsive behaviour and BPD. https://www.verywellmind.com/impulsive-behavior-and-bpd-425483

• Verywell Mind. (2020). What is emotional dysregulation? https://www.verywellmind.com/what-is-emotional-dysregulation-425483

• Winsper, C., Lereya, T., Zanarini, M., & Wolke, D. (2016). Involvement in bullying and risk of personality disorders in adulthood. Journal of Personality Disorders, 30(1), 1–21. https://doi.org/10.1521/pedi_2015_29_185