Borderline Personality Disorder
- Alison Miller, MSN, RN-BC
- Jan 25
- 2 min read
Updated: Feb 2
At some point, the enormous committee that works on updating the DSM may decide that our understanding of BPD no longer supports it being labeled as a personality disorder. I hope that day is coming sooner rather than later, but I do think it's coming. We have strong evidence that childhood trauma—especially chronic interpersonal trauma and sexual assault—is a core component of the development of BPD.
Yes, the field is split on whether that means BPD is misnamed, over-pathologized, or is actually a trauma-related condition rather than a “personality disorder.” However, since 60-90% of those diagnosed with BPD have suffered severe childhood trauma, it's clear that BPD is in a category all its own among personality disorders.
Think about it: Do any of the other personality disorders have treatment protocols that actually help and improve the patient's quality of life? Nope.
So, here are two important points to consider:
When working with patients (or family members) diagnosed with BPD, always keep in mind that what may be fueling the patient's behavior are a set of childhood experiences that were totally out of their control. Their emotional dysregulation and psychological upheaval may be more aligned with cPTSD than BPD.
When walking into ANCC's PMH-BC exam, forget this whole discussion and focus on this: BPD (as it is currently being diagnosed) is expressed as high emotional intensity, dramatic engagement, chronic, sometimes extreme impulsivity, chaotic personal lives, and in some cases, chronic parasuicide and suicide attempts.
It's important to note that patients with BPD do sometimes kill themselves. It is a myth that they "only" engage in parasuicidal behaviors. Take every suicidal gesture very seriously.
P.S. Did you know that I am now posting tidbits just like this on Facebook every Tuesday and Friday? The same goes for Instagram. Please stop over, "Follow" or "Like" my pages so that you'll get updates every time I post.
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