Borderline Personality Disorder

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.” But since 60-90% of those dx 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 two points here:

1. When working with patients (or family members!!) diagnosed with BPD, try to always keep in mind that what may be fueling the patient's behavior are a set of childhood experiences that were totally out of the control of that person. Their emotional disregulation and psychological upheaval may be more cPTSD than BPD. And

2. When walking into ANCC's PMH-BC exam, forget this whole discussion and focus on this: that 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, chronic parasuicide and suicide attempts. (And yes, patients with BPD do sometimes kill themselves. It is a myth that they "only" engage in parasucidal 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? Same with Instagram. Please stop over, "Follow" / "Like t" my pages so that you'll get updates everytime I post.

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