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There are so many persistent myths about Borderline Personality Disorder. But, the reality of being quote “borderline” is much more nuanced — and hopeful.

Hosted by: Hank Green
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For many, just mentioning “Borderline Personality Disorder” conjures up images of an endless cycle of therapy sessions and hospital visits. There’s this idea that people who are diagnosed with it have been basically broken by a bad childhood — and there’s nothing that can be done to fix them. But that comes from some persistent myths about the condition.

The reality of being quote “borderline” is much more nuanced — and hopeful. People with Borderline Personality Disorder, or BPD, are generally impulsive, undergo extreme shifts in mood, and have lots of trouble with interpersonal relationships. And when it comes to myths about BPD, we might as well start at the beginning, so to speak.

Many people mistakenly believe it’s entirely caused by trauma or abuse. But how BPD develops is definitely more complicated than that. It is true that patients with this condition are likely to have histories of trauma, and are more likely than the general public to have a history of abuse.

But, not all people with BPD have such experiences. And doctors may be missing or misdiagnosing a lot of the BPD cases from people who don't have traumatic histories. Plus, it’s worth noting that, by far, most people who have been abused don't develop disorders.

So trauma is neither necessary nor sufficient for the development of BPD. This may be because both genes and a person's life have important roles to play. We do know that BPD is highly heritable, meaning genetics strongly influence the likelihood a person develops the condition.

But it’s proven especially difficult to pin down how or why. Like, there’s no “BPD Gene” or even set of genes, despite lots of people looking for them. More recently, researchers have come to think that’s because those studies were looking for genes related to a BPD diagnosis, when it might make more sense to look for genes that contribute to a vulnerability to the disorder.

Basically, the idea is that susceptibility is passed along genetically, but there still needs to be some kind of environmental factor for the disorder to develop. If this idea is right, then trauma may act as a trigger for BPD. Meanwhile, those cases that don’t involve trauma might imply that other stresses can be involved.

And figuring out exactly how genes make a person susceptible to this would go a long way towards identifying those other stressors. They might also point doctors towards more effective treatments and better ways of diagnosing the condition in the first place. As it happens, right now, diagnosing BPD is kind of a tricky thing.

And that’s contributed to another persistent myth: that BPD is the same thing as bipolar disorder. Now, if you just look at a list of symptoms and also the acronym, it's easy to see how someone might mix them up. They both involve having volatile emotions that can vary wildly over time, for instance.

And even doctors confuse them. Studies have found that patients with BPD are likely to have been previously misdiagnosed as having bipolar disorder. But one of the key differences is that people with BPD suffer from what psychologists call identity disturbance.

Which basically means they don’t have a good sense of who they are. Most people can tell you some traits about themselves, important things in their life history that shaped their personality, and can share some thoughts about how they're seen socially. But people with BPD have a harder time piecing those kinds of things together into a coherent whole — and that can feel kind of disturbing.

People with bipolar disorder can get that too, but it’s less common and tends to be only at highs or lows, whereas nearly everyone with BPD reports it. It’s a big reason why one of the most common symptoms of BPD is suicidal thoughts. The emotional changes that come from BPD also look a bit different than bipolar disorder.

Both disorders tend to come with rapid shifts in mood — that’s where the idea of being “bipolar” comes from. But with BPD, a person’s mood shifts can be even quicker — so much so that artificial intelligence can use the speed of mood swings to tell the two disorders apart. Plus, the two look really different neurologically.

Like, people with BPD often have lower activity in regions of their frontal lobe, as well as lower gray matter volume and density there. That’s the opposite of people with bipolar disorder. All of this leads to very different methods of treatment.

There’s not a lot of good evidence for treating BPD with medication, for instance, but drugs like mood stabilizers are great for bipolar disorders. That actually leads really well into our final myth about

BPD: that it's permanent. In reality, most people's symptoms improve over time on their own. And that improvement can be accelerated with proper treatment. So getting a BPD diagnosis doesn't mean you're doomed to having an emotionally volatile life with unstable relationships.

This myth might have arisen from a misunderstanding of the disorder that happened early on. See, the whole idea of someone being “borderline” came from an old model of mental illness. It meant they were on the border between a neurosis, which was considered treatable thing, and a psychosis, which was not.

Nowadays, we know that classification system isn’t great, and that treatment can help. That can include drugs — sometime — like antidepressants for certain mood symptoms. But, as I mentioned earlier, the evidence for treating BPD with meds is somewhat mixed.

What does generally work well is a form of talk therapy that was designed for BPD called dialectic behavioral therapy. It’s goal is to teach specific skills that help the person manage their emotions when something distressing happens. Like, how to observe thoughts or emotions as they are without trying to change them.

Or, learning how to be assertive in relationships — like, telling people “no” or asking for help when you need it. One 2014 study found that after a year of treatment, 77% of those who completed this therapy no longer met diagnostic criteria for BPD. And a randomized control study in 2006 found that people with BPD who got dialectic behavioral therapy were half as likely to attempt suicide than those who received regular talk therapy.

So people with BPD who get the right treatment can have happy, healthy lives. Part of getting there is getting the right diagnosis, of course — which thankfully, is also improving, now that everyone has a better understanding of what separates BPD from bipolar disorders. And researchers are continuing to suss out exactly how BPD develops, and what roles genes and experiences play in that.

All of which means it’s time to stop seeing BPD as this life-dooming diagnosis. Thanks for watching this episode of SciShow Psych! And thanks to today’s sponsor, Babbel.

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