While the treatment of Rebecca’s character and her diagnosis was ultimately relatively well-handled (MIC even asked for my feedback on this), I was initially worried as the plot unfolded that the show, far from treating Rebecca and her character’s diagnosis with empathy and grounded clinical information, would only reify and sensationalize the largely negative stereotypes surrounding BPD.
I was worried about this because, BPD, while an actual clinical diagnosis, has become somewhat of a pop psychology pejorative term in recent years. “Oh! She’s so borderline you wouldn’t believe it!” “That’s so borderline!”
It’s become a term that’s used to describe generally bad or erratic behavior. That, in reality, may or may not bear a resemblance to BPD at all.
It’s become a term that both laypeople and even clinicians have strong, and sometimes negative reactions to. Making those with BPD who seek treatment or disclose their diagnosis often highly susceptible to criticism and prejudice.
And, frankly, I have such a hard time with this.
I think BPD and those that struggle with it have a poor reputation. That doesn’t help either them or the clinical community attempting to help them.
BPD has become a term that’s often misunderstood and misaligned, and so my hope in today’s post is to provide a little psychoeducation about what BPD actually is and offer a reframe about how we can think of this diagnosis as a wider community, both clinical and lay alike, to cultivate more empathy, compassion, and, ultimately, support around this.
What exactly *is* Borderline Personality Disorder?
Borderline Personality Disorder (BPD) is a mental health condition defined by the Diagnostic and Statistical Manual of Mental Disorders (the bedrock clinical manual of the mental health field). If you’re interested in reading the full criterion of the disorder, you can do so here.
But, essentially, BPD is a mental health condition characterized by emotional lability. (an inability to regulate one’s emotions.) An unstable sense of self, challenges forming and sustaining relationships, and a tendency towards erratic, often self-harming, behaviors and impulses.
BPD is quite common. It’s estimated that 1.6% of the adult U.S. population has BPD. But that number may be as high as 5.9% and of those diagnosed, nearly 75% are women.
So, if the diagnosis is so common and so impactful, we have to ask the question. In what context would it come to pass that someone would develop BPD?
In my opinion, this can be answered in three words: complex relational trauma.
A compassionate reframe.
Borderline Personality Disorder is, in my clinical opinion, a trauma disorder. More specifically, a relational trauma disorder.
What do I mean by this?
Overwhelmingly, BPD patients have a history of childhood trauma.
And, even though trauma is not used as one of the diagnostic criteria of BPD, I personally think we have to bear in mind the impact that complex relational traumatic experiences can have on a child.
Complex relational trauma is a series of experiences that takes place over time in the context of caretaking or authority relationships.
The experiences of trauma can be anything that undermines the integrity, well-being and personhood of the individual who experiences it and what makes it traumatic is that it subjectively overwhelms the person’s ability to stay present and to cope.
As I’ve written about before, the impacts of complex relational trauma can be vast and impactful on the individual who experiences it.
This doesn’t necessarily mean that an individual who experiences complex relational trauma in childhood will develop BPD. But it does mean that when someone is diagnosed with BPD, we can and should be curious about their childhood history of traumatic experiences and how this has shaped their responses to the world.
What do I mean by this?
Well, let’s imagine a little girl was frequently locked into her closet. For hours at a time. By her mother, whenever the mom got angry or overwhelmed.
