Can’t Get Better? Maybe It’s the Wrong Diagnosis and Wrong Treatment

I’m not a big believer in labels. I think that people live up to their labels. Most labels we give each other and ourselves aren’t very empowering, so I don’t like putting people in negative boxes. But even a stopped watch is right twice a day, and sometimes having a label is a good thing. Like when you’re diagnosing a mental illness. The wrong diagnosis leads to the wrong treatment.

One of the most misdiagnosed mental illnesses is borderline personality disorder (BPD). People with BPD tend to be viewed as difficult. So, when I was an intern, I got a lot of the BPD clients because many people don’t want to work with them. Fortunately for me, I like difficult people! Give me a challenge!

Because I’ve worked with BPD a long time, I didn’t realize that other professionals had a hard time diagnosing them until my clients told me! Incredibly, it could take YEARS before they got the right diagnosis. Wrong diagnosis = wrong treatment. This means years of needless struggling. So, let me give you a sketch of what BPD looks like so that you can help yourself or someone else get on the right track.

What is Borderline Personality Disorder?

Borderline personality disorder is a condition where the sufferer experiences intense mood swings and has trouble maintaining emotional stability. This can result in unstable relationships, loneliness, feelings of depression and anxiety, isolation, impulsivity, and addiction. People with BPD often engage in self harm and suicidal gestures. The risk of completing a suicide is 8 to 10% higher than in the general population, so you can see, this is a serious disorder. BPD is the only disorder whose diagnostic symptoms includes suicidality.

What Causes Borderline Personality Disorder?

No one really knows what causes it. As with most conditions, there is probably a genetic link. There is certainly an environmental one. Most people suffering from BPD come from what we call an “invalidating environment.” This generally means that they grew up in a situation of physical or sexual abuse or neglect. It doesn’t have to have been extreme or violent. It could have been due to a parent who had an erratic work schedule so the child never knew when he or she would be gone. Maybe a parent went to prison, there was a sudden divorce, an adoption, or a parent caring for a sick relative so the child didn’t get appropriate attention.

As a result, the child grows up with fear of abandonment. The child is always on high alert for danger, so she’s super sensitive and is more likely to see innocent things as threats. This is a defense mechanism designed to keep her safe, but as you might imagine, it’s pretty exhausting both for the sufferer and those around her. People often say that being around someone with BPD is like walking on eggshells. You never know if you’re going to get the sweet sunny person or the volatile one.

Another feature of BPD is that they can be really black and white. They love you or hate you. They idolize you or think you’re the devil. This can go back and forth really quickly. It’s an “I hate you, don’t leave me” kind of thing because of a fear of abandonment and need for safety.

How Common Is It?

About 6% of the American population has BPD. This is twice as many as people with bipolar and schizophrenia combined.

What Is the Prognosis?

There is good news and bad news. The good news is that some people age out. By the time they reach their 40s or older, they just learn how to deal with the world in ways that makes the mood swings fewer and further between. When stressful situations arise, the old ways of coping can come back. So, unlike some disorders where, once you have them you have them, this may not be forever.

The bad news is that many people kill themselves, so they don’t get a chance to age out. Many people are misdiagnosed, so they don’t get the treatment that they need.

What is the Cure?

BPD has a thinking, behavioral, and biological component. Dialectical Behavioral Therapy (DBT) was designed specifically to treat BPD by a psychologist who had it. It’s incredibly effective at giving people different ways of thinking about things. If you don’t automatically take offense or see a threat in everything that comes your way, you have a lot more flexibility in how to handle things. It also gives people behavioral suggestions for how to deal with overwhelming emotions, distress, and interpersonal interactions.

This can prevent crises as well as de-escalate them. With practice, the person can be more adaptive throughout all aspects of life.

Some find this tremendously helpful, while others find it a white knuckling way to deal with things. My perception is that this is probably because something is left out – the brain.

When any mammal experiences overwhelming stress, the brain releases chemicals to help deal with the threat. The blood moves away from the inner organs to the extremities to prepare the animal to fight, flee, or freeze. When the threat is over, the animal goes into a shut down mode and the body shakes to tell the brain to stop producing these chemicals. The brain does a reset. The blood flow returns. Digestion and heart rate normalizes, and all is well.

Except that not all mammals do this. Animals in captivity (zoos, laboratories, farm animals) and humans don’t do this. Fortunately this can be relearned.

If BPD treatment does not include a treatment to help the brain release the trauma, it may not be successful. BPD is so closely related to trauma that when the treatment manual used by all professionals and insurance companies was revised, they considered making BPD the same diagnosis as post traumatic stress disorder.

I find people with BPD delightful. They are incredibly observant and usually really intelligent. Because of this, they can be really easy to work with if you approach them with sincerity, respect, and kindness. They are used to be seen as prickly, so they tend to come well armed. Disarm them by seeing the tender, sweet inside. You can also learn DBT too so that you have less chance of triggering them. If they are triggered less and you are triggered less, everybody’s happy.

One other thing I’d like to say about this is that there is this movement out there to normalize the level of sensitivity by labeling it as something spiritual. Sensitivity plus reactivity is not spiritual. It’s a sign of dis-ease. Please do not accept and live with this because you think it makes you special. You can be spiritual without suffering. You can also be sensitive without being reactive.

A wrong diagnosis is so not helpful in this case. A person with BPD is not going to get better by taking a drug. That won’t make him feel safe or reset his brain. A healthier diet will improve the baseline, but that won’t take care of the core issue either. Detox, prayer, exercise, and so many thing could help, but it doesn’t deal with the underlying issue. You can’t get there with the wrong diagnosis.

If you’d like help with this, please contact me. I have an online DBT group and expertise in this area. I think people with BPD are wonderful and would love to work with you or your loved one.

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