Thus far on this blog, I have described my recovery from borderline symptoms and outlined a psychodynamic understanding of Borderline Personality Disorder.
Today I would like to take on some of the highly prevalent myths about BPD. These ideas circulate across the internet on forums, blogs, and webpages about BPD. To me, they are unreasonably pessimistic, scientifically baseless, and unhelpful.
Here are five myths that people newly diagnosed with BPD are often told:
Myth #1: Borderlines cannot become lastingly free from borderline symptoms (i.e. BPD can only be ameliorated, not removed).
Myth #2: Effective treatments that “cure” BPD have not yet been developed.
Myth #3: BPD is caused by genes and biology.
Myth #4: Medication and therapy are equally effective treatments for BPD.
Myth #5: BPD is a valid diagnosis and a real medical condition.
If you are upset by any of these ideas, you don’t have to continue reading – after all, I can’t force people to give up their view of BPD as incurable, genetically-based, and a valid scientific diagnosis. But if you are open to the possibility that rejecting these notions can be encouraging and useful, read on.
- Myth #1: Borderlines cannot become lastingly free from borderline symptoms (i.e. BPD can only be ameliorated, not removed).
On some BPD blogs, one reads that BPD is a “life sentence”, that “there is no cure for BPD”, that “BPD symptoms can only be managed”, and so on. My reaction to these statements is pity. It is tragic that people who are already facing severe life challenges have their problems compounded by such unwarranted pessimism. It creates a vicious cycle, where people who are already struggling with real emotional problems are further discouraged by hearing – falsely – that they are unlikely to recover. This then exacerbates their real problems, leading to further discouragement, and so on.
Can I prove on this blog that BPD can be fully recovered from, as one can prove that water boils at 212 Farenheit? No. But what I do have is my own experience, plus a large amount of research on BPD gleaned from former BPD sufferers and therapists.
For the six year period from about 2003-2008, I suffered with all of the nine borderline symptoms in the DSM. It was absolutely hellish – most days were a psychological war, filled with constant anxiety, bleak depression, hopelessness about the future, suicidal thinking, feeling horribly alone, being unable to relate positively to anybody, and so on. Because I’ve been there, I understand where other blogs about BPD being so difficult are coming from. I describe my difficult experience more in post #3, “The Tragic Borderline Experience.”
But as of 2014, I have been developing increasingly good relationships and functioning better and better for the last 5-6 years. I don’t have any of my former borderline symptoms, nor do I fear they will recur. Most of the time, I’ve felt vigorous, alive, capable, motivated, and real. A small minority of the time, I feel worried and down, but not more than most people and not without real cause. In light of my past history, I feel that I have triumphed. I describe how this progress occurred in post #2, “How Did I Recover from BPD?”
This personal experience convinces me that BPD can be recovered from in a deep, lasting way. We only truly know what we directly experience, and that is my “proof”. My experience indicates that BPD can not only be ameliorated and managed – it can be fully dissolved, removed, and triumphed over.
Perhaps somebody reading this is saying, “Edward, how do we know you’re telling the truth? This whole blog could be a fantasy.” While that is untrue, let’s indulge that fantasy for a moment. 🙂 Taking my experience out of the equation, what other evidence says that borderlines have recovered to live good lives as non-borderlines?
Firstly, there are many other blogs reporting full recovery or great improvement from BPD symptoms. For example, Scottish Clare’s blog (http://www.tacklingbpd.com), Debbie Corso’s blog (http://www.my-borderline-personality-disorder.com), A.J. Mahari’s blog (http://www.borderlinepersonality.ca), Rachel Reiland’s book and website (http://www.getmeoutofherebook.com), are examples of former borderlines who write about their recovery.
Secondly, there are dozens of books with hundreds of case studies of borderlines who recovered. For example:
James Masterson – Psychotherapy of the Borderline Adult
Jeffrey Seinfeld – The Bad Object
Helen Albanese – The Difficult Borderline Patient: Not So Difficult To Treat
Peter Giovacchini – Borderline Patients, the Psychosomatic Focus and the Therapeutic Process
Bryce Boyer – Psychoanalytic Treatment of Schizophrenic and Characterological Disorders
Vamik Volkan – Six Steps in the Treatment of Borderline Personality Organization
William Meissner – Treatment of Patients in the Borderline Spectrum
Gerald Adler – Borderline Psychopathology and Its Treatment
Donald Roberts – Another Chance to Be Real: The Treatment of Borderline Personality Disorder
Harold Searles – My Work with Borderline Patients
These are some of the psychodynamic books that are my area of interest (if one added in CBT and DBT, you could come up with a much bigger list of books that are optimistic about BPD). These ten books alone contain about 40-50 case studies of borderline patients who recovered fully and/or made great improvements to become diagnostically non-borderline. I don’t recommend reading these books, because it is more useful to connect with real people. However, they show that many therapists have worked successfully long-term to cure patients with Borderline Personality Disorder. I doubt that all of these authors are colluding to lie about borderlines getting better 🙂
So, an increasing number of direct-experience accounts and professional-therapist accounts of BPD recovery are now available to provide hope. The question should no longer be whether borderlines can become non-borderline, but how better to provide them the resources to enable deep and lasting recovery.
- Myth #2 : Effective Treatments that “Cure” BPD Have Not Yet Been Developed
As a medical word, “cure” is probably not the right word for an emotional condition like BPD. Perhaps one would do better to say “deep recovery”, “living the life you want”, “finding fulfillment and meaning”, “being free from constant emotional suffering”, etc. Whatever terms are used, there are treatments and support systems that make these things a real possibility for sufferers of BPD.
Since it is very similar to the first myth, I will not write about this idea at length. However, there are several effective treatments that can lead a person to no longer meet the criteria for BPD. My favorite approach is psychodynamic-psychoanalytic psychotherapy, of which all the books listed above under Myth #1 are examples. Reading the case studies in these books leaves little doubt that borderlines can become free from their symptoms. That’s not to say it’s easy or immediate; it takes years of work. But it’s possible for anyone.
Other effective approaches include DBT (Marsha Linehan’s approach), Mentalization Based Therapy (Peter Fonagy), and Transference Focused Psychotherapy (Otto Kernberg). I am not as familiar with these approaches, so cannot comment at length. However, many people with borderline issues have reported that they are very helpful, as can be seen at forums like http://www.PsychCentral.com . Debbie Corso’s blog gives a lot of information about DBT and how she used it to recover. I recommend the reader to check out her story, linked above.
Interestingly, empirical longitudinal studies show that many patients diagnosed with “BPD” recover to become diagnostically non-borderline. Here is an example – http://www.borderlinepersonalitydisorder.com/wp-content/uploads/2012/07/Zanarini10-yearCourseofBPD-10-23-12.pdf
Although some aspects of this report are suspect (since it is based on the medical-model version of BPD, and implies that it is partly a biologically-caused disorder, which I disagree with), it is encouraging in that it reports statistics such as:
– Over a 10-year period, over 90% of patients eventually experience a remission of BPD as defined by not meeting enough of the DSM criteria for the disorder.
– 78% of (formerly) borderline patients attain broadly-defined good psychosocial functioning over a 10-year period (defined as at least one meaningfully close relationship with a partner or friend, and good work/vocational functioning).
These numbers are based on about 300 borderline patients who were followed for 10 years after initial intake into a hospital in the Northeastern US. It’s not possible to generalize to any one person based on group statistics, but they show that improvement and remission from BPD is very possible. Many people diagnosed with BPD are still being indoctrinated with the idea that it is an incurable, life-long illness. It’s time to begin changing that attitude.
- Myth #3: “BPD Is Primarily Caused by Genes and Biology”
This is a statement that I read now and start laughing. Often promoted by drug companies, hospitals and universities (funded by Big Pharma), or establishments psychiatrists, websites touting this viewpoint say, “We now know that BPD is caused by both genetic and environmental factors!” or, “A person with BPD has a broken brain!” or, “BPD has now been found to be 68.72% hereditary!”
To go back to one of my earlier articles, I’d ask the reader to consider the following:
BPD is based on 9 subjectively assessed symptoms. Jack could have symptoms 1 through 5 only. Jane could have symptoms 5 through 9 only. Both would be “borderline”, even though they shared only one symptom in common and have four unique symptoms each. For example, they could both have self-injurious acting out (e.g. being promiscuous or abusing a substance), but be completely different in their other symptoms.
The extreme biological determinists would say that Jack and Jane have the same “disease,” and that is it is genetic and biological, caused by misfiring neurons. This makes no sense. Patterns of complex human emotional problems that (in some cases) barely overlap cannot be reduced to a biologically-caused disease.
In my view, the motivation behind labelling BPD as a biologically-caused disorder is profit. Pharmaceutical companies want to sell more drugs, and to do so, they need to promote the myth that emotional problems originate in brain biochemistry. This is discussed further here:
As for BPD being hereditary, that is equally ridiculous. Firstly, the notion that a genetic percentage-contributor for the condition can be quantified is simply not true, given the complex way in which genes and environment interact. I recommend the reader to Evelyn Fox Keller’s outstanding book, “The Mirage of a Space Between Nature and Nurture”, for an explanation of this concept.
While constitutional vulnerability to stress may be a factor in who develops so-called “borderline” symptoms, that does not mean BPD runs in families due to genetic factors (although, it may certainly run in families due to generationally-transmitted abuse and neglect). In an earlier article, the way in which gene studies misrepresent BPD and other mental health conditions as biological diseases was discussed:
These two linked articles extensively undermine the genetic and biological arguments. I will leave it to the reader to peruse them further if desired.
- Myth #4: Medication and therapy are equally effective treatments for BPD.
One of the best current forums attacking the myth that medications really “work” to treat most mental illnesses long-term is Mad In America (http://www.madinamerica.com/).
I recommend the reader to peruse some of its intriguing articles on medication, such as:
Given that medications only treat the anxiety and depression associated with BPD, rather than BPD itself, my position is that medications can at best be palliative. Palliative means they reduce symptoms to a limited degree, without treating the root cause of someone’s problems. At worst, medications can cause horrible side effects, waste money, and promote the fantasy that pills will solve long-standing personality problems.
I have never heard of a borderline who was cured by medication alone. But as discussed above, there is convincing evidence, both from first-person accounts of recovered borderlines, and from third-person accounts of therapists working with borderlines, that full lasting recovery from BPD can be achieved via psychotherapy, self-help, and human support in general. Therefore, psychotherapy and human support are the treatments of choice for BPD.
It should be noted that medications are not all bad. In my early years of coping with extreme rage and hopelessness, I used psychiatric medication for a limited time. It stopped me from being overwhelmed by anxiety. However, after entering therapy and stabilizing, I gradually titrated off the medication. In the big picture, medication was a very limited tool.
- Myth #5: BPD is a valid diagnosis and a real medical condition.
It is time to reveal my true colors. I do not believe that BPD is a real disorder, although I believe all its symptoms are real and painful. Let me explain.
Saying that BPD exists is like saying that a certain group of stars in the sky are the “Big Dipper” constellation. There is nothing in nature that makes a constellation exist, only humans’ illusory projection of order into the stars’ positioning. In other words, a constellation itself is not a real external entity – it’s just an idea in people’s minds projected onto that external entity. It is a reification or simulacrum.
Likewise, BPD is an artificial construct. Like a constellation based on stars, BPD is based upon an artificial grouping of human behaviors, although there is nothing innately in those behaviors that makes it valid. Unlike constellations, BPD is even less reliable, because at least constellations are based on artificial groupings of clear physical entities. BPD, on the other hand, is based on subjectively assessed psychological-emotional symptoms which must reach a certain threshold intensity for inclusion. Why those nine symptoms were chosen for BPD (and not dozens of other possible symptoms), why it should be nine symptoms and not more or less, and when exactly each symptom is intense or different enough from “normality” for inclusion, are all mysterious, hard-to-answer questions.
More insidiously, these questions lay bare the fact that BPD is a nonscientific figment of psychiatrists’ imagination. I have no hesitation in saying this, despite having had all nine “borderline” symptoms myself. BPD as a medical condition is a fraud. It is richly ironic that the term “borderline” appears so often on this site, when I do not even believe in its validity.
However, as I noted in article #8 on the BPD diagnosis, BPD does have its uses. It does have some generally understood, if imprecise, connotations. One must admit that BPD means something to some people, although exactly what is not always clear. Because people insist on speaking about BPD as a valid medical diagnosis, I have found a way to think about it usefully. I usually translate “borderline” to mean that a person is struggling with some uncertain degree of severe emotional problems, often based on early neglect and/or abuse, and usually involving splitting in which negative perceptions of self and other are stronger than the positive self-and-other units. For me, this is more meaningful than the trite and superficial DSM diagnosis. This self-and-object theory is described here:
When I read on a blog that someone “has” BPD; my first thought is that this doesn’t tell me much about them. I am more interested in hearing about their personal history, what they are anxious about, their hopes for the future, what resources they are using to improve, etc. Those things are real. The main positive aspect of the BPD label is that it allows people to find effective help for the range of problems that are imperfectly described by that label.
I would like to share here the viewpoint of the British Psychological Society (Great Britain’s counterpart to the American Psychological Association) on the validity of personality disorders and other mental health diagnostic categories:
“One way of examining the validity of mental health diagnostic categories involves using statistical techniques to investigate whether people’s experiences actually do cluster together in the way predicted by the diagnostic approach. The results of this research have not generally supported the validity of distinct diagnostic categories. For example, the correlation amongst symptoms for specific mental disorders has been found to be no greater than if the symptoms had been put together randomly. Similarly, cluster analysis – a statistical technique for assigning people to groups according to particular characteristics – has shown that the majority of psychiatric patients would not be assigned to any recognizable group. Statistical techniques have also highlighted the extensive overlap between those diagnosed with one disorder and those diagnosed with another.”
(from the newsletter of the British Psychological Society (BPS), 2000, pg. 17. I have altered a few words to make the meaning clearer as applied to personality disorders, rather than psychoses, which the original paragraph also discussed. However, the essential meaning of the passage is unchanged.)
The BPS viewpoint implies that there are no clear boundaries between, and thus little validity or reliability within, each of the mental disorders of the DSM, including Borderline Personality Disorder.
Interestingly, if ones accepts that Myth #5 is indeed a myth (in other words, that BPD is not a valid medical condition), then it becomes necessary to reevaluate myths # 1 through 4. Here they are again:
Myth #1: Borderlines cannot become lastingly free from borderline symptoms.
Myth #2: Effective treatments that “cure” BPD have not yet been developed.
Myth #3: BPD is primarily caused by genes and biology.
Myth #4: Medication and therapy are equally effective treatments for BPD.
If the placeholder “BPD” is actually an unreliable, fictional diagnosis, then many of these ideas cease to have meaning. One cannot become free from a condition that is not diagnostically valid; one cannot be cured of something that cannot be reliably identified, genes cannot cause a fictitious disorder, and medication and therapy cannot be compared for the treatment of a speculative phenomenon.
This is how I now think about BPD. Such an approach might seem invalidating. However, I empathize with people’s experience of being borderline as an identity, as I thought of myself that way for many years. What I am saying doesn’t mean that people’s suffering or experience is not real, only that the medicalization of emotional suffering, crystallized in BPD as a diagnosis, is suspect.
Paradoxically, I find rejecting the notion of BPD as a valid diagnosis to be encouraging and human. All nine symptoms listed under the BPD diagnosis are real and occur to different degrees in different people. But, I don’t believe someone suddenly “has” BPD when they have five out of nine of them.
Rather, I try to see human problems, including the nine so-called BPD symptoms, as existing on a complex continuum. On this spectrum, everyone’s problems are unique and cannot be compartmentalized into “diagnoses”. Such an approach is more human and respectful of individual differences. It’s not easy to think that way, since we are accustomed to think in categories and divisions. But I never liked how psychiatry labels many severely troubled people as “borderlines” when really, everyone’s problems are their own.
Some of these ideas might be controversial, especially this last myth. I don’t expect everyone to agree. If you have your own opinion, feel free to share it in the comments below. There’s a need for increasing dialogue, both about what can help people who are diagnosed with BPD improve, and also about the worth of the BPD diagnosis. Although it may be controversial, such dialogue may be interesting and useful, and can only have a positive effect for those diagnosed with BPD in the long-term.
I welcome any correspondance at firstname.lastname@example.org
If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.
This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.
– Edward Dantes