BPD: When You Can’t See the Kindness in Others

With an estimated prevalence rate somewhere between 1.6 percent and 5.9 percent (APA, 2013), Borderline Personality Disorder (BPD) is the third most common personality disorder. The disorder is much more common in women than men, with 75 percent of cases being diagnosed in women. As in virtually all mental health disorders, the symptoms of BPD affect the life of the person diagnosed with the disorder as well as their friends, family members, and others whose lives intersect with their own. Individuals with BPD may have a pattern of substance abuse, erratic employment history that may reflect the inability to complete their education, legal issues, suicide attempts, and difficulty maintaining relationships. Friendships, family relationships, and romantic relationships are challenging.

Where Does BPD Begin?

The symptoms of BPD generally first appear in late adolescence/early adulthood. While the precise etiology is unknown, there appear to be genetic components as well as environmental components. Within the family environment, contributing factors include familial substance abuse, issues with maternal attachment, and family boundaries that were inappropriate (Chapman et al., 2023). External environmental factors include social deprivation and social fragmentation (O’Donoghue et al., 2023). Given the most prevalent symptoms of BPD, these specific conditions make practical sense as potential contributing factors.

Individuals with BPD typically have unstable interpersonal relationships due to their intense fears of abandonment. If they perceive a threat of abandonment or rejection, their behavior, thoughts, emotions, and self-image may veer off the rails and lead to seemingly inexplicable reactions. Individuals with BPD have difficulty regulating their emotions and can be “swallowed whole” by their emotional response to a neutral event. For instance, while anyone might be disappointed when a friend cancels plans at the last minute, a person with BPD bypasses “disappointment” and may go straight to “despair” or to “fury,” unable to accept that rejection is not the reason for the change in plans.

Individuals with BPD cannot easily distinguish between what they “think” someone meant by their actions or words and what the other person’s true motivations actually were. This kaleidoscope-like perspective leads them to swing between extremes in their evaluations of others and experience a “love’em until they hate’em” relationship with others. New friends, new romantic partners, and even new bosses may be idealized and put on pedestals by a person with BPD. However, when their “feet of clay” are revealed or they seem less invested in the relationship, the person with BPD can turn on a dime, and the once idealized person may be brutally pushed from the pedestal and become the target of attack.

The Paradox: Fear of Rejection Leads to Actions That Invite Rejection

Relationships are built on mutual emotional investment over time. Strong and healthy relationships tend to be resilient to temporary fluctuations in the availability of resources one person can give. For individuals with BPD, relationships can be mystifying. Often growing up without a healthy maternal bond, they are unable to manage the ebb and flow of adult relationships. Mothers teach their children that they can provide unconditional love even though there are times when they must discipline their children. Mothers also show that there are times when their children please them, as well as times when a child may disappoint them, but that their investment in the mother-child relationship is enduring.

Without experiencing the vast range of emotions that a healthy relationship can generate or sustain, individuals with BPD can respond to perceived threats of security in boundary-pushing and potentially hazardous ways. Individuals with BPD have an increased risk of violence, which may be attributed to their inability to effectively regulate their emotions coupled with their impulsivity (Wojciechowski, 2021). Learning how to self-regulate emotions and curb impulsivity is essential for maintaining healthy relationships. Learning to accept that no one is “all good” or “all bad” all the time is also key. Individuals with BPD will protect themselves by rejecting others before they are rejected themselves. While protecting oneself from emotional harm is normal behavior, individuals with BPD have a very hard time discriminating between threatening and non-threatening behaviors.

A Predilection for Negative Feelings?

Recent research shows that individuals with BPD don’t just latch on to others’ expressions of negative feelings or negative facial expressions. When confronted with a mildly negative verbal comment from someone, it is magnified exponentially in their mind; when they catch a mildly unpleasant expression on someone’s face, they interpret it as much more intense than it actually is (Daros et al., 2014). They also lack the ability to mirror another’s expressions, which can inhibit social connection with others. This may be a byproduct of the absence of parents/caregivers who engaged in mirroring behaviors with them as infants. Sadly, while one statistic noted that BPD symptoms recede over time, it was suggested that this may be due to an individual’s retreat from social interactions and relationships rather than being evidence of the remission of symptoms (Chapman et al., 2023).

Tips for Maintaining Healthy Relationships with Individuals with BPD:

1. Recognize that this disorder did not develop overnight and cannot magically “go away” just because you or your partner want that to happen.
2. Encourage treatment adherence; there are many therapies that show effectiveness with BPD, including cognitive behavioral therapy, dialectical behavior therapy, and schema-focused therapy.
3. Consider the messages you send via your facial expressions and your body language.
4. Monitor your reactions to their upset or attacks; maintain as calm a demeanor as possible to avoid antagonizing situations. Don't intentionally escalate disagreements.
5. Be supportive of your partner, but maintain a strong support system of your own.
6. Work together to develop healthy boundaries and ensure that you both are aware of and will honor one another's personal boundaries; this conversation can be an anchor later on if boundaries are being intentionally trampled.
7. Recognize that their behaviors may alienate friends and family members, so do the work you need to do to ensure that your relationships with supportive others are not also cut off.
8. If you have children together, prioritize a healthy parent-child bond by providing unconditional acceptance along with healthy boundaries; protect your child from extreme behaviors and model loving patience and healthy emotional range for your child.

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