Borderline personality disorder is really a pattern of trauma responses.
Ihave studied Borderline Personality Disorder (BPD) for years. Two things that have always affected me are how subpar many treatments are for BPD and how backwards diagnostics are regarding this very confusing — and stigmatized — disorder.
BPD affects a person globally in many more ways than “just” their personality. If we’re looking at the old Global Assessment of Functioning (GAF scale, now changed to the WHODAS) to assess a person’s level of functioning, those with BPD typically have a significantly reduced score. On a scale of 0–100, with 100 being a perfect functioning level, the “average” person is roughly between 100–81 on any given day.
Scores this high suggest that any deficit in their functioning is often environmental and situational, such as heightened anxiety before an exam that returns to baseline functioning when the exam is over. On the flip-side, if we’re to assess someone with BPD based on the older GAF scores, their average functioning level typically vacillates between 60–20, depending on whether their life is “good” or whether they’re experiencing more severe symptoms of BPD, including suicidal ideation.
Symptoms of BPD can annihilate a person’s ability to function. Some can’t hold down a job. Some find themselves in a revolving door of toxic relationships with predatory types because they learned that having their boundaries and needs violated is “comfortable” from an equally toxic childhood. Some can’t tolerate stress and self-medicate to the point of developing drug or alcohol addictions. Many were never taught how to “adult” — meaning they don’t know how to take care of themselves financially, emotionally, safety-wise, relationally, socially, or physically and wind up in a cycle of learned helplessness.
Others develop obsessions with their bodies and may begin starving themselves, going on dangerous “high protein” or “low carb” crash diets, restrictive calorie counting, or developing dangerous and compulsive exercise routines or “health” kicks. Others obsess about their looks to the point that they can’t be seen in public without a full face of makeup, while others are so emotionally dysregulated they live in toxic positivity because they’ve become scared of their emotions and afraid of what is under the mask of “happy”.
Many with BPD have a limited sense of self-identity and don’t know who they are outside of a relationship or in mirroring those in their lives. They may change how they look, how they dress, the sports they’re into, the hobbies they engage in, or the values they hold based on the people they idealize.