A personality disorder is described as a long-standing pattern of perceiving experiences and depicting behaviors that are essentially unhealthy and different from others. There are 10 different types of personality disorders. Individuals with Borderline Personality Disorder display a pervasive pattern of instability beginning by early adulthood and present in a variety of contexts. Some of the symptoms given by The American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) are:
  1. Fear of abandonment
  2. Unstable interpersonal relationships
  3. Unstable self-image
  4. Impulsive behaviors
  5. Self-harm and/or suicidal behaviors
  6. Unstable mood
  7. Chronic feelings of Emptiness
  8. Intense anger
  9. Paranoia or dissociative feelings
Like all other disorders, borderline personality also ranges in terms of its severity and experience. Sometimes, less severe symptoms may resolve spontaneously with age and maturity. After all, personality disorders initially manifest in teenage and young adulthood.  In my clinic, I have seen individuals with BPD being extremely sensitive to rejection or even the slightest possibility of it. This tendency of rejection sensitivity is of high importance for understanding and treating the disorder. Patients and their loved ones mainly notice the emotional instability and mood reactivity the most. This emotional instability becomes glaring and difficult to handle and predict. Individuals are also seen to be sensitive about their feelings of emptiness, which their loved ones are often unable to understand. This leads to them feeling more lonely, which increases their stress experience and leads to intense emotions like anger, which in turn affects their interpersonal relationships with family, friends, and romantic partners. These emotions also lead them to act in impulsive manners which may even lead to self-harm. Basically, they report feeling like they are in a constant state of internal conflict and confusion, and they do not know how to resolve them. This state of turmoil is likely to leave individuals feeling tired and even depressed.  However, most of these problems can be managed if we focus on rejection sensitivity. Those with BPD are extremely sensitive to rejection, even if it is not real. This is largely impacted by their lower than usual sense of self-esteem. They are likely to say things like “nobody loves me/cares for me”, “ I am all alone in everything I do” etc. In most normal situations, people with BPD may suspect, expect and even perceive rejection when it does not exist. Sometimes, this sense of rejection may border on paranoia and delusions. In the case of real rejection, their fears are often intensified. It is important for all of us to understand the impact of this rejection sensitivity so that we are able to identify this as a real problem that needs to be dealt with.  Individual and Group Psychotherapy can help them restore faith in their own skills. It can also help them learn that they, like others, are not perfect and are likely to experience disappointments like the rest of us. Practical social skills, like asking for clarification when rejection is perceived, can help. It has been seen that cognitive and behavioral therapies, like Dialectical Behavioral Therapy, are found to be very useful in helping the patients make sense of and manage their thoughts, emotions and interpersonal relationships. Also, practical skills like ways to achieve impulse control, emotional stability, learning to have trust in close friends and family, and engaging in meaningful work and leisure activities go a long way in treatment. Mindfulness is also an important skill that has been seen to help individuals achieve the aforementioned goals.  With appropriate personal and professional support, individuals with Borderline Personality Disorder can learn to be healthy with regards to their thoughts, emotions, behaviors and social life as well as maintain a healthy and consistent sense of self.