Reader’s Question

My psychologist agrees that I have a lot of the symptoms associated with borderline personality disorder, but I haven’t been in any romantic relationships because I know I’d be a horrible partner. Does not being in a relationship mean I can’t have BPD?

Psychologist’s Reply

Not having been in a romantic relationship doesn’t necessarily mean that you can’t have borderline personality disorder. BPD can seriously impact relationships, but there are many other important symptoms associated with this personality disorder. The symptoms can range from mild to severe, but typically there tends to be an unstable sense of self, risky or impulsive behaviors (often including things like spending, sex, suicide/self-injury or even substance abuse), significant mood swings, a chronic feeling of emptiness, frequent anger and outbursts and sometimes paranoia or feeling disconnected from the present moment. (To read more on BPD, see the NIMH overview.)

There are certain aspects of BPD that can really damage a relationship. Those with BPD often experience intense, frantic efforts to avoid real or imagined abandonment. People with the disorder are often very sensitive and devastated by the feelings that come with loss and abandonment, whether the situation is real or just feared. These emotions are typically difficult for them and often lead to negative behaviors. For example, they may become inappropriately or disproportionately upset when their partner is late for lunch or doesn’t return a text in a timely manner. The fear of abandonment or rejection can lead to manipulative attempts to prevent the other person from leaving through the use of shame, guilt and anger. Persistent manipulation can easily drive their partners away, the exact thing they were hoping to avoid. The fear of rejection and abandonment can also contribute to high levels of distrust that could prevent the person with BPD from even wanting a relationship for fear of encountering those feelings. I’ve heard some with BPD even say they would rather be alone then potentially face those issues in a relationship.

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Individuals with BPD are also prone to sudden or dramatic shifts in their views of others. These shifting views can often be very confusing for their partners, who wonder if they are loved or hated by them. Often they may idealize their caregivers or romantic partners and want to spend all of their time with them, quickly become attached, and share their deep personal secrets early in the relationship — only to suddenly shift and devalue the person. They may begin to feel the person does not care enough or put enough effort into the relationship and quickly become distrustful of them. Some studies have suggested that those with BPD have patterns of brain activity associated with disruptions in the ability to recognize social norms or modify impulsive behaviors and reactions.

Despite these issues, there is treatment available, including learning relationship skills that can help ensure a good, healthy relationship. There are proven and effective treatment strategies (like Dialectical Behavior Therapy, or DBT, and Interpersonal or Relational Therapies) that help those who struggle with the disorder. Even couples therapy can be used to help in addition to these. Many of those who suffer with BPD can experience repetitive disappointment and emotional pain from their relationships over time that lead them to strongly believe that love and commitment are out of reach. Try not to believe that. These valuable things are within reach for anyone, including those suffering with borderline personality disorder; it just takes commitment to treatment and partners who are willing to be patient.