Advice to a Young Psychiatrist About BPD

Recently, I was in the psychiatric ward of a local hospital. While I was there, a young psychiatrist interviewed me. He asked me "What advice do you have for me regarding treating borderline personality disorder (BPD)?"

I was caught off-guard because nobody ever asked me that. Yet he genuinely wanted my opinion, so I shared it. Then I figured that other psychiatrists might want to know, so here's the advice I have.

Be Patient

I'll be the first to admit I've frustrated a lot of mental health professionals. One told my mother--with me present--"She'll drift in and out of hospitals her whole life until they're tired of treating her." Another told my mother I had a "victim mentality"--right after I'd been raped. And more than a few nurses have wondered if I'm making up my symptoms to get attention.

The answer to that accusation is an emphatic no.

People with BPD are, above all else, survivors. Many of us have been through unspeakable trauma. Once you know and understand that, you can understand why we do what we do. It is all for survival. We are simply trying to ease our pain.

Cutting and other forms of self-injury are an attempt to deal with the pain of our trauma or the pain of dissociation. Substance abuse is an attempt to ease the pain. Clingy behavior is an attempt to avoid pain of rejection or abandonment. When it comes down to the heart of it, our conduct is an attempt to deal with our pain.

We have been in pain for so long we often forget what it feels like to not be in pain. So be patient. We've suffered a lot and it won't clear up overnight.

Understand Our Point of View

Once you understand that everything we do is an attempt to cope with pain, you can understand why we do what we do. And once you understand why we do what we do, you can attempt to understand our point of view.

Cutting your arm because you failed a math test may not seem reasonable to you. But to a person with BPD, it can be reason enough. You have to understand that the person feels like a failure in all aspects of life, not just math. You have to understand the person has assumed the worst-case scenario and is terrified of it. Once you understand this, you can help the person understand that he or she is not a failure condemned to a lifetime of failure.

You have to be the Healthy Adult so you can help us be healthy adults. You have to understand our modes of operation, whether Angry and Abandoned Child, Vulnerable Child, or Punitive Parent, and respond accordingly. You have to help us comfort and confront each of these modes by understanding where we're coming from.

Research Post-traumatic Stress Disorder

According to one psychiatric theory, BPD is a subtype of post-traumatic stress disorder, or PTSD. Even if it isn't, there's a high rate of co-morbidity between the two, and many people with BPD have experienced some type of severe trauma. So it is perfectly logical to research how to treat trauma.

Understanding trauma survivors is vital to treating people with BPD. Trauma survivors, like people with BPD, have a lot of pain and will do whatever it takes to survive. If you understand that, you can help us learn healthy behaviors instead of a "law of the jungle" mentality. You can understand where to start from and work from there.

Understanding is key to treating people with BPD. But to do that, you have to be patient and try to see things from our point of view.

Readers, what advice do you have to offer?