Borderline Personality Disorder (BPD) is one of the most common yet misunderstood personality disorders. It is characterized by nine distinct traits or criteria, five of which must be present in an individual for a diagnosis. These include:
- Frantic efforts to avoid real or imagined abandonment;
- Unstable and intense interpersonal relationships;
- Lack of clear sense of identity;
- Impulsiveness in potentially self-damaging behaviours, such as substance abuse, sex, shoplifting, reckless driving, binge eating;
- Recurrent suicidal threats or gestures, or self-mutilating behaviours;
- Severe mood shifts and extreme reactivity to situational stressors;
- Chronic feelings of emptiness;
- Frequent and inappropriate displays of anger; and,
- Transient, stress-related feelings of unreality or paranoia.
The disorder is listed under Cluster B Personality Disorders by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is globally recognized as an authoritative guide for mental health disorders.
Feminist research on psychiatric disorders has highlighted the gendered nature of the diagnosis, particularly for BPD. The disorder is more frequently assigned to women so much so that BPD is often perceived as a “women’s illness”. The diagnosis for borderline personality works as a double-bind; it pathologizes “traits associated with both conventional femininity, such as emotionality, dependency, and self-destructiveness, and unconventional femininity, such as rebelliousness and sexual promiscuity.”
Popular media has played a significant role in projecting women with borderline traits as manipulative, controlling, or socially inept. Even within psychiatric settings, women with BPD are turned down as clients. The disorder is often dismissed as “a lost cause” and it is presumed that borderline individuals can only live a highly unstable life with minimal interest or intention in social adaptation and integration. This completely undermines the fact that when their symptoms can be managed. Women with borderline traits can lead a perfectly “functional” life with academic and professional achievement, stable relationships, and a healthy sense of self.
The stigma around borderline personality disorder sidelines the condition itself and how it may have developed in an individual. Feminist research on psychiatric disorders such as Borderline Personality Disorder, Discrimination, and Survivors of Chronic Childhood Trauma(Andrea Nicki) has found that“… [a] majority of people diagnosed with BPD are female survivors of chronic childhood trauma.” Childhood trauma including loss of one or both parents, parental neglect, rejection, and abandonment, boundary violations, and abuse have a correlation with a BPD diagnosis, in addition to long-term consequences. These may range from eating disorders, depression, anxiety, mood disorders, and attachment problems to suicidal behaviour, post-traumatic stress disorder, substance abuse, alcoholism, and violence.
A growing body of research also confirms that people suffering from borderline pathology may have experienced prolonged illness, witnessed or experienced physical and sexual abuse, or have had to face trauma repeatedly at an early age. Seen from this perspective, borderline traits appear to be strategies developed for coping and surviving against these experiences, most of which affect women disproportionately.
Social and cultural determinants have a powerful influence on the development of a borderline personality. Gender-specific risk factors such as economic inequality, violence, the burden of care work, and a subordinate social status have a disproportionate impact on women’s mental health.
It is essential to view the lived experiences of women with BPD against their social realities so that their difficulties are not over-pathologized and their choices and behaviour understood in relation to their experiences and social realities. Persistent stressful and triggering life situations such as unemployment, relational conflict, academic and professional difficulties, conflicts and crises, prolonged illness, and physical, emotional, and sexual abuse can act as triggers. When compounded by insufficient support and redressal, these triggers provide the context in which borderline traits operate and therefore, cannot be dismissed.
However, studies on BPD have been limited to exploring and highlighting borderline pathology. Most research narrates the borderline individual’s diagnosis from an observer’s point of view; mostly a psychiatrist or a researcher working with the individual. Often conducted in clinical settings, these studies narrate the experiences of borderline individuals up until the point they are diagnosed and/or are admitted to psychiatric settings such as after a life-threatening incident. The power dynamics in research and therapy rob us of the opportunity to learn about women’s stories and lived experiences, as narrated by them, about their motivations for healing, self-awareness concerning the borderline traits, and about the arduous but worthy attempt to find the right coping skills.
Therefore, women’s narratives are essential for building understanding and eliminating stigma around BPD. That borderline personality disorder generates a response akin to contempt and dislike among mental health professionals indicates the necessity for a “democratic and inclusive” approach and with a “greater inclusion of the perspectives of those who have experienced psychiatric services.”
A gender-sensitive perspective encourages an empathetic research that takes into account social and cultural factors, childhood trauma, and women’s lived experiences. It make it possible for us to understand that women are individuals with agency and are trying their best to manage their BPD traits with skills and strategies learned from therapy and other sources, to live a healthy and fulfilling life.
To add value to therapy it's crucial to understand how women regulate their borderline traits in different settings and during important phases in their lives. This can go a long way in helping healthcare providers identify and treat mental health conditions in women and promote fairer health policies addressing women’s needs.
Making women’s own stories central to the narrative allows us to re-conceptualize and de-stigmatize personality disorders. Debbie Corso, author of Stronger Than BPD: The Girl’s Guide to Taking Control of Intense Emotions, Drama, and Chaos Using DBT (2017), writes, “I’ve learned to embrace the difficult parts of my personality and appreciate the benefits of having gone from a person who was completely out of control and at the mercy of her emotions to someone who remains emotionally sensitive, who still experiences her feelings intensely but who now has tools to skilfully handle them so that she no longer needs to be marked as fragile—by myself, professionals, peers, and loved ones.” Corso’s appeal is a simple one— we ought to see that women with BPD, like each of us, are also trying their best to live a happy and wholesome life.