Why Is It Called Borderline Personality Disorder?

The term Borderline Personality Disorder(BPD) was named “borderline schizophrenia” by Adolph stern in 1938. “Borderline” is a fitting term since the disorder seemed to be on the border of previously known conditions of psychosis and neurosis. Over the decades, the name changed a few times, while the stigma surrounding the disorder is still misportrayed by pop culture.

Where does the term Borderline come from

The term “borderline” has its roots in the unfamiliarity with the true nature of the disorder. Adolph Stern, an American psychoanalyst, coined the expression in 1938 after analyzing a group of patients suffering from an apparent form of mild schizophrenia. The group showed symptoms that did not fit into the psychosis or the neurosis categories. The condition was referred to as “borderline schizophrenia” up until the ’60s. The disorder seemed to be on the border of previously known conditions of psychosis and neurosis, therefore the name borderline.

In the ’60s and ’70s, the view on the disorder shifted from borderline schizophrenia to borderline affective disorder, which is a mood disorder. The name borderline personality disorder, although not universally acknowledged, was integrated into the DSM-III in the ’80s.

What are psychosis and neurosis?

Psychosis and neurosis are not stand-alone mental illnesses but symptoms of a vast range of disorders.

Psychosis In psychosis, the brain cannot process information correctly. Psychosis causes a break from reality. The individual suffering from this symptom might experience, see, hear, and believe things that are not real. The causes of psychosis can range from substance abuse to trauma, mental illness, or severe stress.

Neurosis Neurosis, or neurotic behavior, is a type of behavior that, at its root, stems from the management of deep anxiety. This symptom is characterized by drastic and irrational reactions in the mental, emotional, and physical realms. Neurosis is also characterized by chronic distress but involves neither delusions nor hallucinations.

Borderline Treatment: Then and Now

In the 1930s, the identification of borderliners had just begun. Before the ’70s, patients with BPD were thought to be difficult and untreatable. The patients that were able to be analyzed were considered neurotic, while those that were not analyzable were psychotic.

After the ’80s, when BPD was introduced to the DSM-III, one thing that became clear was that the illness had nothing to do with schizophrenia. The most common treatment for BPD was psychoanalytic psychotherapy, which rarely resulted in concrete improvements. At the end of this decade, what became clear was that if the patient felt close to the clinician, the outcomes were more positive. What also became clear was that group therapies were very helpful. Perhaps one of the biggest discoveries BPD-wise was the development of dialectical behavior therapy (DBT) In 1993 by Marsha Linehan. This method was and still is particularly effective for the treatment of BPD. The therapy focuses on patient-therapist interaction.

In 2001, guidelines for BPD treatment were published, which included patient-therapist collaboration, family involvement in psychoeducation, and the use of medication.

As much as there has been great progress in both research and treatment of BPD, the illness remains stigmatized, and many mental health professionals actively avoid and dislike working with borderliners because of the difficulties.

BPD in pop culture

Borderline personality disorder is considered to be the leprosy of mental illnesses because it fits in the category of diseases where just the mentioning of it makes people cringe in horror. The negative stigma of BPD is unmatched by any other mental illness. But what is exactly the reason?

One of the reasons could be that BPD is often associated with relationships. When described, the illness is often seen through the lens of parents, lovers, and friends of borderliners. What these people see are the reactions, the outbursts, and the quick emotional changes. They do not see nor can describe what is going on inside the person showing all of these behaviors. And that is what pop culture gets wrong: the representation lacks the human factor and empathy.

In TV shows, borderline characters seem to be added to the storyline to complicate things; they are there for the shock factor. They are the criminals, the difficult teenagers, and the abusive partners. They are often seen as the enemy and rarely as the victims that they truly are.

Another reason why there is so much stigma surrounding this disorder is that BPD is often associated with suicide. 8 to 10 % of borderliners commit suicide, and many live with suicidal ideation for long periods. This results in hospital and psych ward admissions, which in today’s society is seen as pure madness. Instead of seeing the importance of psych hospitals, and the pain borderlines experience that drives them to attempt the unthinkable, society sees them as crazy people closed in their own crazy environment. The stigma surrounding suicide engulfs the stigma surrounding mental illness, forming a huge bubble of misconceptions and discrimination.

Television and pop culture stigmatize BPD in a way that demonizes the sufferers even further. From characters like Effy in the popular TV show Skins to Winona Ryder’s Susanna in Girl, interrupted, people suffering from BPD are often portrayed as crazy maniacs unable to control their emotions, and tormented by drastic self-destructive behavior.

As much as self-destructive behavior, suicidal tendencies, and poorly regulated emotions all fit the BPD profile, what pop culture does is either romanticize the disease or portray the sufferers as walking diagnoses. BPD sufferers are represented as just that, the illness they suffer from, when in fact they are so much more.

BPD in real life

People that suffer from BPD can have symptoms ranging from fear of abandonment, suicidal ideation, chronic emptiness, dissociation, and paranoia. Borderliners often experience unstable relationships because of their illness, which only deepens their fear of abandonment and self-destructive behaviors. Substance abuse is not uncommon within BPD, with around 50% of sufferers having abused substances within the last year.

In the US, 1.6% of the population is diagnosed with BPD. The number is probably higher and likely reaches 5.9% of the general population. BPD is more often diagnosed in women, with about 75% of the diagnosis being in females. A reason for this could be that males often feel stigmatized to not get diagnosed.

Probably the most striking statistics are the ones relevant to suicide: 1 in 10 people suffering from BPD will successfully attempt suicide, while about 70% of borderlines attempt suicide at least once in their lifetimes.

The prognosis for people with BPD remained optimistic, despite their living conditions: After two years, one-third of the 290 inpatients diagnosed with BPD were in remission, and after ten years, nearly 90% of the inpatients were in remission. Remission is the decrease or disappearance of the symptoms.

The problem is that what most people consider a borderliner is what they show during an episode of their symptoms. People with BPD are not always self-destructive, aggressive, or indecisive. Borderliners can be just as functional and empathetic as everyone else when they are aware of their emotions and triggers and have the tools to cope with them. Stigma only worsens their conditions.

BPD does not only impair a person’s life, but it can somehow also add value to it. Since borderliners experience emotions very strongly, they can be very passionate people. Lastly, living with such a difficult illness every day creates a form of resilience in people with BPD which is hard to find in anyone else.

Borderliners can have a fulfilling life despite the challenges and stigma associated with the illness if they learn to cope through therapy, medication, and a support group.