Borderline Personality Disorder (BPD) is among the most stigmatized mental health conditions. People living with it are often written off as hopelessly psychotic and difficult to be around. In my experience though, it can be managed, and the loving core of people living with BPD can emerge in amazing ways. If you know someone who you know has the diagnosis, but especially if you are romantically engaged, knowing a bit about the condition will help you set healthy boundaries and give you the best chance of developing a relationship that is safe for both of you.
Some would argue that BPD shouldn’t even be a diagnosis, because so many of its symptoms can be seen as rooted in trauma. The diagnosis of Complex PTSD is used in much of the world, but has not yet penetrated the US psychiatric establishment’s bible, the Diagnostic and Statistical Manual (DSM). The persistent emotional, physical, and often sexual trauma endured by people with BPD makes it feel somewhat cruel to describe what they are left to live with as a ‘disorder.’ Isn’t the real disorder all of the trauma they had to endure?
That said, the DSM diagnosis has utility. Historically it referred to the ‘borderline’ between psychosis and neurosis. Though the word neurosis is rarely used anymore, the name has stuck. I like to see the essence of unmanaged BPD as embodied in the statement ‘I hate you, don’t leave me.’ People with BPD have a very hard time trusting people or being vulnerable. If they do start to trust and get vulnerable, they often become deeply enmeshed, losing their clarity about where their own feelings end, and where the other person begins. If a romantic relationship becomes tumultuous, someone with BPD may even threaten suicide or self harm to keep the partner from leaving.
Another lens on BPD is through attachment theory. Attachment theory emerged in the 1950s and explored the dynamics of infant attachment to caregivers. Originally researchers studied young babies and their reactions to their mother’s leaving a room full of toys, and then returning after some time. Over time, the language has evolved and has been applied to romantic relationships, platonic friendships, and more.
Attachment theory describes secure attachment as describing a situation in which someone has a healthy trust in a close person in their life that is durable with clear boundaries. Anxious Attachment is when someone is always afraid that people who care about them will leave. Avoidant Attachment is when people keep their guard up and avoid connecting or do not communicate expected levels of affection for people in their lives.
The fourth big attachment category is called Disorganized Attachment. With Disorganized Attachment people are often both anxious and avoidant at the same time. The psychological literature has moved towards viewing Disorganized Attachment as a keystone of BPD.
In my experience though, what’s amazing and quite hopeful is that a person with BPD developing even one solid, stable, healthy relationship can help them heal in other arenas. This can be described as “Earned Secure Attachment.’ With this, someone with either an anxious, avoidant, or disorganized profile, learns how to be vulnerable without becoming unmeshed in at least one significant relationship.
Over time, it is amazing how many other relationships will heal. It’s also remarkable that the growth of Earned Secure Attachment makes it much easier to meet new people and make deep connections without trauma dumping, over-sharing, or acting like a secretive black box–all of which are frequently traits associated with BPD.
There is hope, but it lies with ongoing therapy or coaching, sometimes medication, and a willingness to be emotionally vulnerable while clarifying and respecting health boundaries.
There is also an ongoing discussion about “Quiet BPD” as another form of BPD. Individuals who do not exhibit the stereotypical reactions to conflict within relationships may still be diagnosed with BPD by meeting 5 of the 9 criteria for a BPD diagnosis (as outlined in the DSM). To differentiate what BPD vs quiet BPD might look like, it is helpful to understand the 4 Fs of trauma responses – Fight, Flight, Freeze, and Fawn.
The “stereotypical” BPD case is often thought of as utilizing primarily the fight and fawn response, becoming verbally, physically, or emotionally abusive during conflict followed by excessive apologizing, love bombing, etc. In Quiet BPD, individuals turn the anger they experience in conflict and broken trust inward, lashing out at themselves. They do not typically go to Fight for fear of damaging the relationship, instead using other Fs to cope with their dysregulation. The concept of quiet BPD further complicates the conversation of BPD vs. Complex PTSD.
Individuals with BPD often experience intense, seemingly childlike emotions to stimuli as a result of having their childhood development disrupted by trauma. These emotions are incredibly hard to regulate, but it is possible to do so and for the intensity of these emotions to decrease over time with quality therapy, coping skills, support network, and symptom management. Another common experience is chronic feelings of emptiness and loneliness without a solid understanding of a core self. You may hear the term “splitting” which refers to when a person with BPD, PTSD, or other trauma becomes triggered and the brain starts to shut down, essentially reliving past trauma and abandonment.
In these situations, BPD individuals suffer from Black and White thinking, often seeing things as entirely true or false, one way or another way, with little room for complexity in between. This is what happens when for example, a partner of a BPD person abruptly hangs up a phone call and the person with BPD may spiral and truly feel like their partner does not love them. This is just an example and not true for every case. Moving forward, it is both great for the partner to provide reassurance that the person with BPD is valued, but ALSO that the person with BPD learn to be able to validate and regulate themselves, lest they become entirely dependent on their partner’s reassurance to feel safe and supported.
visual art by Christopher G. Kempton
–BYPO PHOENIX & Alex Kirschner c)2025
