Why do people with borderline personality disorder act the way they do?

Quite some time ago I told you about some of the main characteristics of people with borderline personality disorder (BPD), and today I’d like to talk about the five core areas of the psychopathology of this disorder, that is, the main dysfunctional areas that explain why these patients behave the way they do.

To give you some context, people with BPD are characterised by being very emotionally unstable and extremely impulsive, and they also have many problems with their self-image and in their relationships with others. Why do they feel and behave like this? It’s because there are five areas that function somewhat irregularly in people with BPD, namely:

Emotional dysregulation: people with BPD find it extremely hard to manage their emotions. They have an extreme, all-or-nothing outlook, which shows in the intensity with which they experience their emotions, which in turn drive their actions. If we combine the low self-esteem that characterises them with this difficulty managing their emotional world, the result is fairly negative, leading to a worsening of their life circumstances (poor relationships, job loss, breakups…) that only lowers their self-esteem further.

Interpersonal dysregulation: their relationships tend to be difficult, chaotic and full of conflict, and they experience them with an intense fear of abandonment. Because they can’t regulate their emotions, their relationships are often damaged.

Behavioural dysregulation: they act impulsively, which frequently gets them into trouble. These impulsive behaviours often include self-harm or suicide attempts. Suicidal and parasuicidal behaviour is especially important in therapy with people with BPD, since it’s part of the psychopathology of the disorder and is therefore quite likely to occur at some point during the therapeutic process.

Cognitive dysregulation: this involves mild episodes of depersonalisation (the patient feels as if they’re leaving their own body and seeing themselves from outside), dichotomous or black-and-white thinking, some mild episodes of dissociation… Delusions can sometimes occur, but this is less common. Low self-efficacy (feelings of uselessness) is also common in these patients.

Identity disturbance: chronic feelings of emptiness and confusion about one’s own identity are quite common. Serious self-image problems are also very common (which is why BPD often occurs alongside eating disorders such as anorexia or bulimia).

In future articles I’ll talk about therapy for BPD, the strategies we use to work on each area, and how to handle the difficulties that can arise with these patients, whose behaviour can sometimes make the therapeutic process quite complicated.