What All That Drama Might Really Mean

We all know one; we may even be one: a person whose life seems dogged by drama. Relationships are turbulent, anger is fierce, actions are impulsive. Overreaction is the order of the day. Is it simply temperament, or is something deeper going on?

In some cases, the force behind the drama may be borderline personality disorder (BPD). It’s a serious mental health condition characterized by emotional instability and a disturbed sense of self and that has at its foundation a deep-seated fear of abandonment. BPD can create chaos, not only for the person struggling with it but for those in his or her orbit.

Life for the person with BPD may include many positives, but these are overwhelmed by the negatives, which are felt deeply and intensely. A minor embarrassment becomes a humiliation, annoyance becomes rage, disappointment becomes tragedy. If a friend arrives a few minutes late, for example, a person with BPD might react as though it were a betrayal rather than a case of too much traffic. Sadly, this frantic fear of rejection and abandonment can become a self-fulfilling prophecy.

An estimated 1.6 percent of us are estimated to be dealing with BPD in any given year, yet it often goes undiagnosed. Intensity of the condition varies, and it sometimes lies dormant until a stressful event brings it to the surface. Other times it’s masked by co-occurring conditions such as substance abuse, depression, anxiety and eating disorders. Sometimes the person with BPD is simply written off as difficult.

The medical community isn’t really sure what causes BPD, but both genetics and environmental factors are believed to play a part. Brain imaging of those with BPD shows greater activity in circuits related to negative emotions and less activity in circuits that help keep those negative emotions from running amok once generated. That suggests those with BPD may be wired to overreact. Other studies find links to childhood trauma such as sexual or physical abuse and neglect – traumas that can prevent the formation of secure attachments.

BPD is sometimes misdiagnosed as bipolar disorder – the other BPD. Both share some similarities, but bipolar disorder has a couple of important differences: It includes instances of euphoria, and its highs and lows represent a move away from the person’s normal state. In borderline personality disorder, the turbulence is the normal state.

BPD Warning Signs

So how to know if BPD might be fueling the drama in your life – or in someone whose life touches yours? There are no precise diagnostic tests. Instead, treatment professionals look for a pattern of behavior that begins in early adulthood and that includes at least five of the following issues:

• Abandonment fears: Any sense that someone is pulling away, whether real or imagined, prompts an extreme reaction that can include rage, depression, neediness, manipulation and panic.
• Unstable relationships: Connections with family, lovers, friends and co-workers are intense and stormy. The person often alternates rapidly between idolizing and vilifying them.
• Identity disturbance: A distorted and unstable sense of self may lead the person to try on different personalities, often several times in the same day. Feelings, values, plans and goals can change from moment to moment.
• Impulsivity: This can manifest itself as substance abuse, unsafe sex, overeating, overspending and reckless driving.
• Self-harm: Behavior may include self-mutilating actions such as cutting, burning and hair pulling, as well as suicidal gestures and threats.
• Hair-trigger emotions: Moods are intense and can change from hour to hour, rarely lasting more than a few days.
• Emptiness: It’s been described as chronic boredom or a feeling of not being there, similar to a daydream state.
• Anger: Frequent outbursts and physical fights are common. Anger can be intense, inappropriate to the situation and hard to control.
• Dissociation: Paranoid thoughts may come with a feeling that they are cut off from reality or observing themselves from outside their body.

If you recognize yourself or someone you love in these descriptions, it’s important to reach out for help, not only to improve quality of life but because of BPD’s heightened suicide risk. The National Institute on Mental Health notes that 4-9 percent of those with BPD will commit suicide and as many as 80 percent show suicidal behavior.

Not long ago, those seeking help for BPD might have been told there was little that could be done. Today, researchers know that’s not the case. A variety of treatments – among them cognitive behavioral therapy, psychoanalysis and dialectical behavior therapy – can help those with BPD recognize distorted thinking and control emotions and behaviors.

For those dealing with BPD, whether in themselves or in someone they love, the key is patience. BPD can be stressful, infuriating and discouraging, but with treatment and recognition that improvement will be gradual, not immediate, drama can make room for peace.