- In a recent study, 50 patients were interviewed about their experiences with borderline personality disorder.
- More than half of the patients said that BPD symptoms substantially impacted their work or school.
- Extreme mood lability and emotional responses were the symptoms reported to be the most problematic.
“Doctors are men who prescribe medicines of which they know little,
to cure diseases of which they know less, in human beings of whom they know nothing.”
Clinicians and researchers are trained to understand, diagnose, and treat illness, but they can’t move inside patients to fully comprehend their suffering. Indeed, most people view illness from the outside. No matter how much empathy you may possess, it is still difficult to fully appreciate what a severe COVID infection, a broken leg, or a persistent psychosis feels like, and which particular symptoms are most disabling, unless you have experienced it. Mental illness, in particular, with all its stigmatization, may be harder to understand for those who haven’t endured it.
A recent study explored the subjective experiences of patients diagnosed and treated for borderline personality disorder.1 Extensive interviews with 50 patients inquired about qualitative patient perspectives living with BPD. Interviewers also asked which symptoms were most troublesome. This study was larger than those previously reported and, unlike most others, included 24 men.
Most of the patients endorsed most of the nine criteria that are established in defining BPD. Typical quotes describing symptoms were:
- “…just complete unregulation of my emotions.”
- “…really unstable relationships…had some really bad abandonment issues.”
- “…not really feeling as though I have a stable consistent sense of self.”
- “Impulsivity, just like acting before thinking.”
- “I felt empty every day when I woke up.”
- “I would be very impulsive with my anger, the shouting, screaming, cursing…”
- “I would have periods where I would [dissociate] just zone out…”
All 50 patients reported extreme mood changes and intense or unstable relationships. Forty-seven patients (94%) described an unstable self-image. Most patients experienced impulsive, self-destructive behaviors. Chronic feelings of emptiness and intense anger were acknowledged slightly less often. Twelve patients related suicidal ideations. Five patients reported dissociative symptoms.
More than half of the patients said that these BPD symptoms substantially impacted their work or school. Legal, financial, or self-care issues were also affected. Difficulties with relationships had the most effect on these problems. Researchers asked which symptoms were the most personally troublesome and interfered most with daily functioning. Extreme mood lability and emotional responses were the symptoms reported to be the most problematic. The next symptom most bothersome was intense or unstable relationships, followed by anger issues, unstable self-image, chronic feelings of emptiness, and impulsivity. Interestingly, the symptom that was the least interfering—only two patients endorsed it—was suicidal ideation. This finding is particularly striking since suicidal threats and behavior are obviously the symptoms that garner the most attention from clinicians and significant others.
Many current treatment approaches for BPD, such as DBT, follow a specific, manual-based strategy. It is important that therapists not get swallowed by a formal technique, but that they retain flexibility to divine the experiences of their patients. This includes attention to the importance of interpersonal connections and self-image. It is the patient's goals, not the doctor’s, that determine therapy direction.
To find a therapist, please visit the Psychology Today Therapy Directory.
1. DiBenedetti, D., Kosa, K., Waters, H., & Oberdhan, D. (2023). "Understanding Patients' Experiences with Borderline Personality Disorder: Qualitative Interviews," Neuropsychiatric Disease and Treatment.