Is borderline personality disorder curable?
Let’s begin this article with a concise TL;DR:
Borderline personality disorder (BPD) can be lifelong, but it doesn’t have to be in most cases.
As a personality disorder, BPD is a set of symptoms and experiences that is woven into the fabric of what it feels like to be you. Meaning, it’s hard to imagine another way of being. It may feel impossible to be different–and ironically–it may not even feel desirable to be different.
Consider the following anecdote from David Foster Wallace’s celebrated commencement address:
There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes “What the hell is water?”
-David Foster Wallace, This Is Water, 2005 Kenyon College Commencement Address
This story captures some of what is tricky about personality disorders. The term for psychological experiences–even negative ones–being inseparable from one’s sense of self is called “egosyntonic.” This is to say, aspects of personality, even ones that comprise BPD, are like water to a fish. Personality is everywhere, yet it’s also invisible. Many professionals miss BPD for the same reasons.
Having BPD is like being one of the fish in David Foster Wallace’s famous anecdote above with one major difference—in BPD the water is a source of emotional pain and discomfort. Before the fish can do anything about the emotional pain and discomfort. She must first begin to develop a concept of water.
In BPD, water means the dynamics of personality. A good therapist, partner, meditation practice, journaling practice, etc. can all be helpful in helping BPD sufferers discover the nature of “water.”
Personality dynamics is a complex subject beyond the scope of this piece, but I’ll try to shed a bit of light on what I mean by that term. The dynamics of character is the way your personality fits together in stable and orderly ways. It answers the questions of:
- What motivates you?
- What do you most long for?
- What most hurts you and disappoints you?
- How have emotional currents been blocked, thwarted, shaped, or created by your developmental context?
In other words, how do the BPD sufferer’s thoughts, feelings, and actions make sense based on how she was born and in what situation she grew up?
Therapists and psychiatrists tend to focus on the acute symptoms, like depression or the anxiety, but miss the big picture. In BPD and other personality disorders, the conditions that generate acute symptoms and continue to be active in the background even after intense affect storms pass.
This is why the problem of BPD can only be addressed by working at the level of personality dynamics.
What Makes Change So Hard After Diagnosing the Problem?
We’ve begun to explore why it’s easy to miss the problem of BPD altogether. But the reason BPD is easy to miss is related to why it’s difficult to treat.
Is borderline personality disorder curable? When trying to “cure” any mental illness or emotional disorder, the pain of that disorder is typically what provides the motivation for change. But what if losing your pain meant feeling like losing yourself entirely? While ersonality pathology is distressing, but changing our personality feels like abandoning the self–an experience especially painful for sufferers of BPD.
Changing from BPD means grappling chronically with the aforementioned question: what good is feeling better if I don’t even feel like myself anymore?
While you may pick up on some failures in logic in this question, doesn’t it feel intuitively true? Would you want to take an elixir that made all of your problems disappear if you no longer felt like yourself? Most unconsciously choose not to, because it feels like a rejection or an abandonment of self–the exact scenario that people with BPD are trying desperately to avoid.
What is BPD, Actually?
Most people know BPD as the laundry list of symptoms that you can find outlined in one of the volumes of DSM or ICD series. A selection of these symptoms may very well describe what you or a loved one seems to go through, but it may leave you wanting more of an explanation of what is at the core of all of those unwelcome experiences.
I’ll define BPD here the following way.
Borderline Personality Disorder is emotional immaturity and frozen state of developmental delay brought about by a chronic state of emotional trauma in the emotional environment of the developing person. The “frozen” aspect of BPD has to do with emotional immaturity and maladaptive defenses being baked into the personality structure. The emotional traumas that cause the ossification of immature defenses are often described as emotional invalidation. Sufferers of BPD are also believed to be more profoundly impacted by repeating instances of emotional invalidation or trauma due to having a more reactive and receptive temperament–a set of traits that can be adaptive when matched with the appropriate environment.
I’ve defined BPD this way because it also explains why I, and many others, are quite sanguine about the prognosis for most cases of BPD. Framing BPD as developmental delay implies that recovery from BPD requires intervention with remedial skills training and copious amounts of emotional validation means. I believe this is in fact the case.
The intense pain and secondary gain associated with having some of the benefits of being immature often make recovery from BPD challenging. However, the temperamental proclivity that many sufferers of BPD have also makes BPD patients capable of not only making remarkable progress in treatment, but also reaching surpristing levels of thriving and success
In my experience, the potential that many patients have would surprise families, loved ones, and clinicians close to the patient–and perhaps most of all, the patient herself. The right care matters, though. A poor fit or an unskilled therapist along with enough self-destructive behavior unchecked by appropriate care can lead to truly awful outcomes, too.
Is borderline personality disorder curable?
It would be irresponsible to suggest that organic growth can occur and alleviate some of the acute pain of BPD if a sufferer of BPD finds good friends, a job in which she succeeds, and/or a romantic relationship wherein she finds support, validation, and excellent communication.
However, positive life choices and experiences alone tend not to resolve BPD. Some intervention is usually required. The reason for this is both simple and complex. BPD is a disorder born of relational trauma. People tend to repeat familiar patterns of relational trauma such that BPD sufferers tend to recreate the same kinds of relationships and life circumstances that brought about the suffering to begin with.
Theoretically this is a challenge to explain and yet many theories attempt to provide sound reasons for why humans tend to repeat patterns that seem so undesirable. Whether repetition compulsion, masochistic acting out/retaliations, or retraumatization is your preferred term, many have observed that we tend to seek out what we know–regardless of whether that known outcome is one that’s good for us.
Some attribute this to comfort. Others attribute this to trying to solve a painful problem by providing oneself another opportunity. Perhaps it’s an attack on a parental figure’s narcissism by destroying the self–a narcissistic extension of the parent.
While organic recovery is technically possible, it usually requires painful cycles of repeating negative patterns with the help of someone who has diagnosed the disorder and is actively working with the sufferer of BPD to resolve trauma and imagine new possibilities in love and life.
Why is borderline personality disorder curable?
The reason that there is always hope when it comes to a pure BPD diagnosis is the core longing for intimacy and connection at the center of the experience. Anyone who has truly experienced BPD, either in themselves or in relation to a loved one, knows how important relationships are to sufferers of BPD.
One could argue that the defining feature of borderline personality disorder is the desperate and frantic efforts sufferers of BPD make to prevent and/or undo abandonment. This stems from a robust and healthy desire to have deep, meaningful, and mutually satisfying relationships.
Of course, the expression of this longing is not always healthy. Sufferers of BPD often manipulate and control, assert emotional needs in destructive ways, and choose the wrong partners and situations to assert these deep longings, but the origin of these desires comes from a healthy, human place.
No matter how disturbed some of the acting out can appear to outsiders, a desire for connection is a positive prognostic feature. While borderline personality disorder is deeply painful for its sufferers and those in its orbit, relational longings and a need to be understood is what separates BPD from more hopeless forms of pathology like malignant narcissism, paranoid personality disorder, schizoid personality disorder, and antisocial personality disorder.
No matter how dramatic and dire things get in the life of a borderline patient, as long as there is a longing for connection, there is hope. After all, it’s the potential to develop a relationship with a concerned other, a therapist most often, that will determine whether these needs can be channeled in healthy ways that will decide if the pathology will soften or become more pronounced.
When and how is borderline personality disorder curable?
Like any condition, the more severe it is, the harder it is to cure. I have not seen a pure case of borderline personality disorder that could not be greatly improved through a commitment to the proper course of treatment.
BPD, like any kind of human experience, exists on a continuum. Some people merely exhibit and experience BPD-like traits, while others struggle to get through a single day without a crisis of cutting, panic, or other kinds of extreme expressions of profound suffering.
For certain individuals who are either more sensitive or were raised in more invalidating environments, the severity of borderline personality disorder can be more extreme. It’s one of the challenges of running groups with individuals who have BPD, as each member often has her own motivation to convince others that her trauma is worth validating, creating a macabre competition of who suffered more.
Things like trauma, pain, and emotional invalidation are hard to quantify. Sometimes people suffer the most gruesome and horrifying traumatic experiences and make it through with manageable symptoms. Others come from wealthy backgrounds, seem to have it all on the surface, and can’t seem to do anything healthy, mature, or forward-looking in their lives.
With BPD, I’ve noticed that sometimes the pure gruesomeness of some experiences can provide with it a kind of validation. Whereas, having apparent wealth and privilege can often make symptoms worse because the individual feels pain but “has no good reason” to be upset about their life.
When answering the question, ‘is borderline personality disorder curable?’ it’s sufficient to say, not all “cases” of BPD are identical. And, just as BPD can get much better over time, it can also get worse through engaging in activities that make everything worse–retraumatizing relationships, substance abuse, suicide attempts, etc. Recovery is always possible, but wherever you are, time is of the essence and finding the right help matters.
I’ll end this post with a dialectic or paradox, which is often equal parts soothing and confounding to the human psyche–especially the mind of the borderline personality sufferer:
It’s never too late to get the help you need, AND, it’s essential that you start as soon as possible.
Wherever you are, start now.
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