Surviving Borderline Personality Disorder Episodes

Borderline personality disorder (BPD) has a bad reputation. People can be less than empathetic with patients with BDP. This rejection leads to suffering in both the patients and their families.
Surviving Borderline Personality Disorder Episodes

Last update: 29 June, 2021

Borderline personality disorder (BPD) is a diagnostic category defined by the DSM-V. It’s featured in many movies or stories. It represents the suffering of many people that live their lives thinking they don’t fit in.

People with BPD have unstable personal relationships, low self-esteem, impulsiveness, and intense affections. These start in adulthood. The disorder manifests in at least five of the following:

  • Desperate efforts to avoid real or imagined abandonment.
  • A pattern of unstable and intense relationships. It alternates between idealization and depreciation.
  • Identity disorders. Intense and persistent instability of their self-image and sense of self.
  • Impulsiveness in two or more aspects, potentially including self-harm.
  • Chronic feeling of emptiness.
  • Intense and abnormal anger or lack of anger management.
  • Paranoid ideas related to stress or serious dissociative symptoms.

Although this criteria exists, BPD has a wide spectrum. As such, this criteria is just a reference, as BPD is complex. Patients with borderline personality disorder can be similar or completely different from each other.

A common symptom is the fear of abandonment, self-destructive behavior, and impulsiveness. These characteristics make it harder to live a normal life.

A person with a box over their head, feeling regret.

How does a patient with BPD survive a crisis?

A person with borderline personality disorder is completely normal. They may be students, have a job, have a family, have friends, etc. The problem is when they suffer a crisis.

Stress or biological factors can trigger a crisis in people with borderline personality disorder. This can be starting their period or using drugs. Sometimes, it isn’t related to anything in particular.

When the crisis happens, a person with borderline personality disorder loses their personality. It’s as if they have two personalities: one that’s kind and stable and another one that manifests once in a while.

It’s a short circuit that makes it impossible to control their actions. A BPD crisis produces an empty, sad, and dysphoric mood. Suddenly, things that made sense and make them feel good no longer do. Their illusions and projects seem pessimistic. Their mind starts to develop thoughts of loneliness: “You’re alone!” “You don’t have any friends!” “No one will ever love you!” “Jump out of the window and stop bothering people!

During a crisis, their closest friends seem like enemies, especially those they love the most. Although they need the most love and compassion from their loved ones during a crisis, they ask for love through disrespect, aggressiveness, and destruction. They may hurt a family member, both physically and verbally. Deep down, they just need love and attention.

What happens after a psychotic borderline personality disorder episode?

Crises make them respond badly to boredom and frustration. Everything that’s slightly uncomfortable seems like the worst thing in the world.

In that context, they can become self-destructive or impulsive and consume drugs, destroy things, spend money uncontrollably, start new projects, become unpleasant, trust in the wrong crowd, or try to kill themselves.

“One time, in the middle of a psychotic episode, I set up a new business in a matter of days. I felt like a failure and thought about killing myself. I decided to rent a space, hire an adviser, and set my own business up. After a few days, I regretted everything.”

A psychotic episode of a person with borderline personality disorder can last between a few hours to a week. In women, it’s more common as a premenstrual symptom. Most patients with BPD can confirm that they feel ashamed and guilty after an episode.

They describe it as feeling “possessed” by someone who has nothing to do with them. This “someone” does things that they’d never do under normal circumstances. Therefore, it’s obvious why these people feel guilty and ashamed after a crisis. Their shame is related to their impulsiveness.

A girl feeling ashamed in front of a mirror.

Sense of guilt

On the other hand, they feel guilty because they did things they didn’t want to do. They feel regret.

For example, a BPD patient can yell at their three-year-old because they feel annoyed by them. Surely, in another time, they wouldn’t have acted that way. But in the middle of a psychotic episode, their impulsiveness overwhelms them and they end up being mean to the child. Later, they feel extremely guilty.

These post-episode symptoms can make the patient feel hopeless and desperate. This hopelessness can cause another crisis and create a cycle. For this reason, it’s important for BPD patients to recognize the pattern and come up with a structured plan to tackle it. Their family and close friends should also recognize their patterns.

A group therapy session for people with Borderline Personality Disorder.

In conclusion

BPD patients experience their crises with hopelessness because they’re hard to manage, even with treatment. People stop trusting their resources and their possibilities. One day, they feel great, and the next, they succumb to BPD.

What can they do? The essential thing is to validate their emotions. Most patients with borderline personality disorder had a difficult childhood and never had the validation they needed. Some children only felt rejection, instead of affection.

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  • American Psychiatric Association (APA) (2014): Manual de Diagnóstico y Estadísitico de los Trastornos Mentales, DSM5. Editorial Médica Panamericana. Madrid.
  • Frías, A. (2017). Vivir con trastorno límite de la personalidad. Una guía clínica para pacientes. Serendipity. Desvele de Brouwer.