It can be easy to joke around about mental disorders: “I’m really OCD about keeping my house clean.” Or, “Ugh, her mood swings are so bad; is she bipolar?”
The truth is, personality disorders—long-term unhealthy and inflexible patterns of thinking—are an all-too-real struggle for roughly 9% of Americans, according to the National Institutes of Health. Of the 10 personality disorders (which include obsessive-compulsive personality disorder (OCPD), paranoid personality disorder, and narcissistic personality disorder) borderline personality disorder (BPD) tends to be the most misunderstood.
The disorder’s name alone is enough to spark confusion, since “borderline” seems to imply that BPD is not a full-blown problem. Experts originally felt BPD fell on the border between psychosis (severe mental disorder) and neurosis (mild mental illness), and didn’t warrant being classified as a distinct disorder, says John Oldham, MD, professor of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston. It wasn’t until the DSM-III was published in 1980 that BPD was listed as its own disorder. Nevertheless, “borderline” stuck.
Since then, experts have grown to better understand and define the complex illness. There’s ample evidence that it’s “partly inherited genetically and partly a function of stressful experiences during growth and development that leads to some pretty significant interference in successful functioning,” though experts still aren’t 100% sure of the underlying cause, says Dr. Oldham, who chaired the workgroup that developed the American Psychiatric Association’s Practice Guideline for the Treatment of Patients With Borderline Personality Disorder.
Wendy Bahary, a New Jersey-based licensed clinical social worker and founding fellow of the Academy of Cognitive Therapy, confirms many of her BPD patients had some form of loss, trauma, or abandonment in their childhood, which they try to reconcile as adults. That said, having a tough upbringing or family history of BPD doesn’t mean you’re destined to have the disorder, explains Dr. Oldham. “It just means that you have that risk factor.”