Borderline Personality Disorder - Learning to Calm Before the Storm

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Background

Stability in an unstable world is how we describe “normal” human behaviour. Being able to remain firm, grounded, and balanced amidst nonideal circumstances is what is often expected, even demanded, in hectic modern societies.

While many people are able adapt to the ebb and flow of life, what about people who, for whichever reason—genetics, early trauma, biological imbalances, lack of secure attachment, missed developmental milestones, etc.—aren’t able to respond in this way? What about those who have difficulty maintaining relationships, lack a secure sense of self, who respond to stressful situations impulsively and often destructively? These individuals are described as having “borderline personality disorder” (BPD). BPD is described as a pattern of instability in multiple facets of life. People with this disorder often have emotional regulation issues and difficulty tolerating distress. They engage in self-harm activities, impulsivity, and attempted suicides. They typically feel empty inside, have mood swings, and may experience dissociations or paranoia.

Abandonment, whether real or perceived, is a big trigger for someone with BPD. They may react with anger, and they have difficulty tolerating these experiences. This can be a reason self-harm behaviours occur; they provides temporary relief to the strong negative emotions. They also tend to provide the company of others whether in the form of medical clinicians, family, or friends. While being alone can be intolerable for someone with BPD, the relationships they do have tend to be unstable and chaotic. They often have a tendency to waiver between idealizing a person to devaluing them. Their relationship with themselves is no better. They suffer from issues with identity, and they may make sudden and dramatic changes to their lives.^[1]

While there are no clear answers for why people develop this disorder, there are some theories:

• Biological: BPD is five times more common among first-degree relatives.^[2]
• Psychological: A harsh family environment and early traumatic events are more common in BPD.^[2]
• Developmental: Marsha Linehan, a psychologist and creator of dialectical behavioural therapy (which was originally intended to treat BPD), theorized that these individuals have dysregulation in their emotional responding. Due to this dysregulation, they are more emotionally sensitive, unable to regulate emotions, and have a slower return to baseline emotions.^[3] This is said to be due to a lack of validation around emotional expression during childhood, leading to failed problem-solving when it comes to the emotional experience.
• Naturopathic Perspective: It’s probably all the above. Constitutional and genetic predispositions, paired with challenging traumatic experiences, without a constructive framework for learning emotional release certainly sounds like a recipe for the symptoms borderline personalities are prone to experiencing. The question is not: “Why are they like that?” but rather: “Why wouldn’t they be?” This is a focal point of dialectical behavioural therapy (DBT) used for BPD.^[4]

Dialectical behavioural therapy is based around the core concepts of simultaneous self-acceptance and willingness to change.^[4] It addresses the difficulties borderline personalities experience in a step-wise manner. It also affirms the actions and behaviours these clients may take, by appreciating their unique challenges and potentially trauma-ridden past. By accepting and understanding their current coping and behavioural patterns, it can allow for room for growth without guilt or shame for the choices they have made. “I am doing the best I can in the present moment, and I will continue to work to improve” is a very important practice promoted by the DBT therapist.[4] The tools help to create the mindfulness used to prevent the storm of emotions entirely. These are important concepts most of us could stand to benefit from! Other conventional approaches to the BPD patient include things like antidepressant selective serotonin reuptake inhibitors (SSRIs), sedating benzodiazepines, and hospitalization when patients are in acute risk. Because of the biological underpinnings to this disorder, and the impossible separation between mind and body, it makes sense to address the whole body, in addition to DBT. Since psychiatric medications have their limitations, natural and holistic treatments and approaches can be tremendous assets for borderline personality disorder. For most psychiatric disorders, stress is a tremendous trigger that leads these diseases to rear their ugly head.

Naturopathic medicine has valuable tools for stress management:

Nutrition: Keeping blood sugars balanced and ensuring good healthy fats and adequate protein are keys for energy and emotional regulation.

Lifestyle: A stress-reducing lifestyle filled with adequate sleep, positive social environments, time spent outdoors, exercise, and restorative activities like self-care or yoga are all good foundational blocks to ease emotional dysregulation.

Adaptogens: Herbs like Rhodiola, Withania, and Scutellaria could all be useful for someone with borderline personality. In addition to general regulation of cortisol and the stress response, they can provide additional support depending on the herb of choice. Rhodiola, for example, in addition to its role in improving resiliency and reducing cortisol and HPA axis activity (stress response), also appears to modulate neurotransmitters, improve neurotransmission, and inhibit neurotransmitter breakdown (similar to an antidepressant).^[5] This makes it a helpful herb for depression, anxiety, and physical and mental fatigue.

Vitamins and Minerals:

Vitamin C seems to improve psychological response to acute stress.

Magnesium tends to be depleted during emotional stress, and it is useful for calming the nervous system and easing muscle tension.

Vitamin B5 is necessary for a healthy stress response, and it can also be depleted during acute or prolonged stress.

Omega‑3 fatty acids have been specifically shown to improve functioning and reduce impulsivity. They can also help with depression and anxiety, which people with BPD are prone to experiencing.^[6]

Yi Gan San/Liver Soothing Bupleurum Formula is a traditional Chinese medicine (TCM) herbal combination. It has a history of use for aggression, temper, and restlessness in children. Some clinical trials have also shown effectiveness for borderline personality disorder. This formula would be best-suited for people presenting with liver imbalances from a TCM perspective.^[7]

Homeopathy: Several remedies could be useful for BPD. The closer the symptoms to the remedies description, the more effective it will be.

Aurum is suitable when the BPD patient is experiencing severe depression and disappointment. These disappointments are often due to perceived failure or unmet goals in their career, or from disappointed love or grief. They often lose their will to live and contemplate suicide.

Chamomile: These patients have great irritability, anger, and hostility. They are prone to sudden outbursts of anger, which make their relationships difficult. They are said to have “capricious minds.” They change their mind unexpectedly; they ask for something then throw it away once received. They are also oversensitive to pain.

Crocus sativa: An important mood-swings remedy. These people may alternate between extreme happiness, affection, dancing, and laughter at one extreme, and great irritability, violence, and sadness on the other extreme.

Ignatia: While Ignatia is a well-known grief remedy, it is helpful for mood swings in BPD. Someone who needs Ignatia will be highly sensitive and prone to disappointments, yet unable to release their emotions. As a result, they may become rude, defensive, have stormy relationships, and alternating moods with laughing turning to tears. This remedy can help that grief and sadness become “unstuck.”

Lilium tigrinum: Making those around you feel like they need to walk on eggshells is the keynote for Lilium tigrinum. This is because these people are especially prone to hysterical rage, great sensitivity (taking offense to almost anything), and are said to be the most irritable of all the remedies. They feel hurried, depressed, and scattered. This might alternate with kindness and even hypersexuality.

While mental health can be challenging and complex, there are a world of options and avenues for those suffering. For those with borderline personality disorder, it is important to be able to explore their emotions, behaviours, and actions in a compassionate, curious, judgement-free way. Connecting the dots, learning about triggers, and exploring unique features of their experience will not only aid in selecting the right therapies, but will provide them a deeper understanding of themselves. It will allow for emotional tolerance and emotional resilience. After all:

“Life isn’t about waiting for the storm to pass. It’s about learning how to dance in the rain.”—Vivian Greene.