Understanding Borderline Personality Disorder: Physiology of the Brain, The Impact of Practicing Mindfulness, and The Importance of Wise Mind

Considered to be one of the most misunderstood and misdiagnosed mental illnesses, Borderline Personality Disorder (BPD) is a personality disorder marked by an ongoing pattern of varying moods, challenges with self-image, and a pattern of unstable relationships. Symptoms of Borderline Personality Disorder often result in impulsive actions and difficulties in relationships. 

Borderline Personality Disorder is referred to as a biosocial disorder; meaning that it starts with a biological inclination which is exacerbated by the social environment. Causes of Borderline Personality Disorder is believed to be a result of an invalidating childhood environment, trauma, abuse, and neglect. The disorder can also be a result of caregivers minimizing or discounting a child’s emotional reactions, if they believe it is exaggerated or inappropriate. 

New insights into Borderline Personality Disorder have led to new, more effective treatments; making the prognosis for someone diagnosed with the disorder much more promising. Current research shows that with the right support and treatment, most people with Borderline Personality Disorder will be able to terminate the diagnostic label. Treatment for Borderline Personality Disorder involves the use of a treatment modality called, Dialectical Behavioural Therapy (DBT). 

DBT targets the amygdala, hypothalamus, and prefrontal cortex to reduce the feedback while changing the way the brain processes threats. It reduces reactivity and negative feedback from the prefrontal cortex. Examining the function of the amygdala can explain the physiology of what is taking place in the brain. In our brains, neural circuits responsible for conscious self control are highly vulnerable to even mild stress. When these circuits shut down, primal impulses can go unchecked and mental paralysis sets in. The prefrontal cortex acts as a control center that keeps our emotions and impulses in check. Under stress and when triggered, the prefrontal cortex can shut down, allowing the amygdala to take over, inducing mental paralysis and panic (fight of flight).

When the brain is stressed, the amygdala commands the production of excess nor-epinephrine and dopamine under these conditions. That shuts down the functioning of the prefrontal cortex and switches on receptors that open channels that disconnect the links between prefrontal neurons. Thus weakening the area’s role in controlling emotions and impulses.

Even small changes in the neurochemical environment can immediately weaken network connections in the brain when stress hits. Elevated levels of signaling chemicals shut off neuron firing and network activity diminishes as does the ability to regulate behaviour. The amygdala alerts the rest of the nervous system to prepare for danger and also strengthens memories that are related to fear and abandonment. You can control this by devising strategies to keep the neural control center intact.

Dialectical thinking refers to the ability to view issues from multiple perspectives and to arrive at the most economical and reasonable reconciliation of seemingly contradictory information and postures. DBT works by targeting the limbic system (fight, flight, freeze, or hide), also known as our basic survival system. It targets the prefrontal cortex which has been repressed, causing a decreased ability to inhibit inappropriate actions, regulate emotions and control impulses. 

Mindfulness targets the amygdala, hypothalamus, and prefrontal cortex to reduce the feedback and change the way the brain processes threats. It is proven to do this. DBT includes four behavioral skill modules, with two acceptance-oriented skills (mindfulness and distress tolerance) and two change-oriented skills (emotion regulation and interpersonal effectiveness).

Criteria for diagnosing Borderline Personality Disorder include: 

Fear of Abandonment

Challenging and Unstable Interpersonal Relationships

Distorted/Shifting Self-Image or Sense of Self

Impulsive, Self-Destructive Behaviours

Suicidal Ideation/Behaviours

Extreme & Frequent Variations in Mood

Chronic Feelings of Emptiness

Intense and Explosive Anger

Stress-Related Paranoia or Severe Dissociative Symptoms

All symptoms are categorized as being biological, psychological, and social. An overlap can lead to emotional dysfunction; a lack of self esteem, depression, anxiety, low energy, problems with activity levels, eating disorders, constant worrying (etc). Emotion dysregulation can cause a number of behaviours to manifest in our lives hindering how we function, our personal enjoyment, our relationships and how we interact with the world.

Although there are a number of helpful and effective DBT skills under each module, Mindfulness and Wise Mind are regarded to be two key components to successfully practicing DBT.

Mindfulness is a mental state achieved by focusing one's awareness on the present moment. When used as a therapeutic technique, it can help us calmly acknowledge and accept our feelings, thoughts, and bodily sensations. Using Acceptance-Oriented DBT skills, allows us to remain in Wise Mind. Practicing mindfulness will control emotions when in crisis/distress mode. Remaining in the present will diffuse the situation before finding yourself in Reasonable Mind or Emotional Mind. 

When accessing the wisdom of our own inner truth and calm, we can say that we are in Wise Mind. Wise Mind allows us to nurture our state of mind. It is the inner wisdom about our own lives that we all have. It is the part of us that can know and experience deep truth. It is the part of us that has the knowledge of what is best for our lives.

Inner wisdom is our ability to recognize and choose skillful ways of being in the world in order to attain goals that align with our values. When we are not in Wise Mind, we are not able to enforce the balance between rational thinking and emotional thinking. It is about balancing our thoughts and emotions so that we are always in the present and are able to guide ourselves peacefully to where we want to be. What interferes with reaching our own wisdom is often our state of mind at the time. When we operate on either end of the spectrum, we miss out on the big picture through the lense of Wise Mind. You can't overcome emotion by being rational and you can't force reason to become emotional.

By learning what is happening to parts of your brain when in crisis, you can direct your mind to change your actions. In the long term this changes the way your brain functions. Those who have experienced trauma do, in fact, have brains that work differently. Despite what you may have been told, this isn’t necessarily a bad thing. Trauma teaches us compassion, understanding, enlightenment, kindness, and empathy.

As we heal and learn to manage our emotions, aspects of our personality we used to experience as liabilities can be used to strengthen our lives.

Fact: You are changing the structure of your brain through practising Dialectical Behavioural Therapy.

Fact: With the right supports in place, you can create a life worth living.

Fact: You do not deserve to feel guilty or ashamed when you have an emotional response. 

Fact: Those diagnosed with BPD are some of the most compassionate human beings with the kindest hearts.

Fact: "Feeling everything" isn't always a bad thing.

The most important fact is that you can transform your trauma.