How should a Christian view borderline personality disorder (BPD)?

borderline personality disorder, BPD
Question: "How should a Christian view borderline personality disorder (BPD)?"

Note: as with many psychological issues, there are often both a physical and spiritual aspect to personality disorders. While we believe psychologists often miss the spiritual nature of the sickness, we strongly encourage anyone suffering with mental illness to seek medical attention and counseling.

Answer: In general, people with personality disorders show a pattern of thinking and behavior that conflicts with the basic expectations of their culture. Personality disorders adversely affect the person’s life and typically begin in adolescence or early adulthood. Many people with personality disorders also have other mental illnesses such as anxiety or depression.

Borderline Personality Disorder
Borderline personality disorder (BPD) is a significant mental health disorder that is so disruptive it was once thought untreatable. Borderline personality disorder is a pattern of instability in interpersonal relationships, problems with self-image, intense emotions, and impulsive behavior. Two significant impairments characterize BPD: an inability to know oneself and an inability to understand one’s value to others. A common description of BPD is “I hate you—don’t leave me.”

People with borderline personality disorder have a weak sense of self-identity. This leads to a host of reactions including low self-esteem, a belief that they are evil or bad, a sense of emptiness, and even dissociative episodes brought on by stress. These traits can manifest in dramatic and impulsive changes in careers, sexual identities, and/or values.

Unable to find worth in themselves and finding it difficult to maintain a stable environment, people with borderline personality disorder seek approval from others. This search, however, is fraught with danger as it mixes with a fear (real or imagined) of abandonment. People with BPD have great difficulty reading others and a tendency to interpret relatively benign social situations as rejection, disrespect, or abuse. Those with borderline personality disorder seek love and approval from others. Their minds tend to latch onto a single person they believe will meet all their emotional needs. But when the idealized individual is unable to provide sufficient and consistent support, those with borderline personality disorder quickly become disillusioned. This leads to fear of abandonment and affirmation that they are bad or unworthy of love. There may be episodes of fierce anger, then guilt, which again feeds the belief that they are bad.

Borderline personality disorder makes stable relationships difficult. Attempts to find peace lead to impulsive behavior such as substance abuse, gambling, or binge eating. Self-harm and suicide rates are high among people with borderline personality disorder. The aspect of borderline personality disorder that most adversely affects relationships is the swing between relational idealization and disappointment that manifests in angry outbursts. The mood swings sabotage the good and stable relationships that they so desire. Those with borderline personality disorder also tend to be highly intelligent, which makes it difficult to change their point of view by arguing.

Causes of Borderline Personality Disorder
The mental health medical field has had problems determining what exactly causes borderline personality disorder. There is a definite genetic link, as direct relatives are five times more susceptible to having the condition. It is most likely caused by a traumatic event or (real or perceived) abandonment during childhood that was not sufficiently addressed, mixed with a physiological or psychological predilection. Some say a child who feels neglected swings between acting out and being good in a search for attention, and, when the desired level of attention does not come, the pendulum swings ever wider until the child can find no equilibrium. But borderline personality disorder can certainly be found in people who had loving, supportive parents.

Treatment of Borderline Personality Disorder
Borderline personality disorder can be a pervasive force in one’s personality, but it does tend to mellow with age and experience. Drugs have little effect, although they may be prescribed for secondary issues such as anxiety. Some Christians with borderline personality disorder have learned to moderate their symptoms by focusing on the sinfulness of their reactive behavior. When they feel angry and resentful, they release those feelings to God. When they feel empty, they remember their identity in Christ. This requires a lot of hard work and spiritual support. Mitigating the symptoms of BPD is not easy.

In recent years, dialectical behavior therapy (DBT) has provided significant help for some individuals with borderline personality disorder, perhaps accelerating the lessons otherwise learned through experience. DBT teaches how to interpret and interact with the world as it is, not as it feels. It helps patients pause and logically consider what they are experiencing, realize which experiences are harmful and which are normal, and remember to express needs directly, without resorting to manipulation. It includes a form of cognitive-behavioral therapy (CBT) that teaches the patient how to change core beliefs that cause unwanted behavior. Dialectical behavior therapy does not have a biblical basis, per se, but it does help those with wounded minds interpret and interact with God’s creation in more biblical ways—for example, taking every thought captive (2 Corinthians 10:5) and being slow to anger (James 1:19).

For the Person with Borderline Personality Disorder
There are a couple of aspects of borderline personality disorder that make the Christian walk particularly difficult. When you are filled with overwhelming feelings of failure and worthlessness, it can be easy to think those thoughts are God’s point of view and not a trick of the disorder. The quick shift to victimhood doesn’t help, as simple religious customs are reinterpreted as oppressive or even abusive. It is important to realize that BPD pushes you to react in ungodly, sinful ways. The Christian with BPD needs to remember that God’s Word is truer than our fallen interpretations, and His commands are right, where our natural tendencies are wrong, even if they feel justified. As 1 Corinthians 13 says, love is patient and kind, not irritated and selfish. Love does not insist on having things its own way. It is not resentful. It bears and endures hardships and doesn’t put the blame on others. Part of being loving means trusting God with your needs and not demanding that others give what only Christ can (Philippians 4:19).

Borderline personality disorder is a serious condition that adversely affects the way you interpret yourself, other people, and the world. Remind yourself of the truth: God loves you, sometimes in ways you don’t appreciate at the moment. Jesus died for your sins, and, if you have accepted Him, God sees you as sinless. Feelings, especially those that are amplified or driven by misinterpreted experiences, are not always representative of the truth.

God will never leave you or abandon you (Hebrews 13:5). If you seek God, you will find Him (Jeremiah 29:13). If you seek first God’s perspective and His reality, you will subsequently find what you need (Matthew 6:33).

For Friends and Family of Those with Borderline Personality Disorder
The highly personalized, rigid worldview and great emotional needs of someone with borderline personality disorder adversely affects loved ones. When God doesn’t come through in the exact way the person wants (which is inevitable when childhood abuse or abandonment is involved), anger flares, and God is rejected. It can be extremely difficult to speak of God’s love and grace to someone who is convinced he is worthless unless he sees you loving him in the way he wants. Prayer is always the first step for any friend or family member of someone with BPD

The next step is to get educated. People with borderline personality disorder need friends with strong hearts and stronger boundaries. Boundaries define what behaviors the friend will tolerate (such as the hours they will pick up the phone) and should reflect the boundaries given in the Bible. Consistently but lovingly pointing out the natural consequences of sinful behavior will help the person with BPD remember the Bible has a truth that is not always accessible to the over-emotional mind. These limits are essential to protect the mental health of the friends so they can continue to be supportive.

Family and friends also need to be able to speak truth repeatedly, offering alternatives for perceived malicious motives or giving reminders that others have the right to have different points of view and different needs. They need to recognize when a discussion is spiraling out of control and the conversation needs to be redirected. If the person is going through DBT or CBT, friends should learn the basics so they can reinforce the therapy tools.

Self-care for friends and family includes occasional reminders of their own reality when their loved one with BPD lashes out in anger and blame. It helps to remember that those with BPD often resort to chronic lying to prevent abandonment. And friends and family should consider enlisting outside support for themselves, even a counselor if need be, so the caretakers are also cared for.

Borderline Personality Disorder and Salvation
The Bible’s promise is clear: “For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord” (Romans 8:38–39).

Emotional wounds, cognitive inabilities, past abuse, and feelings—none of these are powerful enough to prevent God’s love from shining on those who trust in Christ. Our salvation is based on Christ’s work on the cross, not our broken feelings. All believers need reminders of God’s goodness and Jesus’ sacrifice and love; people with BPD just need those reminders more often. All believers need a community for encouragement and exhortation; people with BPD need a community that is exceptionally stable.

The offer of God’s salvation brings up one more truth for both the person with BPD and his or her loved ones: forgiveness. If you suffer from BPD, you must learn to forgive those who do not meet your expectations, whether those expectations are legitimate or unrealistic. If you know someone with BPD, you must learn to forgive the neediness, lies, and volatile emotional outbursts. For either person, you may need to spend some time apart, but do so as an opportunity to seek guidance and support from God, not out of anger. “Love covers all offenses” (Proverbs 10:12, ESV). As Jesus said, we are to forgive our brother seventy-seven times (Matthew 18:21–22). Our Lord is exceptionally experienced in forgiveness and can equip us to follow His lead.

Recommended Resource: Blame It On the Brain? by Edward Welch

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