IPOH: Stormy relationships, intense mood swings and suicide attempts are among the experiences faced by Malaysians with borderline personality disorders (BPD).

For those living or working with them, the experience is like "walking on broken glass".

"They consume you emotionally. They want to get under your skin and into your mind," said psychotherapist associate professor Dr Brian Ho Kong Wai at his plenary talk at the Seventh Perak Mental Health Convention yesterday.

The usual reaction was to reject a person with BPD, which only reinforced their feelings of betrayal and abandonment.

BPD was a common psychiatric disorder, he said, estimating that one or two out of every 100 Malaysians had it, and that it was more common in women.
According to Ho, Susanna Kaysen, who wrote her memoir entitled Girl, Interrupted, had BPD, while other celebrities, including Marilyn Monroe and Princess Diana, were said to have many traits indicating that they had BPD.

Besides having difficulties in maintaining close relationships, those with BPD had feelings of emptiness and engaged in risk-taking behaviour which put them in circumstances which were inherently dangerous, he said.

They might also be confused about their identity, have brief transient psychotic or disassociative episodes, experience significant disruption to their relationships and work, and be sensitive to criticism and feared rejection, he added.

Are people with BPD manipulative?

"We are all manipulative. We don't become what we are without being manipulative.

"If you are a businessman, you will network with others. Is that being manipulative?

"Someone who is truly manipulative will not be discovered as such. We are talking about those who are faulty in the skills and ways of dealing with people."

Ho said that problem could have been caused by childhood BPD, a common disorder from neglect or abuse, or a traumatic event which led to a person failing to mature from seeing "black and white" such as good-looking heroes and ugly villains as described in fairy tales, to accepting "grey" areas.

"Everything is clearly right or clearly wrong to them. There is no middle ground. What they perceive as good is idolised and omnipotent.

"When they find that it is gone, it is hated and rejected. There is a lot of negativity."

He said the main treatment of BPD was not medication but building trust and negotiating with patients, helping them accept changes, identify their emotional reactions and learn new skills like being mindful and adapting.

"You have to do a little re-parenting in helping them to grow and go. Remember that some of them had traumatic childhood experiences and lacked nurturing."

While many improve as they grow older, those who recover more quickly are those who are likeable, honest, able to see the truth about themselves, willing to try to improve themselves and seek therapy, and have a supportive group of friends and family.