Dan came into his therapist’s office convinced his wife had Borderline Personality Disorder (BPD). After reading several articles and blogs on the internet, he diagnosed her erratic behavior, heightened sensitivity, occasional outbursts, and mood swings as evidence of BPD. He desperately wanted the therapist to affirm his analysis, confront his wife and “make her better”.
Having met his wife already, the therapist was not convinced of his perspective. But because he was so insistent, the therapist ran through the BPD checklist as outlined in the DSM-5 with the wife and not Dan. While his wife had some of the characteristics, she did not meet the full standards and had some glaring missing necessities to meet the criteria. However, the discussion of the symptoms did lead to another possibility: a highly sensitive person (HSP).
This is a common mistake made by people who don’t understand the difference between the two. While most BPDs and are also HSPs, the reverse is definitely not true. HSPs can even do some BPD behaviors when under the extreme stress of abuse or trauma, but it is not pervasive (in every environment) which is an essential element for BPD. Here are some other areas of similarities and differences:
- Heightened sensitivity: A common characteristic shared by people with BPD and HSP is an acute awareness of their own emotions and the emotional energy of others. Both feel and sense the full range of each individual emotion. For instance, anger can be felt on a scale from 1 to 100. Whereas others may only feel it from 1 to 10. While both groups are able to sense the emotions of others, a person with BPD actually absorbs the emotion and is unable to separate themselves from that emotion.
- Love relationships: When a person with BPD or HSP falls in love, they give their entire self over to the other person. The difference is a person with HSP tends to be selfish at the beginning of the relationship, withholding large parts of themselves until they feel safe. A person with BPD dives right in without any hesitation regardless of any warning indicators about the other person.
- Abandonment: A BPD’s intense and pervasive fear of abandonment (whether real or imagined) literally permeates their decision making abilities. This is at the core of a diagnosis of BPD and is wholly necessary. Friends, family, partners, children, and co-workers can all testify to panicky reactions a person with BPD expresses when the fear is activated. A person with HSP might be also be fearful of abandonment and react very emotionally when it happens, but it does not propel them into self-destructive behaviors and is not seen by every person in their sphere.
- Trauma response: One of the gifts of a person with BPD is the ability to dissociate during traumatic events. This is a survival coping mechanism which comes naturally to BPDs. The ability to step outside of one’s self during abuse/trauma allows the ego to stay intact. A person with HSP does not have this ability naturally. When they are met with abuse/trauma they shutdown, have a hard time moving forward, and even harder time forgiving. It is as if their emotions received too much stimulus and need long periods of rest before re-engaging.
- Depression: While other people may experience depression only a few times in their lives, persons with BPD and HSP experience it with regularity. When BPDs and HSPs discover that they feel deeper than others, this becomes a source of isolation, heaviness, and ultimately alienation. Both groups can become suicidal at times however, only persons with BPD struggle with these thoughts almost daily. To remove the pressure, BPDs tend to self-harm, act impulsive, or engage in high risk behavior. People with HSP tend to be too cautious to engage in this type of behavior as they tend to fear pain of all sorts.
- Mood swings: The ups of “You are the best” to the downs of “You are the worst person in the world” can be very confusing to others. But people with BPD and HSP really do feel these extremes on a regular basis as well as every emotion in between. Sometimes their emotions overtake them so quickly that they are unable to explain the source of the extremity. The big difference is that people with BPD tend to be willing to express themselves in any and all environments regardless of who is present. Whereas people with HSP tend to be more withdrawn in front of others and reserve their mood swings for a few safe people.
Once Dan was shown the differences between BPD and HSP, he eventually came around to agreeing with HSP. While the internet does provide useful information, it is extremely important that a person be properly evaluated by a licensed professional and not self-diagnosed.