“Attention seeking.” “Manipulative.” “Difficult.” “Crazy.”

These are words I’ve often heard others (even mental health professionals) use when describing someone with an attachment-based trauma disorder, otherwise known as borderline personality disorder (BPD). To me, this feels like one of the more stigmatized mental health disorders, likely due to a misunderstanding of what it is like for someone living with the after effects of an attachment-based trauma. I can remember the first client I had as a therapist almost 5 years ago that struggled with attachment-based trauma, and how initially I thought it was something else like depression. Once I realized that this person was living with BPD, it became clear that the most helpful tool I could use was connection. Since working with this person, I have had many other experiences of working with folks with attachment-based trauma, and I’ve realized just how stigmatized BPD can be, which has led to a great passion for me for serving this community of folks. As a self-proclaimed advocate for folks with BPD, my mission as a therapist is not only to support folks that have a BPD diagnosis, but to also de- stigmatize this diagnosis and help others better understand what it is like for folks who live with BPD.

What is BPD?

There are a couple ways to really define what BPD is – the very clinical, DSM-based kind of way, and from the perspective of someone experiencing BPD. First up is the clinical definition of BPD, as defined by the DSM:

– Frantic efforts to avoid real or imagined abandonment
– A pattern of unstable and intense interpersonal relationships characterized by alternating extremes between idealization and devaluation
– Identity disturbance: markedly and persistently unstable self-image or sense of self – Impulsivity in at least two areas that are potentially self-damaging
– Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior – Affective instability due to marked reactivity in mood
– Chronic feelings of emptiness
– Inappropriate, intense anger or difficulties controlling anger
– Transient, stress-related paranoid ideation or severe dissociative symptoms

These symptoms can often overlap and feel connected. For example, someone that has experienced an attachment-based trauma can feel emotions very intensely and have difficulties managing anger, in addition to intense fears that someone very important to them is going to leave them. This can lead to difficulties in interpersonal relationships, both friendships and romantic relationships, as this person may end up ‘blowing up’ on an important person in their lives due to fears of abandonment and find themselves pushing this person away so they don’t end up being abandoned. Additionally, folks that have the recurrent suicidal ideation and thoughts of dying, often do not actually want to die, but rather want to make the emotional pain they are experiencing stop, and this is the only way they can think of to make that happen. Folks with BPD also may engage in life-threatening or self-damaging behaviors due to the recurrent thoughts of suicide or feeling ambivalent toward living and ambivalent toward dying. A quote that I feel accurately describes the intensity of emotional pain for folks with BPD comes from Marsha Linehan, BPD expert and pioneer of dialectical behavioral therapy (DBT): “People with borderline personality disorder are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” Thinking about emotional pain in this way, in my opinion, can help deepen empathy and understanding for folks with BPD.

On the flip side of the more clinical definition of BPD, there is the perspective of a person that is experiencing the symptoms of an attachment-based trauma. For this piece, I’d like to draw from a couple of authors who have a BPD diagnosis:

“What void am I trying to fill? It was a dumb question. I know the void. The void is the pit in my stomach that I can never fill, no matter how many bowls of cereal and pints of Ben & Jerry’s Americone Dream I eat. The feelings of abandonment when someone, after spending three days straight with me, has to go home. The frustration I feel when a partner is on top of me but I need the person closer, want our bodies to merge into one. When I get a text back but need a thousand. When I get attention but need a world of it. When I’m loved but it still isn’t enough.”

– Courtney Cook: The Way She Feels: My Life on the Borderline in Pictures and Pieces

“I’ve read that, for some borderlines, the flip side of abandonment fear is the fear of engulfment. It’s another one of those “screwed if you do, screwed if you don’t” situations. All you want is love and belonging, and your very existence depends on it. But when you get it, you have no existence except that love; there’s still no you.”

– Kiera Van Gelder, The Buddha and the Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy, Buddhism, and Online Dating

Origins of BPD

Something else that I believe to be helpful in increasing the understanding of this diagnosis is where BPD can come from. For most folks, BPD stems from attachment traumas experienced in childhood and often up into early adulthood. Attachment trauma is defined as a rupture in a healthy attachment. We come into the world without the ability to self-regulate, and in healthy attachments, caregivers are able to adequately teach regulation. If a caregiver is unable to meet these needs, development and growth are put at risk. In explaining what BPD is for folks that may have never heard of it, I usually will share that it stems from this rupture in attachment. Maybe a caregiver was not emotionally available, like they were physically present and met all your basic needs, but your emotional needs were neglected. Folks with attachment-based trauma often have either a disorganized or insecure attachment style, which comes from not having a stable or consistent connection with a caregiver in their childhood. In adulthood, this can result in either attaching too intensely with someone and/or pushing them away, sometimes both at the same time. When someone ends up attaching too intensely, it is because they fear losing this person as they’ve been abandoned earlier in life (usually by caregivers).

Common Misconceptions and How to Challenge Them

Folks often have a hard time understanding what BPD actually is. I have seen this from my experience working in various hospital settings. Folks with an attachment-based trauma end up coming to the hospital many times, either due to a suicide attempt, serious self-harm injuries, or just generally feeling unsafe with suicidal thoughts. The term ‘frequent flier’ gets used quite a bit with folks with a BPD diagnosis. This serves to further the stigma around this diagnosis, and will often deter folks with a BPD diagnosis from seeking help when they need it. The ultimate goal is to figure out how to manage these symptoms well enough outside of a hospital setting. If folks can zoom out from their perspective of someone being a ‘frequent flier’ and think about it a little differently, this person is seeking out safety and security, something that often feels like it is missing from their lives. I believe this can help reduce stigma a bit around the high utilization of emergency services for folks with BPD.

Other language I have heard used around this diagnosis includes – attention-seeking, difficult, manipulative. In my work with folks with BPD and also consultation with some compassionate and amazing therapists that also work with folks with BPD, the number one way to reduce the stigma is to shift the language we use. Instead of attention-seeking, what about something like connection-seeking? After all, we all need connection as humans, especially if we have experienced an attachment-based trauma. And instead of difficult, shifting the language to exquisitely interpersonally sensitive. Folks with a BPD diagnosis may struggle in interpersonal relationships, however that does not mean they don’t have a keen interpersonal sense. And when we think about someone being manipulative, what if we thought about this as a bid for caretaking? Folks with this diagnosis initially may not have the skills needed to ask for support and connection directly, and this ends up coming out in risky or impulsive behaviors/statements. I think shifting the language we use not only reduces the stigma but it also helps better understand what needs this person is trying to get met and overall helps better understand attachment-based trauma.

Treatment and Support for Folks with BPD

So what are the most effective treatments and support for folks with a BPD diagnosis? One-on-one therapy is a great starting place. Stable and consistent connection is the first step. From my perspective as a therapist (and I would say this holds true for anyone), building connection helps build trust, which increases the sense of safety in a relationship. After building and nurturing this connection, there are a few different treatment modalities that can be helpful for someone with this diagnosis:

– Dialectical Behavior Therapy (DBT): DBT was developed by Marsha Linehan specifically to help folks with attachment-based trauma manage their symptoms. DBT is traditionally taught in a group setting; however it can be used in 1:1 therapy as well, with the components being mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

– Cognitive Behavior Therapy (CBT): CBT is also a helpful treatment modality for folks with a BPD diagnosis. CBT works to identify and shift core beliefs and thinking patterns and can help reduce anxiety as well as suicidal ideation and engagement in self-harming behaviors.

– Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a type of trauma therapy that uses bilateral stimulation (often through eye movements but it can also be done through tapping) to shift negative core beliefs that surround trauma and ultimately helps reduce trauma symptoms. This can be a helpful treatment modality for folks with BPD after some work has been done to build emotion regulation and distress tolerance.

In addition to therapy, having support from others that experience similar challenges can be helpful. This can be available either through support groups or resources (books, podcasts, etc.) that help to reduce the stigma around BPD.

Helpful Resources

To wrap things up, I wanted to leave you with some resources that can not only help folks better understand attachment-based trauma but also can be great sources of support for folks experiencing challenges related to attachment-based trauma.


– The Buddha and the Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy, Buddhism, and Online Dating, Kiera Van Gelder

– The Way She Feels: My Life on the Borderline in Pictures and Pieces, Courtney Cook – Building a Life Worth Living: A Memoir, Marsha Linehan


– From Borderline to Beautiful: Hope & Help for BPD with Rose Skeeters, MA, LPC, PN2

– You and Me and BPD, Stef RB

– back from the borderline, mollie adler

Youtube Channels:

– Borderliner Notes

– The BPD Bunch

– Early Morning Barking – Talking about BPD and NPD

If you’ve made it this far, congratulations! One last note (and this is the last one, I promise 😉 ) is for folks struggling with BPD. I know that every day is a battle and things feel hard nearly constantly. Please remember that you are deserving of connection, love, and self-care. ❤️