How to Equip Employees with Borderline Personality Disorder to Flourish

For many employees who have borderline personality disorder (BPD), thriving in the workplace can feel impossible. 

Living with BPD often means grappling with symptoms like intense anger or difficulty controlling it, and experiencing paranoid thoughts or severe dissociative symptoms. With nine defined symptoms, it’s easy to understand how these challenges can affect job performance and the ability to gain acceptance and trust from co-workers and peers.

Unfortunately, most employers are not equipped to support a person with BPD. However, a reimagined workplace environment led by knowledgeable People leaders trained in the dynamics of BPD can make all the difference. 

Increased awareness and empathy can be transformative for employees suffering from BPD, providing the much-needed predictability, stability, and comfort required to flourish at work.

What is borderline personality disorder?

The DSM 5 defines borderline personality disorder as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts.” 

It is a unique type of personality disorder that causes significant emotion swings, including dramatic and erratic behaviors. 

BPD symptoms generally occur in four domains: affectivity (emotions), interpersonal functioning (relationships), cognitive functioning (thinking patterns), and impulse control. While the diagnosis of BPD requires that at least five (or more) of nine specific criteria (symptoms) be met, these three are generally required:

1. The person has symptoms that occur in a wide variety of areas, both personally (education, church, friends, family, recreation) and professionally (in the workplace).
2. These symptoms occur regularly and over many years, often with onset in the late teenage years or the early twenties. 
3. These symptoms involve all aspects of the person's functioning—how they feel, think, behave, and interact with others. 
   

It’s estimated that just 1.4% of the adult U.S. population experiences BPD. According to NAMI, nearly 75% of people diagnosed with BPD are women. Recent research suggests that men may be equally affected by BPD, yet are commonly misdiagnosed with PTSD or depression.

Both factors make correctly identifying BPD (as a non-medical professional) even more challenging. Despite its rare occurrence in the population, BPD is one of the most stigmatized mental health illnesses.  

At the same time, many people with BPD often have high levels of personal stigma due to widely-held prejudices and stereotypes, labeling sufferers as dangerous, weak-willed, unstable, and unreliable.

What does borderline personality disorder look like in the workplace?

People with borderline personality disorder are often more empathetic toward others, have a strong sense of other people's emotions, and can be more keenly perceptive to others in this way. 

An employee with BPD may appear similar to their co-workers. They may have interviewed very well and are excelling in their role on the team. Yet, with continued interactions over time, you may notice them struggling in various areas that weren't perceived before.. 

In the workplace, borderline personality disorder can manifest in several distinct ways:

• From a subjective point of view, people with BPD can feel empty, lonely, and insecure, as they haven't felt safe enough to develop a sense of self. 

• A high level of ambivalence, in terms of relationships with other people (sometimes referred to as “I hate you, don't leave me”). The DSM 5 describes this as “a pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation).”

• Commonly approach relationships from a place of insecurity. They might unintentionally be untruthful or deceitful with co-workers or managers as a result. For example, they may exaggerate what they did over the weekend to gain praise or affection from their peers. 
• Due to physiological and psychological imbalances, they are highly responsive to mood shifts, with difficulty regulating emotion. Across all personal relationships, you’ll see strong and sometimes unpredictable reactions. Any level of criticism from a supervisor can trigger feelings of abandonment or rejection, leading to outbursts, anger, or other impulsive behaviors.

• A person with BPD may not understand why others around them are upset, as they might not be the least bit upset themselves. They have a unique talent for upsetting the natural balance that previously existed. For example, they may spread unsubstantiated rumors or tell one co-worker one thing and tell another co-worker something entirely different.

• Their perception of the proper context for certain workplace situations is inconsistent with everyone else’s.
  

It’s important to remember that the severity of these symptoms can vary widely from person to person, ranging from manageable to severe (and completely unmanageable). 

What types of challenges can BPD present for People leaders?

Often, people with BPD are undiagnosed and have not sought mental health care or support. Unlike mental health disorders such as depression or phobias—where an individual would commonly seek ADA accommodations—people with BPD rarely do so because they don’t recognize the problematic nature of their symptoms. 

In fact, most people with BPD are entirely unaware of their condition—neither their behavioral traits nor their thoughts—and its impact on family, friends, and co-workers.

As a manager, you may only notice a specific behavior or action of a single employee and take it at face value. Maybe you attribute it to a “bad day” or built-up frustration boiling over. 

If you aren’t aware of the signs and symptoms of BPD (compelling you to examine the situation more closely), you’re unlikely to understand the root cause of why it’s occurring. 

How to reduce BPD stigma and support well-being in the workplace

Taking the time to educate yourself about BPD—to develop a basic understanding of what living and working with BPD is like—is the best first step you can take. Manager training on less common mental disorders can be the foundation for a new workplace environment that best supports people with BPD.

Here are several ways to create a supportive, positive, and inclusive environment for BPD:

• Since a lack of flexibility is a key feature for any personality disorder, creating a more consistent, structured workflow—with frequent, well-defined deliverables—can help them flourish.
• Establish open lines of communication with the employee to encourage them to communicate their needs, concerns, and limitations without fear of judgment or repercussions. Regular check-ins or one-on-one meetings can provide a safe space for discussions. 
• Respect the employee's privacy and maintain confidentiality regarding their mental health condition. Ensure that only essential personnel are aware of the situation and inform them about the importance of confidentiality.
• Work with the employee to establish effective ways of delivering feedback and praise. Understand their specific sensitivities and preferences regarding feedback, and strive to provide constructive feedback in a supportive and non-critical manner. Focus on highlighting their strengths and achievements, and provide specific examples of their positive contributions.
• Offer flexible work arrangements to accommodate the employee's mental health needs. This could include flexible hours, remote work options, or a modified workload during heightened stress or treatment.
• Pair the employee with a mentor or coach to help the employee navigate challenges, build confidence, and provide additional resources for personal and professional growth.
• Encourage meaningful conversations between HR leaders and employees that outline strategies to manage stress, triggers, and maintain mental well-being. This could include breaks, self-care activities, or access to therapy or counseling services on site. 
• Provide employees with access to an innovative EAP, offering mental healthcare that’s precise and 100% confidential. With insecurity playing a prominent role in the lives of people with BPD, having more people around them in a support role provides a greater sense of security. 

Fortunately, employers and peers of individuals with borderline personality disorder can access valuable resources to support them in the workplace. This can play a crucial role in fostering awareness and developing a deeper understanding of the significant challenges faced by people with BPD.

When we train leaders in the dynamics of BPD and provide them with comprehensive resources led by awareness and empathy, we can give these employees the essential elements of predictability, stability, and comfort in the workplace.   

BPD isn’t the only mental health challenge impacting your employees. Hear what it's like to live and work with Bipolar disorder from a Spring Health employee, and learn how you can better support Bipolar individuals and their families.