Borderline personality disorder
Borderline personality disorder (BPD) is a mental health issue that is characterised by severe mood instability and impulsive behaviour. Although it is more common than some other mental health conditions, BPD is often misunderstood. There tends to be some confusion about what it means and how it is treated.
The term 'borderline' derives from an assessment in the 1940s, which found that the disorder was on the border between psychosis and neurosis. This is no longer considered an accurate description. Today borderline personality disorder refers to a disorder of the mood and interpersonal function.
In some cases BPD symptoms improve with age, and some eventually disappear altogether. Most of the time the condition affects sufferers throughout their whole life. Fortunately there is treatment available to help get mood swings under control and promote healthier behaviour. This can allow sufferers to lead happier and more fulfilling lives.
This page will explore borderline personality disorder in more detail, highlighting common symptoms and causes. It will also look into the common therapies used in borderline personality disorder treatment.
On this page
- Living with borderline personality disorder
- Borderline personality disorder symptoms
- Borderline personality disorder causes
- Borderline personality disorder diagnosis
Living with borderline personality disorder
BPD ranges from mild to severe in different people. The impact it can have on the lives of sufferers and those around them can be significant whatever the severity. Essentially, people living with borderline personality disorder will find it hard to cope with demands of everyday life, and will experience a range of difficult emotions and unpredictable mood swings. They can be particularly sensitive to disapproval and rejection. As a result of this, they will need constant affirmation and comfort from others to support their self-worth and self-image.
At other times, however, people with BPD can take a disliking to those around them and may be verbally abusive. This erratic behaviour can make it difficult for others to understand and tolerate sufferers, which can lead to unstable relationships. Unfortunately strained relationships can only add to the feelings of loneliness, lack of support and unfair treatment in people with BPD.
On the other end of the BPD spectrum is intense impulsivity. Sufferers are likely to partake in risky activities such as gambling, promiscuous sex, shoplifting and substance abuse. This is to satisfy their urges and fend off feelings of emptiness. It is perhaps due to this behaviour that there is a lot of stigma surrounding this condition. Sufferers can appear determined to self-destruct and push people away. Despite being a widespread psychological disorder, BPD continues to be misunderstood. This makes the lives and well-being of people living with the condition even more problematic.
Borderline personality disorder symptoms
Borderline personality disorder produces a wide range of symptoms. Some of these may resemble those of bipolar disorder and depression. BPD is recognised as a condition of:
- emotional instability
- unhealthy patterns of thinking or perception
- intense but unstable relationships with others.
It is very complex and extensive in terms of its symptoms. Below we explore these four areas of the condition in more detail.
People living with borderline personality disorder will experience several negative emotions that alter their behaviour and thinking. These include rage, sorrow, shame, panic and long-term feelings of emptiness and loneliness. They may also have intense bouts of anger, anxiety or depression that can last several hours or even days. Mood swings will vary between periods of dysphoria to periods of euphoria, and from manic self-confidence to severe anxiety and irritability.
Unhealthy patterns of thinking
Borderline personality disorder is associated with a level of thinking that is considered unhealthy. Many sufferers will view the world in a rigid, black and white fashion. They will be unable and unwilling to accept alternative views and other people's opinions. There are also other unhealthy patterns of thinking common in people with BPD. These are categorised into three levels:
- Upsetting thoughts - Some people living with BPD will think they are terrible and horrid, and may feel like they don't exist. It can be hard for them to understand these beliefs. Many sufferers will seek constant reassurance that they are not true.
- Brief episodes of strange experiences - BPD Sufferers may have hallucinations such as hearing voices outside of their head. In some cases these instruct them to cause harm either to themselves or to others. It can be hard for sufferers to figure out whether these voices are real.
- Extended episodes of abnormal experiences - In some cases people will experience distressing beliefs and troubling hallucinations. Others can rarely talk them out of these beliefs and they can be quite severe, sometimes psychotic. For example, a BPD sufferer may believe that their family and friends are trying to kill them.
People living with borderline personality disorder will likely engage in reckless and irresponsible activities. These include gambling and binge drinking/eating. They may also experience uncontrollable impulses to self-harm. These often emerge out of anger, and suicide threats are not uncommon. Impulsive behaviour tends to be worse when a sufferer is in the middle of a brief psychotic episode. This is because their judgement is impaired.
Borderline personality disorder can put great strain on relationships. Sufferers often shift from great admiration to intense dislike of friends, family and loved ones. Their unpredictable behaviour makes it difficult for people to understand them and be supportive. Adding to complications is the fact that many BPD sufferers are scared of abandonment. This negative thinking can lead to an excessive dependency on others. Sufferers are more likely to make frantic attempts to avoid being left on their own.
- constantly phoning or texting other people
- making sudden calls to people in the middle of the night
- physically clinging on to particular people and refusing to let go
- threatening to harm or kill themselves if someone they value leaves them.
Alternatively, BPD can make sufferers feel like people are overcrowding or smothering them. This too can lead to fear and anxiety that trigger more negative behaviours. However in this situation sufferers tend to push people away rather than cling on to them. Typical behaviour involves emotionally withdrawing from social situations, rejecting others or being verbally abusive. Along with feeling misunderstood, bored and empty, BPD makes it incredibly hard for sufferers to maintain healthy relationships.
Borderline personality disorder causes
Borderline personality disorder causes are still unknown. However, there are theories that point to a combination of factors that are thought to shape a person's likelihood of developing the condition. These include biological, genetic and environmental.
It is thought that many people living with borderline personality disorder have an abnormally functioning neurotransmitter in their brain called serotonin. Altered serotonin activity has been linked to other mental health issues such as depression. It also leads to an inability to control destructive impulses such as drug abuse. Some evidence suggests that BPD sufferers may have altered functioning of two other important neurotransmitters - dopamine and noradrenaline. This may be behind their emotional instability.
It is thought that people with a family history of BPD are at a higher risk of developing the condition. However, research into a definite genetic link is limited.
The environment that a person grows up in is considered one of the most influential borderline personality disorder causes. The majority of sufferers show common signs of the following experiences:
- being a victim of physical, sexual or emotional abuse
- being exposed to distress or chronic fear as a child
- being neglected by one or both parents
- growing up with a family member who suffered from a serious mental health condition.
People with BPD often have troubled relationships and unresolved fear and anger relating to past traumatic experiences. It is for this reason that counselling is a highly recommended source of treatment. It helps sufferers explore and change a variety of distorted thinking patterns that can stem from childhood experiences.
Borderline personality disorder diagnosis
If you are worried that you or a loved one has borderline personality disorder, you should make an appointment with your GP. Here you can talk about your feelings and explain your symptoms. This will help your GP to make a diagnosis. They will want to know how your symptoms are impacting your quality of life and will make sure there is no immediate risk to your health and well-being. The aim will be to rule out any other mental health conditions. Then they will organise the next step in your recovery.
If your GP suspects you have BPD, they will refer you to a local community mental health team (CMHT). The CMHT will carry out a more in-depth assessment and will devise a special care plan to suit your needs. It will outline the various borderline personality disorder treatments and support groups available.
Borderline personality disorder treatment
Counselling or psychotherapy is nearly always the treatment of choice for BPD. Medication is typically only provided to help stabilise mood swings. Therapy can be a long process but it can help sufferers to get a better understanding of their thoughts and feelings. A therapist will provide support and guidance; encouraging clients to discuss sensitive issues and suggesting ways to resolve problems. The aim of therapy for BPD is to shape healthier thoughts and feelings and help sufferers to take control of their symptoms.
The two most common therapies used in borderline personality disorder treatment are:
Dialetical behaviour therapy (DBT)
Dialetical behaviour therapy is specially designed to treat BPD sufferers. This approach addresses two important factors that can contribute to the development of the condition: emotional vulnerability and a person's environment. The goal of DBT is to help clients believe that their emotions are acceptable, valid and real. It also teaches them to be open about their opinions and ideas, rather than thinking in a solely black and white mindset. These concepts are used to promote positive behavioural changes and help sufferers of BPD to perceive the world in a way that is not rigid or limiting.
DBT is recommended by NICE as a leading borderline personality disorder treatment option. It can be provided in group or individual sessions.
Mentalisation-based therapy (MBT)
This is an additional long-term form of borderline personality disorder treatment. It's based on the idea that people with the condition are unable to effectively examine their own thoughts and beliefs, or assess whether they are realistic. For example some people with BPD may have an urge to self-harm and will do so without questioning their behaviour. They lack the ability to take a step back and consider their actions.
Another aspect of this inability to 'mentalise' is failure to understand and recognise that other people have their own thoughts, feelings and needs. BPD also means sufferers will not see how their actions impact on other people's emotional states. This can further complicate their relationships. The goal of MBT is to address these issues and help clients to see themselves and others in a more realistic and healthier light.
What should I be looking for in a counsellor or psychotherapist?
At present there are no regulations that stipulate what level of training or qualifications a counsellor needs to treat borderline personality disorder. However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments, including the following:
- If borderline personality disorder causes you many problems, or you have other conditions, you may be offered a psychological treatment in a special programme usually run by a team of people.
- Psychological treatment lasting about a year or longer is best for people with borderline personality disorder.
- Women with borderline personality disorder who self-harm on a regular basis may be offered a treatment called dialectical behaviour therapy.
- You should not usually be offered medication specifically to treat borderline personality disorder or for any related symptoms or behaviour (such as self-harm, unstable moods and risky behaviour). This includes a type of medication called an antipsychotic as a long-term treatment.
- You may be offered medication called a sedative for a short time (no longer than a week) to help you in a crisis. You may also be offered medication to treat another mental health problem.
Read the full NICE guidelines:
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- Why do I feel nothing? Emptiness and borderline personality
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- What is Mentalisation Based Therapy?
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- ‘I can’t get it right’
Imi Lo: Psychotherapist, Art Therapist, Supervisor (UKCP,HCPC,MBPsS,MMH)26th December, 2013
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