Borderline personality disorder (BPD)
We recognise that borderline personality disorder (BPD), as with the other types of personality disorder, can be considered a controversial diagnosis. It is completely your choice which term, if any, you want to use, knowing that your doctor or care team may use another.
We appreciate that the feelings and behaviours associated with personality disorders are very difficult to live with, and everyone deserves understanding and support. We recognise the diversity in understanding of experiences and preferences around terms individuals may wish to use. We are also aware that some professionals disagree with the system of personality disorder diagnosis, and that some people given the diagnosis find it unhelpful and stigmatising.
The terms used on Counselling Directory are those that are generally used in the UK, currently. We refer to these terms throughout, with the hope of reaching and supporting as many people are possible.
What is BPD?
Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a type of personality disorder. You may be diagnosed with a personality disorder if you have difficulties with how you think and feel about yourself and other people, and as a result, are having problems living your life.
Despite affecting around one in 100 people, BPD/EUPD is often misunderstood. Symptoms of BPD/EUPD can be very similar to other mental health problems and so, misdiagnosis is common, and many people struggle to find the support they need.
In this video, accredited psychotherapist Bola Shonubi MSc (Psych) MBACP explains more about borderline personality disorder, the benefits of therapy, and how to find the right counsellor for you.
Borderline personality disorder symptoms
Borderline personality disorder can produce a wide range of symptoms. Because people can have very different experiences, and many symptoms are similar to that of other mental health problems, understanding of BPD/EUPD is often limited.
If you are worried that you or a loved one has BPD/EUPD, you should make an appointment with your GP. Here you can talk about your feelings and explain your symptoms, which will help your GP to make a diagnosis. They will want to know how your experiences 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 treatment.
If your GP suspects you have BPD/EUPD, they will refer you for further support. This may include sending your details to your local community mental health team (CMHT).
You may be given a diagnosis of BPD/EUPD if you experience at least five of the following signs and if they have lasted for a long time, or are having a severe impact on your life:
- You feel very worried, or have extreme reactions to feeling abandoned.
- Your emotions can be very intense, lasting hours/days and can change very quickly.
- You lack a sense of self, and it can change significantly depending on who you are with.
- You feel empty often.
- You find it difficult to make and keep stable relationships.
- You can act impulsively, in a way that could be damaging, such as substance abuse.
- You often self-harm or have suicidal feelings.
- You have very intense, hard to control feelings of anger.
- You may experience paranoid thoughts or dissociation when stressed.
What is quiet BPD?
The term quiet BPD may be used for those who don't have typical or outward appearing symptoms of borderline personality disorder. While this isn't currently a recognised subtype of the condition in the medical world, understanding quiet BPD symptoms can be helpful when it comes to diagnosis and treatment.
At the core of quiet BPD is internalised anger: rather than 'acting out', you 'act in'. Rather than expressing your feelings towards others or seeking help, you hide how much you are suffering to the point of implosion.
For people with BPD, ‘splitting’ is a commonly used defence mechanism that is done subconsciously in an attempt to protect against intense negative feelings.
Splitting causes a person to view things in black and white, ‘absolute’ terms, stopping them from being able to recognise any ‘grey areas’. This allows the person to tolerate difficult and overwhelming emotions by seeing someone or something as either good or bad, idealised or devalued. This can make it easier to manage the emotions that they are feeling.
Living with BPD
Symptoms of BPD/EUPD can range from mild to severe, affecting each individual differently. Your experience of living with BPD/EUPD will be unique to you, however, there are some common experiences you may recognise, including:
- difficult feelings and behaviour towards yourself or others
- alcohol and substance misuse
- other mental health problems, such as anxiety and panic attacks, depression and PTSD
- experiences of facing stigma
Whether you experience milder, or more severe symptoms, the impact it can have on your life and those around you can be significant. With BPD/EUPD, you may find it hard to cope with the demands of everyday life, feeling a range of difficult emotions and unpredictable mood changes. Some people feel particularly sensitive to disapproval and rejection and as a result, need the comfort and affirmation of others to support their self-worth and self-image.
Other people may take a disliking to those around them. You might feel like nobody understands you, or that you don’t understand them, or that loved ones will leave you if angry or upset. As a result, you may get angry or frustrated with people, or push people away. These behaviours can make it difficult for others to understand the behaviour, which can then lead to unstable relationships and enhance feelings of loneliness.
Without the right support and the misunderstanding and stigma that surrounds BPD/EUPD, life can be incredibly lonely. But there is help available. Progress is being made and slowly, people are learning more about BPD/EUPD and the stigma is starting to diminish.
I wanted to be there for people when no one was there for me
- Read Chris’ story.
Talking therapies are thought to be the most helpful treatment for BPD/EUPD, although more research is needed into the types of treatments that are most effective. Two talking treatments recommended by the National Institute for Health and Care Excellence (NICE) are dialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT).
Counselling can be a long process, but it can help people to get a better understanding of their thoughts, feelings and behaviour. A counsellor will provide support and guidance in a safe, non-judgmental space, where clients can discuss what they are experiencing.
DBT is an approach that aims to address two key factors of BPD/EUPD: emotional vulnerability and a person’s environment. The goal of DBT is to help clients believe that their emotions are acceptable, valid and real. DBT aims to help people ‘break free’ from seeing their world as narrow, rigid or limiting and instead, find freedom and opportunity. DBT uses individual and group therapy and is recommended by NICE as being a helpful treatment for women with BPD/EUPD who have a history of self-harming or suicidal behaviour.
Another type of long-term psychotherapy thought to be effective in managing BPD/EUPD is MBT. Based on the concept that people with BPD/EUPD have poor capacity to mentalise (think without thinking) MBT aims to help a person recognise and understand their own and other people’s mental states. It aims to teach people how to ‘step back’ and examine their thoughts about themselves and others, questioning if they are valid or not.
Before, I didn't really understand why I was feeling the way I was; my moods were so up and down for no real reason. My counsellor has helped me to understand my mental health struggles and how what I have been through has had a major impact on my life
- Read Sarah’s story.
When you’re ready to contact a counsellor, take your time during your search. We encourage our members to provide as much information as possible in their profiles, so you can learn more about the way they work and their experience. Once you’ve found a counsellor you resonate with, simply send them an email.
Different views on diagnosis
While some people find a diagnosis a helpful way to explain and for others to understand their difficulties, some people disagree, instead finding diagnosis unhelpful and stigmatising.
Some of the symptoms of BPD/EUPD are similar to that of other mental health problems, such as bipolar disorder, depression and complex post-traumatic stress disorder (PTSD). Because of this, and depending on your life and how you are feeling at that time, the professional you are speaking to may find it hard to understand which diagnosis best fits your experiences. This can lead to misdiagnosis and a recommendation for treatment for something other than BPD/EUPD.
What if I disagree with my diagnosis?
If you’re unhappy with your diagnosis, it’s important you speak to a mental health professional so you can make sure you are getting the right treatment. Remember, it’s OK to ask for a second opinion or to speak to someone different - your health and happiness are the priority.
How can I help myself?
If you experience BPD/EUPD, it can feel like every day is a struggle. But there are lots of things you can do to help yourself, both now and long term.
Mental health charity, Mind has some great suggestions for coping with some of the intense feelings you may be experiencing. They recommend, when you’re feeling overwhelmed, to try focusing on one feeling at a time and practising some steps to get through it. For example, if you are feeling angry or frustrated, try listening to loud music, ripping up paper or doing a practical activity, like gardening.
Visit Mind for tips and suggestions on how to cope with ‘right now’.
As well as these more timely suggestions, there are lots of things you can try that may help you manage certain experiences and live your life as full as possible, including:
- talking to someone
- keeping a mood diary
- make a self-care box
- try peer support
- look after your physical health
- make a support plan (NICE recommend that everyone with BPD/EUPD has a crisis plan)
Because borderline personality disorder is a complex diagnosis that is typically misunderstood, you may find that some people have misconceptions about those with BPD/EUPD, or have a negative image of it. This can make the diagnosis and living with BPD/EUPD very difficult. You may feel hurt or frustrated at the lack of understanding, especially if the person feeling this way is someone close to you or someone you trust.
But, it is important to remember that you are not alone, and there is support available. If you’re experiencing stigma or discrimination, know that you have options. Consider the following:
- Talk. Talk to people and provide them with information to help them better understand BPD/EUPD and what your diagnosis really means.
- Get involved in your treatment. Remember, you do have a say in your treatment and if you’re not happy with the options provided, you have other options. Mind has information on seeking help for a mental health problem, which you may find helpful.
- Know your rights. You can find more information about your rights on our disabilities and discrimination pages.
- Take action. Raise awareness of mental health and challenge stigma.
- Personality disorders
- Antisocial personality disorder
- Avoidant personality disorder
- Dependent personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
- Obsessive-compulsive personality disorder
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder