Borderline Personality Disorder (BPD): What is it and how to treat it?

While most of us have heard the term Borderline Personality Disorder (BPD), many of us do not know much about what BPD is, what the indicators are, what causes it or how it can be managed.

This article explores these questions. It aims to provide general information about Borderline Personality Disorder.

BPD is a complex, serious disorder that can have devastating consequences. It needs accurate diagnosis and professional treatment. Therefore, if you or someone you know appears to have symptoms that may indicate BPD, it is imperative that accredited mental health practitioners be consulted for expert information, advice, support and treatment.

What is borderline personality disorder?

The Mayo Clinic defines borderline personality disorder as a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes self-image issues, difficulty managing emotions and behaviour, and a pattern of unstable relationships (2021).

  • Self-image issues: People with BPD can have confusing and fluctuating ideas about who they are and where they fit in their world.
  • Difficulty managing emotions and behaviour: People with borderline personality disorder may be emotionally intense and volatile. In seeking to manage their emotions they may resort to expressions of frustration and anger, even self-harm.
  • Problems relating to other people: Mood swings, and unpredictable or impulsive behaviour can make it difficult for the person with BPD to develop and maintain relationships. At the same time, they find it difficult to be alone.

Borderline personality disorder can be a very serious condition. It can cause significant distress and can lead to family, social and work problems. In addition to managing the condition itself, people with BPD may also have to deal with misunderstandings that are often associated with the term.

Common misconceptions can include beliefs that those with BPD are attention seeking, or hypochondriacs, or will not help themselves. These misconceptions can result in stigma and discrimination towards those with BPD. This has seen some discussion about renaming the condition. However, the term continues to be widely used.

BPD is a serious, stressful and sometimes misunderstood condition, but is considered to be very treatable. Successful treatment begins with an accurate diagnosis.

What are the symptoms of borderline personality disorder?

There is some variation in the way symptoms associated with borderline personality disorder are described. However, there is broad agreement about what these symptoms are. Table 1 lists and describes these. The symptoms are based on the listing on the HealthDirect BPD diagnosis website. The explanation of each symptom is a synthesis of current discussion in the professional literature. References to this literature can be found at the end of this article.

Table 1: Symptoms of borderline personality disorder

Symptom
Explanation
Frantic efforts to avoid real or imaginary abandonment.People with BPD may be extremely anxious about maintaining relationships. They may constantly worry about being abandoned or rejected. This fear can be present even in everyday situations which most people view as acceptable behaviour – for example, a partner arriving home late or going out alone with friends. To avoid abandonment, the individual may resort to begging, arguing, and possibly even physical force. Such behaviour can drive family and friends away, thereby exacerbating the situation.
Consistently intense and unstable relationships with other people.While they may desire stable relationships, people with BPD constantly struggle to develop and maintain these. Their relationships with family, friends and loved ones tend to be intense and unstable, swinging rapidly from feelings of deep intimacy to feelings of strong dislike. These rapid swings and extremes can be frustrating and emotionally draining for partners, friends, or family members.
Low self-esteem and unclear or unstable self-image.A person with BPD may have low self-esteem and an unstable self-image. Sometimes they feel positive about themselves while at other times they may feel dislike, even hatred of themselves. They can be confused about who they are and their place in the world. This low self-esteem and lack of clarity can see the individual with BPD constantly changing their mind about their friends, partners, beliefs, values and career and life goals.
Impulsive behaviours that are potentially self-damaging.Impulsive, potentially self-damaging behaviours may be a way of coping with strong feelings and emotions. They can include spending sprees, risky sexual behaviour, substance abuse, driving recklessly or binge-eating. These behaviours may provide some positive feelings in the short-term but can have long-term negative consequences. This symptom does not include self-harming/suicidal behaviour which is viewed as a separate symptom of BPD.
Ongoing self-harming behaviour, suicidal behaviour or threats.Some people with BPD may attempt to harm themselves by, for example, cutting or burning. They may also think, talk about, or show suicidal behaviour. This may be a way of expressing emotional pain.
Intense, feelings lasting hours to days.A person with BPD can experience intense emotional mood swings. These swings are so intense that they interfere with everyday life. Someone with BPD might feel fine one second and then really angry or upset the next. Because the individual can be oversensitive, these changes in mood may often be disproportionate and easily triggered by things that other people would brush off. While intense, these mood swings tend to pass fairly quickly with each episode lasting from a few minutes to a few hours or, occasionally, a few days.
Long-term, chronic feelings of loneliness and emptiness.A person with BPD may experience feelings of emptiness or emotional detachment. This may be accompanied by feeling lonely and hopeless.
Difficulty controlling intense and inappropriate anger; moodiness and irritability.While everyone feels angry or irritable sometimes, a person with BPD feels intense inappropriate anger that is out of proportion to the apparent cause. They also have difficulty controlling these emotions and may exhibit constant displays of bad temper, irritability and anger. This can escalate into physical aggression.
Feeling paranoid and emotionally detached.An individual with BPD, particularly when they are feeling stressed, may have suspicious thoughts about the motives and actions of other people. This makes it difficult for them to trust people. This may be exacerbated by feelings of dissociation, of being out of touch with reality, or feeling as if they are outside their own body.

People with BPD experience some, although not necessarily all of these symptoms. They may also occur in different combinations, so people with a diagnosis of BPD can seem very different from one another.

It should also be noted that some of the symptoms discussed here could point to other mental health conditions. A diagnosis of BPD may be made if an individual has several symptoms that are long-standing and impact on many aspects of their life. This diagnosis should be made by an accredited mental health practitioner. It is important that such a professional be consulted if you or someone you know is experiencing a number of the symptoms described here.

What causes a person to develop borderline personality disorder?

While research is still exploring this question, our understanding about the exact causes of BPD, current knowledge indicates that a combination of family history, genetics, brain factors and environmental, social and cultural factors may make an individual vulnerable to developing BPD (Ref). Again, the following description of these factors is a summary of current discussion. See the end of this article for information sources.

Family History

BPD appears to run in families. People who have a close family member with BPD may be at higher risk of developing borderline personality disorder. However the extent to which this is due to genetics or environmental factors is still being researched.

Genetics

Some studies, particularly twin studies, suggest that genetics may be a factor in BPD. However the NHS (2021) in England notes that there is currently no evidence of a specific BPD gene.

Brain factors

Some research suggests that People with borderline personality disorder can have structural and functional changes in the brain especially in the areas that control impulses and emotional regulation. But again, it is not clear whether these changes are risk factors for the disorder, or a consequence of the disorder (National Institute of Mental Health, 2021).

Environmental, Cultural, and Social Factors

People with borderline personality disorder appear to have a number of environmental, cultural and social factors in common. These include childhood experiences of trauma or neglect, abuse and/or parental insensitivity.

Although these factors may increase the risk of developing BPD, their presence does not mean that the individual will develop borderline personality disorder.

At what age does borderline personality disorder develop?

Borderline Personality Disorder is usually diagnosed in adolescence or young adulthood although some symptoms may be present in younger children.

When making a diagnosis, mental health professionals take into account that some behaviours associated with BPD are to some extent characteristic of adolescence itself. For example, many adolescents indulge in risk-taking behaviours such as experimenting with sex, alcohol or drugs.

However this may be more due to curiosity than to escape painful emotions. At the same time, it is important to identify and begin supporting adolescents who are experiencing BPD. Mental health professionals generally look for symptoms that have been occurring for more than a year – symptoms that are persistent and unlikely to be limited to a particular developmental stage such as adolescence.

How is BPD treated?

Treatment for the person with BPD

With early diagnosis and appropriate treatment and support, the prognosis for people with BPD is positive. The primary approach for managing BPD is psychotherapy – talking to a psychologist or therapist in one-on-one or group settings. A therapist or counsellor can tailor a psychotherapy program for each individual. Therapy for borderline personality disorder aims to help the individual to better understand and manage his or her feelings, responses and behaviour.

There are several different psychotherapies that are used. They include dialectical behaviour therapy, schema-focussed therapy and mentalization-based therapy. Dialectical behaviour therapy was developed specifically to treat BPD. This therapy focuses on helping people with BPD to manage their emotions, deal with stress and develop more enduring relationships.

While some people may take medication to help manage symptoms, there are no medications to specifically treat BPD.

Many factors affect the length of time it takes for symptoms to improve once treatment begins, so it is important for people with borderline personality disorder and their loved ones to be patient, persistent and consistent in following the treatment recommendations of their mental health therapist.

Help for family and friends

Borderline personality disorder impacts not only on the diagnosed individual, but also their loved ones, family and friends. Families and friends are more able to offer support to the individual, and to cope better themselves when they have some understanding about the condition. Therefore, therapists and support organisations may offer support programs for family members and carers.

Information in this article is not intended as a substitute for informed professional advice. If you or someone you know is concerned about possible borderline personality disorder, you should consult with an appropriate healthcare professional.

References

Biskin R. S. (2015). The Lifetime Course of Borderline Personality Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(7), 303–308. https://doi.org/10.1177/070674371506000702

Health Direct (2021), Borderline Personality Disorder (BPD) Diagnosis https://www.healthdirect.gov.au/borderline-personality-disorder-bpd-diagnosis

Mayo Clinic (2021) Borderline Personality Disorder https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237

NHS (2021) Borderline Personality Disorder, https://www.nhs.uk/conditions/borderline-personality-disorder/causes/

About the editor, Amelia Cambrell

About the editor, Amelia Cambrell

Amelia Cambrell, Psychologist & Counsellor, BA; BSc (Hons); M Psych (Counselling); Dip Clin Hypnotherapy, is a senior psychologist at Counselling in Melbourne and with 15-years of experience in the mental health space is driven to seek client outcomes.

Find out more about Amelia Cambrell

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