Borderline Personality Disorder (BPD) is a mental health condition which causes a person’s feelings towards themselves and others to fluctuate between emotional extremes.
Living with BPD can make it hard for the person to trust others, to have a deep understanding of self, and to control their emotional state in times of conflict – big or small. This can lead to relationship breakdown, impulsive decision making, and a constant feeling of abandonment.
Yet, it is important to remember that BPD is not someone being difficult. People living with BPD are always managing their distress as best as they can. Navigating life is a constant challenge – not just when things are trickier than usual.
BPD can make it very hard to gain a strong sense of identity, to maintain interests, and to feel understood by loved ones. Without this foundation of self-understanding and self-value, people living with BPD can quickly feel both attached to and/or rejected by people around them – this could be friends, partners, co-workers.
Signs and symptoms
There are some very specific signs and symptoms that may suggest that someone may be experiencing BPD. These include:
- Difficulty controlling and regulating emotions: Someone living with BPD may find it hard to control how they feel towards themselves and others. They can be very quick to direct negative emotion towards others or themselves. The triggers for these negative feelings can be hard to explain to other people, as they are often rooted deep in childhood experience.
- Pattern of unstable relationships: People living with BPD will often experience intense and unstable relationships with people they are close to. Someone may be quick to like someone a lot, before just as quickly feeling like that person dislikes them and wants to hurt them.
- Sense of abandonment: Existing in a cycle of unstable relationships often instils a constant fear of abandonment. People living with BPD often fear that people are about to abandon them and that they have to try and stop it.
- Feeling of emptiness: Many people with BPD describe a feeling a numbness to the world around them. This can be caused by a feeling of disconnect towards themselves and other people.
- Impulsive behaviour: People experiencing BPD can have difficulty controlling impulsive urges. These urges could be things like reckless spending of money or excessive consumption of drugs and/ or alcohol. Impulsive behaviour can be used as a short-term distraction from negative emotions, but ultimately does not address the root problem.
- Suicidal ideation & self-harm: Statistically, people living with BPD are much more at risk of self-harm and suicidal ideation. This could manifest as threats to others, self-mutilation, or risky/ dangerous behaviour.
The sooner the person seeks help from a mental health professional, the sooner they can manage their symptoms.
Causes of borderline personality disorder
The cause of BPD is not fully understood, but it is thought to be a disorder influenced by a combination of childhood experiences and genetics.
Exposure to trauma, abuse, or neglect in childhood can make someone more vulnerable to developing BPD. Absence, distance, or dysfunctional parenting styles can also reinforce behaviour in children that resembles BPD. There is not literally a gene that causes BPD, but research has shown that when unstable childhood environments mix with certain traits relating to emotional sensitivity and regulation, the person can be more likely to develop BPD.
How is borderline personality disorder diagnosed?
In Australia, only a clinical psychologist or a psychiatrist can diagnose BPD. There is no formal procedure to diagnosing BPD; it will evolve over the time a clinical psychologist or psychiatrist spends with their client. They may notice symptoms like the ones described in the ‘Signs and Symptoms’ section above and use this as an indication.
If a clinical psychologist or psychiatrist suspects that someone has BPD, they may choose to tell them straight away, or wait until it is most useful to help that person improve their life.
Finding a clinician who respects BPD is very important. Do not be afraid to shop around and look for a psychologist or psychiatrist who has worked with BPD before. Everyone deserves to have a psychologist or psychiatrist that understands their experiences and wants to help them on the journey to recovery.
How is borderline personality disorder treated?
Common treatments for borderline personality disorder include medication and talk therapy as described below.
Because people with BPD often display feelings of emptiness, suicidal thoughts, and heighten states of emotional behaviour, 75% are put on medication to help their symptoms. These medications are usually mood stabilisers or anti-psychotic medication. However, medication is not an effective treatment if the underlying case of BPD is not understood. Often doctors will first treat for depression or anxiety without understanding that they are linked to BPD. Medication is far more effective when used as a secondary treatment to other forms of psychosocial therapy, like dialectical behaviour therapy and transference therapy.
The most well-known treatment for BPD is Dialectical Behaviour Therapy (DBT). DBT is a type of talk therapy that encourages mindfulness and self-acceptance, while methodically working to reduce harmful behaviour and help people achieve their life goals. More holistic and involved than other types of psychotherapy, DBT consists of group skills training, individual therapy, and phone consultations.
It works backwards step-by-step through each layer of harmful behaviour, starting at the most severe, and workshopping solutions to each problem in a way that works together with the client to achieve their goals. DBT is the only specialist treatment for BPD that has gone through rigorous research and is regarded as the most effective form of treatment for people with high levels of suicidal ideation or emotional control problems.
Transference therapy is another type of talk therapy aimed at helping someone living with BPD to manage their emotions in social situations. At points of distress or conflict, the therapist helps the client reflect upon how they act out emotionally towards other people, and what is motivating their behaviour in that moment. Through repeated scenarios, transference therapy can help reveal the underlying fears and anxieties that may cause someone living with BPD to enter the ‘all-or-nothing’ state of mind that leads to relationship breakdown.
Help & Support
The Australian BPD Foundation estimate that in Australia between 1% and 4% of people are affected by BPD at some point in their life. BPD symptoms usually appear in early adolescence to early adulthood. For adults in hospital with mental health-related issues, it is estimated that 25-43% of inpatients and 23% of outpatients have experienced BPD. People experiencing BPD can get support and treatment.
A clinical psychologist or psychiatrist is the best place to receive treatment for BPD. They have the training and experience to help someone to recovery. To find a suitable psychologist or psychiatrist, it is often best to speak directly to local mental health organisations. They will already know who the best clinicians are in the local area. Access a directory here to find the right people to talk to.
Once you know which psychologist or psychiatrist you want to see, visit your local GP to receive a referral. They will give you the right paperwork so you can book an appointment with your chosen psychologist or psychiatrist.
If someone suspects that they or their loved one may be experiencing borderline personality disorder, it’s important to speak to a GP, psychiatrist or other trusted health professional.
There are also many support groups, websites and virtual networks, that can assist to understand the disorder or help connect with others who have lived experience. There are several organisations in Australia dedicated to helping people living with BPD.