Borderline Personality Disorder (BPD)

What is Borderline Personality Disorder?

Borderline Personality Disorder or BPD is a personality disorder that is characterised by a pattern of emotional instability and unstable relationships with other people. It affects a person’s thoughts, emotions, self-image and behaviour. It is not usually diagnosed before the age of 18 but symptoms can be recognised in younger people.

What are the signs and symptoms Borderline Personality Disorder?

Emotional Instability

Emotional instability or Emotional dysregulation is the inability to modulate the range, intensity, liability, and appropriateness of the emotional response. People with BPD may experience mood swings and tend to view things in extremes, such as all good or bad. Those with BPD may experience these feelings:

• Intense and highly changeable moods, with each episode lasting from a few hours to a few days.
• Inappropriate, intense anger or problems controlling anger.
• Chronic feelings of emptiness.
• Feelings of dissociation, such as feeling cut off from oneself or seeing oneself from outside one’s body, or feelings of unreality.

Disturbed Patterns of Thinking or Perception

Disturbed patterns of thinking or perception are extreme and inaccurate perceptions and interpretations of oneself and those around a person. The following may show a sign of disturbed patterns of thinking and perception:

• A person that is considered to be friends one day, may be considered as an enemy or a traitor on another occasion.
• Devaluing other people or oneself, extreme black-or-white thinking.
• Distrustful and suspicious thoughts that are unusual, or odd beliefs that are contrary to cultural norms and thoughts; may include perceptual distortion and bodily illusions.

Impulsive Behaviour

People with BPD find it hard to regulate their internal drives or impulses which may lead to risky behaviours such as:

• Uncontrolled spending sprees.
• Unsafe sex.
• Substance abuse.
• Reckless driving.
• Binge eating.

Intense and unstable relationships with others

Symptoms that a person with BPD may have such as emotional instability, disturbed patterns of thinking or perception and impulsive behaviour make it difficult for individuals to form and maintain healthy relationships. This is why those with BPD may have unstable relationships with others. Signs of unstable relationships include:

• Loved ones, family and friends experiencing extreme closeness and love, to sudden extreme dislike or anger.
• Relationships may feel rapidly intimate (physical or emotional) or distanced and cut off, as those with BPD make extreme efforts to avoid real or imagined abandonment.

What are the causes of Borderline Personality Disorder?

There is more research to be done as there are no clear reasons as to why some people experience difficulties associated with BPD. However, researchers think that BPD is caused by a combination of factors such as:

Stressful or traumatic life events

Experiencing traumatic and stressful childhood events can increase the risk of Bipolar Personality Disorder. Events such as:

• Lack of care as a child: often feeling invalidated or afraid.
• Unpredictable family: Parents who have alcohol or drug abuse, absent parents.
• Abuse: Sexual, physical or emotional abuse or neglect.
• Bereavement (losing a close loved one).

Genetic Factors

Researchers believe that genetic factors may have a role in causing BPD. If a relative has received a BPD, you are more likely to be given a diagnosis.

What are common treatments for Borderline Personality Disorder?

Psychological treatments

Talking therapies are thought to be the most helpful treatment for BPD. Examples of helpful talking therapies include:

DBT - Dialectical Behaviour Therapy
Often used for people who self-harm, this therapy teaches them to cope with overwhelming feelings they may be experiencing.

MBT - Mentalisation-based Therapy
Therapy helps people become more aware of mental states including themselves and of others. This awareness can help solve problems and can improve their relationships with others.

CBT - Cognitive Behavioural Therapy
Therapy that explores people’s thoughts, feelings and behaviour in order to improve managing the disorder.

CAT - Cognitive Analytic Therapy
This therapy helps people focus on the relationship between them and their therapies as well as CBT’s practical methods. Reflecting on how they relate to other people, as well as themselves, and what patterns have developed for them.

Arts therapies
This therapy aims to help people who are finding it hard to express their thoughts and feelings verbally. Therapists will help them think about what they have created and whether it relates to their thoughts and experiences.

Medication

There are no psychiatric medications currently licensed to treat BPD. However, medicines are often used if they have other associated mental health conditions such as depression, anxiety or bipolar disorder. These medicines include antidepressants, mood stabilisers or antipsychotics depending on their symptoms.

What help and resources are available for people who need support or further advice?

Make an appointment with a GP:

To get treatment on the NHS, they would need to visit their GP, who can refer them to their local community mental health team for an assessment. During this assessment, they will be asked how they feel, about their recent behaviour and how it has impacted their quality of life.

Therapeutic Communities and Services

Therapeutic communities and services help them cope with their disorder as well as understanding all treatments possible. Reaching out for help can make them feel less alone and very supported when experiencing conditions:

• The Consortium for Therapeutic Communities (See here)
• Reading Well Scheme (See here)
• Borderline Arts (See here)
• The National Association for People Abused in Childhood (See here)
• Frank (See here)

What are the recent developments in research for Borderline Personality Disorder?

Testing a pilot intervention for young people with early borderline personality disorder

Dr Ruchika Gajwani and her team at the University of Glasgow are assessing the feasibility of a newly-developed treatment programme that is personalised for each person, and delivered in the community instead of in specialised care settings. This is in the hope that this new treatment will help young people with BPD have their support needs recognised by everyone involved in their lives. Find out more.

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