Borderline personality disorder

People who experience borderline personality disorder have a pattern of having very unstable relationships, having difficulty controlling emotions, moods and thoughts, and behaving recklessly or impulsively.

Overall, ten different types of personality disorder have been identified. A diagnosis of personality disorder is only made where the person's problems result in significant difficulty in their day to day activities and relationships, or cause significant distress. 

Just as we have physical features that make us who we are, we also have our own distinct personality features. Our personality is the way we see, think about, and relate to ourselves, other people, and the wider world – whether we see ourselves as good or bad, trust or mistrust others, or see the world as a good or bad place. 

The term "personality disorder" implies there is something not-quite-right about someone's personality, but that is actually not what is meant by the term. The term "personality disorder" helps health professionals group a set of typical features for people with aspects of their personality that they, and others, may find difficult to deal with.

People experiencing a personality disorder are often out of step with others and with their community or culture and their personal and wider social lives may be considerably disrupted. 

Borderline Personality Disorder (BPD) is diagnosed in around 2% of adults and in up to 20% of people using mental health services. It is more commonly diagnosed in women than men. 

 

It is often assumed that borderline means ‘a marginal but not full-blown disorder’. This is not accurate. People with BPD are frequently in significant emotional pain. 

It was originally thought to be on the ‘border’ between psychosis and neurosis – that’s how it got its name. We now understand people with BPD experience difficulty managing their feelings and this impacts their relationships and behaviour.

A personality disorder such as BPD will show up by late adolescence or early adulthood. It remains relatively stable throughout adult life, and can gradually improve with increasing age. This is in contrast to other mental health conditions, which come and go over time, with periods of illness interspersed with periods of wellness.

The risk of suicide in people who experience a personality disorder is significant.

It is important that if you are having any suicidal thoughts you seek help immediately. 

People with borderline personality disorder may experience mood swings and display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly.

People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships.

People with BPD experience some or all of the following:

The severity and frequency of symptoms and how long they last will vary depending on the individual and their history of distress.

People with BPD may develop other mental health conditions, particularly if stressed. These include eating disorders, social phobia, bipolar disease, post-traumatic stress disorder, depression and drug and alcohol abuse.  

It is vitally important for people with personality disorders to learn ways of coping with stress and to seek help early should any of these other conditions arise. 

It is important to get diagnosis and treatment as early as possible. With the best possible treatment there is evidence to show people with BPD can live well.

If you think you have a personality disorder, or you are worried about a loved one, it’s important to talk to your GP or counsellor or someone else you can trust as a first step to getting the important help you or they need. 

Unfortunately the causes of BPD are not certain. There is good evidence that development of personality is a combination of our genes and our environment/upbringing. 

People with a personality disorder have often experienced trauma or very difficult times, including abandonment, sexual or physical abuse, traumatic experiences, being in an unhappy family/whānau, feeling alienated from people and society, or alienated from their culture or from their faith,  or not living up to people's expectations.

Other people with personality disorders cannot identify things that have gone wrong in their lives. They may agree feel their disorder is genetic. 

Many believe it is a combination of these things. 

It's important to remember that it is not your fault you experience a mental health problem. 

Factors that may be important include: 

Family history: People who have a close family member (such as a parent or sibling) with the disorder may be at a higher risk of developing BPD or BPD traits

Sensitivity: People who are emotionally sensitive and reactive may be more likely to be diagnosed with BPD. Being sensitive is not a bad thing but people with BPD find it difficult to learn to manage their feelings. 

Brain factors: Studies show 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. It isn’t clear whether these changes are risk factors for the disorder or caused by the disorder.

Environmental, cultural, and social factors: Many people with borderline personality disorder report experiencing traumatic life events, such as abuse (sexual, physical and/or emotional), abandonment, or adversity during childhood. Others may have been exposed to unstable, invalidating relationships, and hostile conflicts. Alienation from culture or faith can be a factor; so can emotional neglect or attachment difficulties in childhood, separation and loss. Similarly, an ‘invalidating environment’ where the person’s feelings are denied, ridiculed, ignored or judged as “wrong” can be factors.

People with personality disorders such as BPD often do not seek out treatment until the disorder starts to significantly impact their life.

Because people with BPD often experience other mental health conditions which may be very similar to symptoms of BPD, it can be difficult to diagnose.

There is no test for BPD. Once you have spent some time talking to your GP, they will refer you to a mental health professional qualified to diagnose and treat people with this condition. 

A diagnosis for BPD is made after talking with you about what you have been experiencing, especially around your level of personal functioning and personality traits that may suggest a particular personality disorder.

For this reason, it’s important the mental health professional gets a full picture of the difficulties you have had, both from you and your family/whānau or others who know you well if appropriate.

To be diagnosed as having a personality disorder, your pattern of behaviour will be causing you significant distress or difficulty in personal, social, cultural, spiritual and/or work situations.

A careful and thorough medical exam can also help to rule out other possible causes of symptoms.

BPD is usually not diagnosed in children. 

For many people with BPD, important goals are: 

Treatment of BPD can involve several things, each of which will be tailored to meet your individual needs. Psychological therapies or counselling are generally seen as the best treatment for personality disorders with medication added only if required. 

This may include individual, couple, family/whānau and/or group therapy.

Successful therapy should:

These therapies involve a trained professional who uses clinically researched techniques to assess and help people to make positive changes in their lives. Therapists may come from many disciplines; for example: psychologists, nurses, occupational therapists, psychiatrists and social workers. 

They may involve the use of specific therapies such as:

Dialectical Behaviour Therapy (DBT) has been found to be effective for people with BPD.  DBT, which was developed for individuals with borderline personality disorder, uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills to control intense emotions, reduce self-destructive behaviours, and improve relationships.

Cognitive Behavioural Therapy (CBT) focuses on overcoming unhelpful beliefs and learning new strategies. CBT can help people with borderline personality disorder identify and change core beliefs and behaviours that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviours.

 

Counselling may include some techniques referred to above, but is mainly based on supportive listening, practical problem solving and information giving.

DBT and CBT approaches are the most effective but must be continued over a significant period of time, often for a year or more.

This is often part of an overall approach, but can also be learnt in special skills training groups. They aim to help you learn more effective ways of dealing with problem situations.

All types of therapy/counselling should be provided to you and your family/whānau in a manner that is respectful of you, and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.

Medication is generally used for treating any other mental health condition that you may be experiencing, e.g. depression. It may also be useful as a short-term strategy to help with coping in times of extreme stress or distress. 

If you are prescribed medication you are entitled to know:

It's really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor. 

Being in good physical health will also help your mental health.

General coping strategies that can help you:

Many people find that having a written plan, developed together with your GP/psychiatrist can help you to feel you’re in control if difficult feelings return. 

 

Make sure others (i.e. family/whānau, partners, and community mental health staff) are aware of your plan and what you’d like to happen if you become unwell again. 

 

Plans can detail (in your own words) symptoms, what can trigger these feelings and what things help you. They can also list the numbers of support people, helplines and more, and outline what you’d like to happen if you need professional support.

It’s a good idea for this plan to detail what your support people can tell family/whānau/friends about your health and what treatment you have found helpful in the past. 

 

These can all help to ensure that you get the support and professional help that you need.

Family, whānau and friends of someone with a personality disorder such as BPD have found the following strategies important and useful.

One of the biggest barriers to recovery is discrimination. This stops many people from seeking professional help. 
 
It is also why stopping discrimination and championing understanding, respect, rights, and equality for people with mental illness is just as important as providing the best treatments and therapies.