Borderline Personality Disorder

Borderline personality disorder, often referred to as BPD, is a mental health condition that affects personality. Personality disorders are mental health conditions which impact the way people behave and cause unpleasant and often distressing symptoms. In the past, BPD was described as a border between psychosis and neurosis, but research has proven this to be an ineffective definition. Now doctors and mental health experts define it as a disorder which affects an individual’s mood and the way they behave around other people.

How is borderline personality disorder diagnosed?

According to guidelines released by NICE (National Institute for Clinical Excellence) there are specific criteria for diagnosing BPD. As a general guide, a GP will diagnose BPD if an individual has five or more of the following symptoms:

• Experiences ups and downs and changing mood quickly; many people with BPD feel very positive one day and full of despair another.
• Find it difficult to form relationships and maintain strong relations with others.
• Have a lack of conviction in your own identity.
• Take risks or act without any thought of the consequences.
• Self-harm or think about harming yourself.
• Have a fear of being abandoned, rejected or unwanted.
• Believe in things that are not really there, including hallucinations or delusions.

What causes borderline personality disorder?

The exact cause of BPD remains unclear and experts believe that there may be different causes. Many of those affected by BPD have suffered traumatic events during their childhood or adolescence, while a high proportion suffers from other mental health conditions. There is also evidence to suggest that BPD may be caused by genetic and physiological factors, but this is not conclusive. Many people with borderline personality disorder find that their symptoms are worse when they are stressed or experience a traumatic or unsettling event, such as losing their job, losing a loved one or breaking up from their partner.

How common is borderline personality disorder?

It is difficult to say how common borderline personality disorder is because many people may have the symptoms, but will never see a doctor and therefore will not be diagnosed with the condition. Some experts believe that BPD is one of the most common mental health disorders, while others feel it is less common. It is estimated that around 1 percent of the UK population is affected by BPD. There are more cases among women, but this could be due to the fact that women are more likely to seek treatment or help than men. Borderline personality disorder is not usually diagnosed until adulthood, but symptoms can develop in adolescence.

Symptoms of borderline personality disorder

In addition to the criteria listed above in the diagnosis section, people with BPD may experience other symptoms, which include:

• Negative emotions, which can be very strong.
• Impulsive behaviour.
• Strange and sometimes disturbing thoughts.
• Mood swings.
• Strange behaviour in relationships; often caused by a fear of being alone and may prompt individuals to want to be in constant contact with another person.

How can friends and family help?

In most cases, people with BPD have a deep-seated fear of being alone or rejected and it helps them to feel safe and secure. If you have a friend or relative with symptoms of BPD, try to reassure them and offer support. If they have not yet been diagnosed, try to encourage them to see a doctor and offer to go with them. Try to make it clear that they should not be ashamed or embarrassed to ask for help. Try, if you can, to be on hand and able to act quickly, as BPD causes sudden changes of mood and can result in distressing feelings. It would also help if you let your loved one know that you are always close by or at the end of the telephone to help when they need you. 

Self-help and treatment

There are many talking therapies, which can help people with BPD, including:

• Cognitive behavioural therapy (CBT): this helps people to identify triggers, sources of stress and find effective ways of coping with their emotions. CBT is usually focused on the present, but when used for patients with BPD the past is also taken into account, as this is often a major cause of emotional difficulties.
• Dialectical behaviour therapy: this therapy is specifically designed for people with BPD. The aim is to break a vicious cycle, which may have been formed during childhood as a result of being emotionally weak and unstable and growing up in surroundings where your emotions were not considered important.
• Counselling.
• Therapeutic communities: involves structured environments, group sessions, therapeutic activities and problem solving.

Individuals who are diagnosed with borderline personality disorder are usually referred to a community mental health team. This is made up of different health professionals, including mental health nurses, social workers, psychologists, psychiatrists and counsellors. The care team is responsible for providing care, support and promoting independence.

Medication is not used to treat BPD and there is currently no licensed medication for this disorder. However, medication may be used if an individual has associated mental health disorders, including depression, severe anxiety or bipolar disorder.

There are many things people with BPD do to help ease their symptoms, including:

• Exercise and physical activities.
• Playing uplifting music.
• Talking to friends and family members on the phone.
• Taking a walk
• Breathing exercises.
• Relaxation therapies.
• Trying to ride out emotions.
• Being open about their emotions.
• Seeking help when necessary.

Getting help in a crisis

If you are worried about a loved one or you are suffering from symptoms of a crisis (for example, you are experiencing dark, distressing emotions and struggling to cope), arrange to see your GP as quickly as possible. Contact your mental health team, arrange an out-of-hours appointment and, if you are really worried, call 999. It is important to treat BPD because it can cause very serious emotions and prompt people to harm themselves or even commit suicide. Help and support is available for individuals with BPD, their family and friends, from the mental health charity Mind.