What is borderline personality disorder (BPD)?
Borderline personality disorder is diagnosed as a cluster of long-standing problems with relationships, identity or sense of self, and the control of emotions and behaviour. Recurring suicidal impulses and self-harm are generally seen as a core problem area.
What are the symptoms?
People diagnosed with BPD experience the following difficulties:
• Problems with emotions and moods can include very strong emotions that are easily triggered. Some people have learned to cope with this situation by suppressing most emotions, but this can be a problem when emotions break through. Suppression of emotions can also result in feelings of deadness, unreality or boredom. Problems with anger are common and may include feeling angry a lot of the time, violent or aggressive behaviour when angry or alternatively blocking most awareness of anger. Problems with moods often include depression.
• Problems with thinking can include problems in experiencing or identifying a cohesive identity or self and difficulty in maintaining a clear sense of one’s own feelings and thoughts when in the presence of others with strong views or emotions.
• Problems with self-damaging behaviour often include deliberate self-harm and/or suicide attempts in response to these emotional problems. Other similar difficulties include the abuse of drugs or alcohol, binge eating and problem gambling which may also be used as ways of attempting to cope with emotions.
• Problems in relationships can include strong and changeable feelings of love and hate and great sensitivity to signs of rejection or criticism. Along with this may go a tendency to not see, or not trust the positive aspects in a relationship. Also common are problems of dependency – either feeling very dependent, or trying to avoid dependency and closeness – and difficulty in coping with losses and separations. Changeable or suppressed emotions can cause difficulties in relationships, as can altered states of mind and difficulties with trust.
How common is borderline personality disorder?
About 2% of the population is estimated to meet the diagnostic criteria for BPD, but that number has risen to as high as 4% after the covid pandemic.
What causes borderline personality disorder?
There is a number of theories about the cause of BPD. All of them however, agree that the combination of a predisposition, neurophysiology and the impact of trauma and neglect play a part in the development of the disorder. All schools of thought agree on the impact of trauma on the development of the condition. 70% of people diagnosed with BPD have a history of trauma, especially sexual abuse. It is important to note that abuse is neither necessary (30% of people have not experienced abuse) nor sufficient (the vast majority of people who are sexually abused do not develop BPD). All schools of thought are mindful of the neurophysiological factors but disagree about the relative importance of these. Possible scenarios include:
• People with a high genetic predisposition might require little environmental trauma to develop BPD.
• People experiencing severe and repetitive emotional trauma might develop BPD with no genetic predisposition.
Risk factors for the development of borderline personality disorder
• Being female – 75% of people diagnosed with BPD are female. It is hypothesised that this is the case because:
– the incidence of sexual abuse is higher in this group
– girls and women live in a marginalised and invalidating environment
– the diagnosis is gender biased (girls and women are more likely to be expressive of emotions). Boys and men are more likely to be treated in the substance abuse system or the justice system.
• History of abuse, neglect and invalidation
Treatment and recovery from borderline personality disorder
Treatment can be effective for BPD over time. Unlike other mental illnesses, for which medication is the primary treatment, support and behavioural strategies are the cornerstone of treatment
for people experiencing BPD. Helping people understand the emotions triggering their behaviour, choosing different behaviours when they are triggered and taking responsibility for themselves and their behaviour is a large focus of the treatment. Associated symptoms such as depression or anxiety are treated with appropriate medication. Treatment for BPD can be effective, but it takes time and commitment from the person with the disorder.
What can family and friends do to help?
In addition to the specific interventions previously mentioned, there are many things friends and family can do to help. Always remember that borderline personality disorder is a medical condition that requires psychological treatment and support. Just as you cannot stop a person’s leg bleeding by talking to them, you cannot stop BPD without medical intervention. Treatment is effective. Find out as much about the illness as you can. Knowledge is power and gives you a much better chance of developing good coping strategies. Be patient. People experiencing BPD need to come to some insight regarding their illness. This is not always easy and takes time. Know what to expect of the mental health system and be prepared to be assertive in seeking appropriate care. Link in with community organisations that offer supports and services that complement the mental health service system. They often provide educational programs, counselling and local
support groups. Remember to stay healthy yourself. Do not underestimate the impact of the illness on you. BPD often involves trauma and grief and has an impact on whole families. Be prepared to seek support to develop strategies that keep you well.
We hope this post has answered a few of your questions about BPD and there are many more articles on this site that go into much more depth about the various things as have talked about here. In the meanwhile, we are always happy to reply to comments, or private chat and advice via our contact us page.