Borderline personality disorder

What is borderline personality disorder?

Borderline personality disorder, also known as emotionally unstable personality disorder (EUPD), is a condition that negatively affects how you process your thoughts and feelings and interact with others. This means your thoughts, feelings and behaviour can be different from most other people.

BPD can have a huge impact on your relationships and self-esteem, but there is support available to help you manage your feelings.

What are the symptoms of borderline personality disorder?

BPD symptoms can be wide-ranging and different for each person. Your emotions, perceptions, behaviour and relationships can all be affected, including:

• Difficulty controlling your emotions – it’s common to feel negative emotions like rage, emptiness and panic and have intense mood swings that can quickly switch between despair and feeling okay

• Upsetting thoughts – this can include thinking you’re a terrible person and needing lots of reassurance

• Abnormal experiences – some people may have psychotic episodes where they hear voices or have hallucinations (seeing things that aren’t there). This is a sign that you need to get medical help if you haven’t already

• Impulsive behaviour – you may experience suicidal thoughts or feel the need to self-harm – this is another important sign to get help. For some people, this drives them to impulsive behaviour like taking drugs, spending lots of money or having unprotected sex

• Fear of abandonment – you may feel lonely and think that others close to you prefer to stay away from you

• Identity problems – you may struggle to understand and accept yourself for who you are

How does borderline personality disorder affect relationships?

Difficulties in relationships are very common. If you have BPD, you might find it hard to make and maintain stable relationships.

You might feel anxious and the need to seek reassurance from your loved ones. Sometimes, you may also feel smothered or controlled by them, making you reject or withdraw from them emotionally.

These two states can lead to an ongoing cycle, causing you to push loved ones away and then ask for them to stay.

What causes borderline personality disorder?

BPD affects people of all ages and genders, although more women are diagnosed with the disorder than men.

The exact cause of BPD is unclear, but experts believe that different factors can increase your risk of developing the condition like:

• Brain chemicals – an imbalance in neurotransmitters (chemicals that control the brain’s functions) – particularly serotonin – is thought to be linked to BPD.

• Brain development – research in people with BPD has found that some parts of the brain were less developed or had unusual levels of activity.

• Childhood trauma – disturbing events, sexual or physical abuse and neglect in childhood are commonly linked to people with BPD.

• Genetics – having a family member with a serious mental health condition is linked to BPD – but more research is needed to understand more about BPD and genetics.

How is borderline personality disorder diagnosed?

The first step is to talk to a doctor about the symptoms you’ve been experiencing. They will do an initial assessment to see if other mental health issues, like depression, could be the cause.

You’re usually referred to a community mental health team (CMHT) if a doctor thinks you could have BPD, where a psychologist or psychiatrist will be able to assess you.

You may be diagnosed if you answer yes to 5 or more questions relating to:

• How you feel about being on your own

• The patterns your relationships tend to follow

• Your self-image

• Your feelings and emotions

• How you cope in stressful situations

How is borderline personality disorder treated?

If you’re diagnosed with BPD it’s a good idea to tell people you trust. This is because many symptoms of BPD affect relationships and treatment can be more effective if they’re involved.

BPD treatment usually involves talking therapy to help you gain better control over your thoughts and feelings. Types of therapy may include:

• Dialectical behaviour therapy (DBT) – designed especially for people with BPD, this aims to help you accept and validate your emotions and open up to new ideas and opinions.

• Mentalisation-based therapy (MBT) – treatment that encourages you to take a step back and examine your thoughts and beliefs before you act.

• Cognitive behavioural therapy (CBT) – helps you understand how your thoughts affect your behaviour and teaches you coping strategies for different situations.

• Other talking therapies – including therapeutic communities, where you work with other people who have mental health problems to support each other and recover as a group. Other effective treatments include art therapy and cognitive analytic therapy (CAT).

Medication isn’t usually recommended to treat BPD, although it may be used to treat associated mental health conditions, like mood swings, impulsive behaviour, and anxiety.