Borderline Personality Disorder (BPD) is a mental health condition characterised by intense emotional instability, difficulty maintaining relationships, and an ongoing pattern of self-image issues and impulsive behaviours.

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People with BPD often experience mood swings, fears of abandonment, and difficulty regulating emotions, leading to significant disruptions in their daily lives and interpersonal relationships.

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The symptoms

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Individuals with BPD may experience a wide range of emotional, behavioural, and cognitive symptoms. Common symptoms include:

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1. Emotional Instability: Extreme mood swings, where emotions rapidly shift from deep sadness to anger or anxiety, often triggered by seemingly small events.  

2. Fear of Abandonment: Intense fear of being rejected or abandoned by loved ones, leading to frantic efforts to avoid perceived or real separation.

3. Unstable Relationships: Difficulty maintaining relationships due to rapidly shifting views of others, ranging from idealizing them to devaluing them.

4. Impulsive Behaviours: Engaging in risky or harmful behaviors, such as reckless driving, substance abuse, binge eating, or spending sprees.

5. Self-Harm and Suicidal Behaviour: Recurrent thoughts of suicide, self-harming behaviours, or making suicide attempts in response to emotional distress.

6. Identity Disturbance: An unstable self-image, often resulting in sudden changes in interests, values, or goals.

7. Chronic Feelings of Emptiness: A persistent sense of emptiness or boredom, leading to a feeling of disconnection from others and life.

8. Intense, Inappropriate Anger: Episodes of anger that are disproportionate to the situation, often followed by feelings of guilt or shame.

9. Paranoia or Dissociation: Temporary paranoia or dissociation from reality, especially during times of extreme stress.

 

BPD is characterised by rigid and unhealthy patterns of thinking and behaving. The symptoms include:

• Difficulty interpreting emotions and relating to people and life experiences

• Unstable interpersonal relationships

• Difficulty in functioning at work and in social situations

• Real or perceived pervasive feelings of rejection or abandonment

• Instability in moods and emotions

• Inability to regulate thoughts and feelings

• Persistent sense of emptiness, hollowness or numbness

• Impulsive and reckless behaviour such as impulsive eating or abuse of alcohol and/or drugs, reckless driving, impulse buying, out-of-control gambling or impulsive, disinhibited sexual behaviour

• Misplaced intense emotion and behaviour.

 

There are strong hereditary factors in the causes of most personality disorders. The individual’s early childhood environment, the form of parenting they experienced, and their early childhood development all play a significant role.

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A real or perceived sense of abandonment or rejection triggered, for example, by the death of a parent or a divorce during the person’s early childhood, could lead to the pervasive feelings of rejection or abandonment.

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Their response is from a place of deep fear and manifests as a regular, frequent pattern of interpreting some small incidents – such as a partner being a few minutes late for a date – as utter abandonment, resulting in accusations and angry outbursts that are disproportionate to the situation, leaving the other person completely confused.

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Unlike other personality disorders, such as narcissism, individuals with BPD do feel intense remorse, guilt and shame, deepening their fear that their behaviour will lead to further rejection or abandonment.

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Treatment options

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While BPD can be challenging, it is treatable, and individuals can lead fulfilling lives with the right support and treatment. The most effective treatments focus on psychotherapy, though medications can also play a role in managing certain symptoms.

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1. Psychotherapy (Talk Therapy)

• Dialectical Behaviour Therapy (DBT): Specifically designed for BPD, DBT helps individuals develop skills to manage emotions, improve interpersonal relationships, and reduce self-harming behaviors. DBT is considered one of the most effective treatments for BPD.

• Cognitive Behavioural Therapy (CBT): Focuses on identifying and changing negative thought patterns and behaviors, helping individuals with BPD regulate their emotions and reduce impulsive actions.

• Mentalisation-Based Therapy (MBT): This therapy helps individuals better understand their own thoughts and emotions as well as those of others, improving emotional regulation and relationships.

• Transference-Focused Psychotherapy (TFP): Focuses on exploring relationship patterns that arise between the therapist and the individual, helping to address interpersonal issues and improve emotional regulation.

 

2. Medication

While no medications are specifically approved for BPD, certain drugs can help manage symptoms such as depression, anxiety, or impulsivity. Common medications include:

• Antidepressants: Help with symptoms of depression and anxiety.

• Mood Stabilizers: Can reduce mood swings and emotional instability.

• Antipsychotics: Sometimes prescribed for paranoia, dissociation, or severe mood swings.

 

3. Hospitalisation

In cases of severe self-harm or suicidal behaviour, short-term hospitalization may be necessary to ensure safety and stabilize the individual during a crisis.

 

With proper treatment, individuals with Borderline Personality Disorder can improve emotional stability and develop healthier relationships. The combination of psychotherapy, medications, and a strong support system is often the key to managing BPD. If you or someone you know is struggling with symptoms of BPD, seeking professional help is an essential first step toward recovery.

 

It’s important that a medical diagnosis of BPD – or any other personality disorder – be made by a professional such as a psychiatrist or clinical psychologist since often co-morbid conditions such as depression, anxiety, substance abuse, suicidal thoughts, self-harm or eating disorder are present.

For families or others living with a person diagnosed with BPD, it’s important to gain as much information and knowledge about the condition to not only support their family member, but themselves.