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Borderline personality disorder (BPD)

Key points about borderline personality disorder

Borderline personality disorder (BPD) is a mental health condition characterised by a pattern of varying and intense moods an unstable sense of self and a negative self-image.
People with BPD use behaviours to reduce stress or punish themselves for what they've done wrong as a way of coping. This may include self-harming.
Key symptoms include a fear of abandonment, unstable and intense relationships, intense and varied moods and impulsive behaviour.
BPD often appears in teens or early adulthood. It can affect your relationships, work and wellbeing but can be managed with support and treatment.

(One Minute Diagnosis, 2017)

Because each person experiences a different combination of symptoms, each person with BPD deals with different difficulties. You may experience some or all of the following symptoms (five are needed for a formal diagnosis):

fear of abandonment (real or perceived) and trying to avoid it
unstable and very intense relationships
quick changes of mood, eg, feeling very happy then very sad in the same day
inappropriate and intense anger
doing things on impulse (not planning to do them or thinking about the consequences)
identity disturbance (not knowing who you are)
often having suicidal thoughts or behaviours
feeling empty most of the time.

If your condition is more severe, you may have thoughts of self-harm or suicide. If you do, get help urgently from your doctor or one of the helplines listed on this page. There are people who can help you get through.

(MedCircle, US, 2018)

The exact cause of BPD is unknown but many factors may play a role. For many people with BPD, their difficulties appear to be related to some of the following:

abandonment or neglect
poor attachment to your parents or parents who are not available to you
sexual, physical or emotional abuse
traumatic experiences such as bullying
living in an unhappy family
having a family member with BPD.

For others, however, the cause is less clear.

If you have some of the symptoms mentioned above, it’s a good idea to see your doctor. They will ask you questions about your thoughts, feelings and behaviour, including sleeping and eating patterns, as well as how long you have been feeling this way. They will also ask if you have experienced these symptoms before and may ask about what is happening in your life at the moment. They may also do a physical examination and blood tests to rule out other causes for your symptoms.

Sometimes, it can be difficult to diagnose BPD because people with BPD may have symptoms that are similar to other mental health conditions or may have other mental health conditions at the same time. Your GP or local doctor may refer you to a qualified mental health professional, who can do a more detailed assessment.

Treatment of BPD can involve a combination of psychological therapy, lifestyle changes and medication, if required. Psychological therapies are usually the treatment of choice for BPD. They may include individual, couple, family or group therapy. Examples of psychological therapies for BPD include:

dialectical behaviour therapy (DBT)
cognitive behavioural therapy (CBT)
mentalisation-based treatment
counselling or psychotherapy.

Medication for BPD may include:

antidepressants to reduce depressive symptoms
mood stabilisers to help reduce extremes of mood
anti-psychotics if under times of extreme stress you become paranoid.

For some people, alternative approaches have been useful, such as mindfulness meditation, yoga and online courses.

Self-care – what can I do?

Small steps are the key to change – choose what feels manageable and build from there. This can include:

building your self-care skills – this builds your resilience so you can cope better with the challenges of life
keeping physically active – this helps your mental wellbeing
finding healthy ways to reduce and manage stress
getting help when you need it – remember this is a sign of strength, not weakness
staying connected to family, whānau and friends
finding a purpose, which increases your sense of meaning and belonging.

Support

If you would like to talk to someone, see your doctor or try one of the following free helplines:

1737(external link)(external link) phone or text 24/7 to reach a trained counsellor
Lifeline (0800 543 354)
Samaritans (0800 726 666)
Youthline (0800 376 633).