Borderline personality disorder or BPD is as much a disorder of mood as it is of personality. A person might have aspects of this condition (ie, borderline traits) or all or most of the key criteria (ie, borderline personality disorder). Like other personality disorders, BPD begins to emerge as a difficulty early on in life – usually during the early teenage years. Unless modified or treated, it can lead a person to live quite a destructive and distressing life, with many difficulties in the area of relationships in particular. Mood instability is a key aspect of this condition, and people will frequently describe feeling “out of control” emotionally. This usually leads to a strong desire to escape from painful emotions through behaviours which usually turn out to be harmful or risky. A person with borderline personality feels emotions more strongly than the average person and has a great deal of difficulty calming down after something or someone has upset them. Relationships and how to handle them are usually the main source of pain and frustration.
People with BPD have usually experienced some consistent form of emotional invalidation in their early life – usually from caregivers. There may be a childhood history of more obvious abuse or neglect, but not always. Treatment involves re-learning how to experience emotions in a healthy way and learning better ways to deal with painful emotions. Treatment is usually very successful if a person can first identify (and take personal responsibility for) how they may be making themselves unhappy with certain destructive coping behaviours, and if they have a strong desire to make key changes in their life. Depression is a common experience for people with borderline personality.
People with this condition have sometimes been given an incorrect diagnosis of Bipolar Disorder (or more realistically Bipolar II), because at times, these conditions can appear similar. They are in fact, very different and require quite different treatments.
BPD can be a difficult condition to diagnose. Accurate assessment usually requires more than one session and should be conducted by a professional with expertise, training and skill in the assessment and psychological treatment of personality disorders.
The are 4 main problem areas or criteria groups involved in BPD. For a diagnosis of BPD, a person will have some difficulties within all four of these areas.
- Intense or inappropriate anger – difficulty controlling anger
- Enduring feelings of emptiness
- Emotional instability – mood swings, fluctuation between different emotions felt strongly, difficulty ‘calming down’ after an upset
- Identity confusion – unstable self-image, unstable sense of self
- Dissociative symptoms – ‘numbing out’ or ‘spacing out’, not feeling real
- Stress-induced paranoia (less common)
- Deliberate self-harm or recurrent suicidal behaviours/suicide attempts
- Impulsive acts that are harmful or risky, done to avoid painful emotions (e.g., risky sex, binge eating, binge drinking, abusing meds etc)
- Unstable and/or intense interpersonal relationships – conflict & volitility in relationships
- Significant fears of being abandoned or rejected – frantic efforts to avoid real or imagined abandonment
There is hope for people suffering from BPD. With the right therapy and sometimes medication as well, people can make real changes in their lives and learn to have more control over their impulsive reactions and feel happier and more stable overall.