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What is borderline personality disorder (BPD)?

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People living with borderline personality disorder (BPD) face challenges with managing emotions, their sense of identity and interpersonal relationships. While the symptoms of BPD can be distressing and difficult to manage, it is important to remember that there is effective treatment available.

 

What are the symptoms of BPD?

 

1. Challenging, strong emotions

People living with BPD often describe intense and changing emotions that feel out of control. These emotions can also be hard for a person to manage, meaning it is difficult to calm down. This can lead to people coping with emotions in any way they can. This might result in behaviours that are extreme or harmful to themselves or others.

 

2. Difficulties in relationships

For people living with BPD, there is often a fear of rejection and abandonment. This intense fear can cause the person to try to prevent real or perceived abandonment, causing stress in relationships. Some people may also experience paranoia, perceiving threats or judgment from others that isn’t real. This could cause them to respond with anger or withdraw from relationships. 

 

3. Problems with identity

People with BPD may have challenges in feeling stable in their identity, having sudden changes in their sense of self or values. This can result in unexpected changes to relationships or goals.

 

4. Self-destructive or impulsive behaviours

To manage very challenging emotions, people with BPD may act impulsively or in a way that could be harmful to them or others. While these actions are often to manage painful emotions, they can have serious impacts on the person or those around them.

 

5. Feelings of emptiness or dissociation

Some other experiences often reported by people living with BPD are difficult feelings of emptiness or hollowness. Some people might also experience dissociation, where they feel removed or ‘checked out’ from the present, or where nothing feels real.

 

What causes BPD?

 

The exact causes of BPD are not known. Currently they are thought to be a combination of genetic and environmental factors. This is especially thought to be an interaction between a biological vulnerability and experiences of trauma in childhood.

 

BPD and trauma

 

There is a relationship between child abuse, neglect and adverse child experiences and a diagnosis of BPD. However, this does not fully explain why some develop BPD in adulthood and others do not. Abuse and neglect are not always present for people living with this diagnosis.

 

Because trauma can often be a part of a person’s experience, treatment that is sensitive to the impacts of trauma and supports a sense of safety is essential for many people.

 

Treatment and recovery

 

Psychological therapy is an important and effective part of treatment for BPD. This involves a supportive relationship with a trained professional. In this relationship people can talk about thoughts, feelings and experiences to better understand themselves. People also gain a range of skills for responding to the world and their own emotions.

 

There are many psychological therapies which are effective in treating BPD. Some of these therapies include:

 

  • Dialectical Behaviour Therapy (evidence says Dialectical Behaviour Therapy is most effective delivered as a structured group program combined with individual therapy. However, it can also be provided in individual therapy).
  • Cognitive Behaviour Therapy
  • Emotion Regulation Training
  • Interpersonal psychotherapy
  • Manual-assisted cognitive therapy
  • Mentalisation-based therapy
  • Motive-oriented therapeutic relationship
  • Schema-focused psychotherapy
  • Systems training for emotional predictability and problem solving
  • Transference-focused psychotherapy

All of these therapies have a few things in common:

 

  • The therapist pays attention to the person’s emotions and experience.
  • The quality of relationship between the person and the therapist is important.
  • The therapy focuses on achieving change in the person’s life (common goals for people are around managing emotions, finding meaning in life and taking care of relationships).
  • Therapy sessions are regular and often one session per week is recommended.
  • The therapist receives support and supervision.

 

Medication is not the primary treatment for BPD. However, it may be used to treat symptoms such as anxiety, depression, or other mental health diagnoses.

 

Finding support

 

As with many mental health issues, seeing a trusted or local GP to explain what you experience and ask about support options is a good start. You can also explore psychologists with expertise in BPD or trauma through Find a Psychologist. Programs that offer specialised support for people with BPD can be found in the Project Air Service Directory.

 

Peer support

 

Many people find peer support helpful in their recovery. This is mental health support based on shared experiences of mental health challenges. This can be provided by a professional Peer Worker or in support groups and online settings. SANE’s online forums are one example of peer support. On the forums, people with experiences of mental health concerns share, listen and support each other.

 

Self-help for BPD

 

A common challenge for someone living with BPD is trying to manage very intense emotions. So anything that supports developing a wider range of skills for dealing with emotions is valuable. Here are some strategies people find helpful:

 

  • Distraction: For short term relief, try talking to someone, watching TV, playing video games, listening to the radio, puzzles, cleaning or arts and crafts.
  • Grounding: If you are feeling dissociated or physically anxious it can be helpful to get in touch with your senses. You can have a shower, smell flowers, taste food, walk barefoot, squeeze a stress ball or pet an animal.
  • Emotional release: For anger and fear, you can go for a quick run, go to the gym, put on some music or a movie that makes you laugh or cry, dance or scream into a pillow.
  • Self-kindness: When you’re feeling ashamed or empty try something you would treat a friend to, like a cup of tea, your favourite meal, having a bath or buying yourself a gift.

 

There’s no doubt BPD can involve very painful experiences, but there is effective treatment available to support people in their recovery. People can and do learn to manage symptoms so that they can achieve their goals in life, relationships and feeling less distress.

 

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11 Comments

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jsm74
Contributor

Great post, thank you for that.  This seems to match my wife pretty closely, so I'll suggest she have a read and talk to her new therapist about it.

Bent
New Contributor

Excellent information 

GreenWazu
New Contributor

I really appreciated the comments about the positive traits of BDP. Until I was properly diagnosed and was able to lock in regular therapy sessions and do DBT my borderline had run havoc in my life. While it's still a challenge now I have much greater acceptance and awareness about myself and my supports do to. I don't fight myself like I used to but rather accept that at times my bdp WILL get the best of me and that I have the skills to lessen it's destructive effect on my life as long as I remember my training.

Atlas_Dad
New Contributor

I appreciate sharing of the experience.

However, the first step of 1000 miles is often the hardest, so what does it take for someone with BPD to accept responsibility for themself & be legitimate about getting help?

You can lead a horse to water, you cannot make them drink.

I certain my wife has BPD, has at least 8 diagnostic criteria from the DSM-V, significant trauma history, and years of family psychological therapy and decades of psychiatric therapy have failed spectacularly. I do not say this lightly, BPD is the only remaining logical explaination after years of other approaches ineffective; forget boundary setting - I then become the unsupportive husband! Can't convince her otherwise; all her troubles are everyone else's doing & fault, so why should she get help? (rhetorical) She tortures herself & our family & there is nothing we can say or do to help her & us. I miss my wife, she consumed by BPD. 2 young children involved, we do not deserve her frequent & sudden outbursts; she has zero empathy of her behaviour on others. So frustrating psychologist & psychiatrist not listening to my pleas & my contributions, because she is not honest with them in session; however that is her distorted view and belief - she is fine. She is destroying our family & I only stay to protect our innocent children & show them how responsible people should behave. She cannot even muster a, "thank you for doing stuff when I am not feeling great, I appreciate it", that is all I would need & I don't think I am being unreasonable to be acknowledged and appreciated, but she can't, won't, doesn't. No imminent risk of physical harm, so acute mental health services not applicable, but her mental torment is relentless.

Thanks for listening, need a record somewhere to reflect I have tried and been pushed too far & help services have failed.

Ammo
New Contributor

Atlas Dad.

You may want to read a book called Stop Caretaking the Borderline and Narcissistic personality, end the drama now.

By Margelis Fjelstad or spelling sort of like that. Helped me a lot with a partner and Mother with these personalities.

You do need to set boundaries no matter how hard and painful it may seem...

Anyway, read the reviews for the book, I've bought 2 now for others and they have understood their situations a lot more and how to deal with them.

You can get through this.

 

 

 

 

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