Borderline personality disorder

Also known as BPD

Borderline personality disorder is a pattern of having very unstable relationships, having difficulty controlling emotions and thoughts, and behaving recklessly or impulsively.

Overall ten different types of personality disorder have been identified. A diagnosis of personality disorder is only made where the person's problems result in significant difficulty in their day to day activities and relationships, or cause significant distress. 

Just as we have physical features that make us who we are, we also have our own distinct personality features. Personality refers to the lifelong patterns in the way we see, think about, and relate to ourselves, other people, and the wider world – whether we see ourselves as good or bad, trust or mistrust others, or see the world as a good or bad place. 

The term "personality disorder" implies there is something not-quite-right about someone's personality, but that is actually not what is meant by the term. The term "personality disorder" just helps doctors group a set of typical features for people with aspects of their personality that they, and others, may find difficult to deal with.

People experiencing a personality disorder are often out of step with others and with their community, so much so that their personal and wider social lives may be considerably disrupted. Borderline Personality Disorder is one type of disorder. 

Who gets BPD?

A personality disorder such as BPD will show up by late adolescence or early adulthood. It remains relatively stable throughout adult life, and can gradually improve with increasing age. This is in contrast to other mental health conditions, which come and go over time, with periods of illness interspersed with periods of wellness.

The risk of suicide in people who experience a personality disorder is significant.

It is important that if you are having any suicidal thoughts you seek help immediately. 

People who have a diagnosis of BPD may develop other mental health conditions, particularly if stressed. These include eating disorders social phobia, bipolar disease, post traumatic stress disorder, depression and drug and alcohol abuse.  It is important for people with personality disorders to learn ways of coping with stress, and to seek help early should any of these other conditions arise. 

It is most important to get diagnosis and treatment as early as possible. With the best possible treatment over a period of time there is evidence to show that people with BPD can improve considerably.

If you think you have a personality disorder, or you are worried about a loved one, it’s important to talk to your doctor or counsellor, or someone else you can trust, as a first step to getting the important help you or they need. 

What causes a personality disorder such as BPD?

There has been considerable debate in the past regarding whether personality is determined by nature (genes) or nurture (upbringing). There is now good evidence that personality development occurs as a result of both genetic and upbringing influences.

People with a personality disorder often believe they developed it because things have gone wrong in their lives – it could be abandonment, sexual or physical abuse, traumatic experiences, being in an unhappy family/whānau, feeling alienated from people and society or not living up to people's expectations.

Other people with personality disorders cannot so easily identify things that have gone wrong in their lives. They may agree with the view that their disorder is genetic in origin. A lot of people with mental health problems believe it is a combination of these things. Sometimes people think their mental health problem is a punishment for their moral or spiritual failure.

 It's important to remember that it is not your fault you experience a mental health problem. 

Signs to look for (symptoms)

People with BPD experience some or all of the following:

• frantic efforts to avoid real or imagined abandonment
• a pattern of unstable and intense interpersonal relationships
• impulsiveness (potentially self-damaging)
• intense anger, that does not fit with the situation, or difficulty controlling anger
• recurrent suicidal behaviour or self-harm
• ongoing feelings of emptiness
• experiencing minor problems as major crises
• ‘black and white’ thinking which often means switching between love and hate in personal relationships

How the doctor determines if you have BPD (diagnosis)

People with personality disorders such as BPD, in general, do not often seek out treatment until the disorder starts to significantly impact their life.

 In addition, because people with BPD often experience other mental health conditions which may be very similar to symptoms of BPD, it can be difficult to diagnose.

Once you have spent some time talking to your GP, they will refer you to a mental health professional qualified to diagnose and treat people with this condition. A diagnosis for BPD is made after talking with you about what you have been experiencing, especially around your level of personal functioning and personality traits that may suggest a particular personality disorder. For this reason, it’s important the mental health professional gets a full picture of the difficulties you have had, both from you and your family/whānau or others who know you well.

To be diagnosed as having a personality disorder, your pattern of behavior will be causing you significant distress or difficulty in personal, social, and/or work situations.

Treatment options

Treatment of BPD can involve a number of aspects, each of which will be tailored to meet your individual needs. Psychological therapies or counselling are generally seen as the treatment of choice for personality disorders, with medication if required. They may include individual, couple, family/whānau and/or group therapy.

Therapy, such as talking therapies

These therapies involve a trained professional who uses clinically researched techniques to assess and help people to make positive changes in their lives. They may involve the use of specific therapies such as Dialectical Behaviour Therapy (DBT), which has been found to be effective; and, cognitive behavioural therapy (CBT), which largely focuses on overcoming unhelpful beliefs and learning new strategies.

Counselling may include some techniques referred to above, but is mainly based on supportive listening, practical problem solving and information giving.

DBT and CBT approaches are the most effective, but must be continued over a significant period of time, often for a year or more.

Problem solving/skill training

This is often part of an overall approach, but can also be learnt in skills training groups. They aim to help you learn more effective ways of dealing with problem situations.

All types of therapy/counselling should be provided to you and your family/whānau in a manner that is respectful of you, and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.

Medication

Medication is generally used for treating any other mental health condition that you may be experiencing, e.g. depression. It may also be useful as a short-term strategy to help with coping in times of extreme stress or distress. If you are prescribed medication you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
•  how long it will be before they take effect
• how long you will have to take them for and what their side effects (short and long-term) are.

If you are breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor about the potential benefits and problems. 

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It's really important to look after your physical wellbeing. Make sure you get an annual checkup with your doctor. Being in good physical health will also help your mental health.

Other strategies to help yourself

• Talk to your doctor about treatment options and stick with treatment
• Try to maintain a stable schedule of meals and sleep times
• Engage in mild activity or exercise to help reduce stress
• Set realistic goals for yourself
• Break up large tasks into small ones, set some priorities, and do what you can, as you can
• Try to spend time with other people and confide in a trusted friend or family member
• Tell others about events or situations that may trigger symptoms
• Expect your symptoms to improve gradually, not immediately
• Identify and seek out comforting situations, places, and people
• Continue to educate yourself about this disorder.

Important strategies to support someone’s recovery

Family, whānau and friends of someone with a personality disorder such as BPD have found the following strategies important and useful.

• Remember that people with these conditions tend to easily take words and actions the wrong way. It’s important to be clear in what you say, and to be willing to clarify your meaning or intention if you get a bad reaction. It’s also important not to take these reactions personally, but see them as a result of the person misinterpreting you.
• Learn what you can about the condition, its treatment, and what you can do to assist the person.
• Take the opportunity, if possible, to contact a family or whānau support, advocacy group or culturally appropriate organisation. For many, this is one of the best ways to learn about how to support the person, deal with difficulties, and access services when needed.
• Encourage the person to continue treatment and to avoid alcohol and drug abuse.
• Find ways of getting time out for yourself and feeling okay about this. It’s important to maintain your own wellbeing.

Thanks to Janet Peters, Registered Psychologist for reviewing this content. Date last reviewed:  October,  2014.