Borderline personality disorder (BPD) is a mental illness that:
• makes it hard for a person to feel comfortable in themselves
• causes problems controlling emotions and impulses
• causes problems relating to other people.
People with BPD have high levels of distress and anger. They can easily take offence at things other people do or say. People with BPD might struggle with painful thoughts and beliefs about themselves and other people. This can cause distress in their work life, family life and social life.
Some people with BPD harm themselves. For most people with BPD, symptoms begin during their teenage years or as a young adult, then improve during adult life. BPD is a condition of the brain and mind. If someone has BPD, it is not their fault and they did not cause it.
Why is it called ‘borderline’?
The name of this illness includes the unusual word ‘borderline’ for historical reasons. In the past, mental illnesses were categorised as ‘psychoses’ or ‘neuroses’. When psychiatrists first wrote about BPD, it didn’t fit into either category. They decided it belonged on an imaginary line between these two groups of illnesses.
Signs and symptoms of borderline personality disorder
• Being prone to fear that other people might leave them. This can cause them to make frantic efforts to avoid being abandoned by other people –including in situations where other people wouldn’t feel let down or wouldn’t take it personally.
• Having relationships that are unusually intense and unstable (e.g. idealising another person, then intensely disliking them).
• Being very unsure about themselves – not really knowing who they are or what to think about themselves.
• Taking risks or acting impulsively in ways that could be harmful (e.g. not thinking before spending money, risky sexual behaviour, risky drug or alcohol use, driving recklessly or binge-eating).
• Repeatedly harming themselves, showing suicidal behaviour, or talking and thinking about committing suicide.
• Experiencing short-lived but intense emotional ‘lows’ or times of irritability or anxiety. This is usually only for a few hours at a time but sometimes this can last longer.
• Experiencing a persistent feeling of being ‘empty’ inside.
• Experiencing anger that is unusually intense and out of proportion to whatever triggered the anger, and being unable to control it (e.g. having fits of temper or getting into fights).
• When stressed, becoming highly suspicious of others or experiencing unusual feelings of being detached from their own emotions, body or surroundings.
Causes of borderline personality disorder
The exact causes of BPD are not yet known. It is probably caused by genes as well as experiences – not just one or the other. For a person who is naturally very sensitive, life problems while growing up might be especially damaging. These problems could include bad experiences or having another mental health condition. It is not possible to predict who will develop BPD.
How is borderline personality disorder diagnosed?
There is no test for BPD. It can only be diagnosed by a mental health professional after talking to the person and getting to know them. The diagnosis of BPD can be made if a person has several of the signs or features. There are many combinations of these features, so people with a diagnosis of BPD can seem very different from one another.
What treatments work for borderline personality disorder?
Psychological treatments (talking therapies) are the best way to treat BPD. These treatments usually involve talking with a health professional one-to-one, or sometimes attending special groups. Medication is not recommended as a person’s main treatment for BPD. For someone who is already receiving psychological treatment, medication may be helpful to manage particular symptoms. Electroconvulsive therapy (ECT) does not work for BPD.
What are the aims of treatment?
For many people with BPD, important goals are:
• To overcome emotional problems (such as depression, anxiety and anger)
• To find more purpose in life (e.g. by making a positive contribution to their community)
• To build better relationships
• To learn how to understand and live with yourself
• To improve physical health.
When should treatment start?
Early treatment is best for people with BPD. It is important to get a diagnosis as soon as possible, so that a health professional (e.g. your GP, psychiatrist, or clinical psychologist) can arrange the right treatment. Even if your diagnosis is not certain, you can still start treatment. Many of the psychological treatments that are effective for BPD can also be useful for other mental health conditions. Young people, including teenagers, can have BPD and can start treatment as soon as the diagnosis is made.