- Borderline personality disorder (BPD) is a mental illness characterised by intense and unstable moods, impulsive behaviours, fear of abandonment, and inconsistent self-image
- Between 2-5% of the population has BPD
- People with BPD often have additional issues such as depression, PTSD, anxiety, or drug addiction
- BPD patients are likely to achieve emotional stability with the right combination of treatment
If a friend tells you she can’t attend your birthday party due to a work emergency, what do you do? Chances are, you’d be disappointed, but you’d keep your cool and get over it because she really had no choice.
But, if you’re one of the Australians living with borderline personality disorder, your BFF’s behaviour could seem like a major personal attack or outright rejection. In an instant, you might go from being gleeful with anticipation of your party to devastated (cue the waterworks!), and your best friend might not seem so worthy of being your friend at all.
Borderline personality disorder (BPD) is a largely misunderstood mental illness that affects mostly women and can show up as early as your teenage years. It impacts the way you perceive yourself and others, and can manifest as an ongoing pattern of wildly unstable moods, bursts of intense anger, impulsive behaviours, and inconsistent self-image. Thinking in absolutes (viewing everything as good or bad, right or wrong, black or white) is common, as is an intense fear of abandonment from those you love.
To better understand BPD, it helps to think of where it lies on the spectrum of sanity, says psychiatrist Paraskevi Noulas. On one end is the neurotic spectrum, which typically consists of high functioning people who are sane and logical. On the other end is the psychotic spectrum, which typically consists of low functioning people who are not sane. People with BPD lie in between and swing from one end to the other. “So one day you can interact with that person and find them behaving normally,” says Noulas, “and the next week they’re paranoid and questioning all of your motives.”
What are the symptoms of borderline personality disorder?
If the above description of borderline personality disorder sounds like someone you know (or even yourself), don’t jump to conclusions just yet. Someone who truly has BPD, according to the American Psychiatric Association’s diagnostic manual used buy Australian psychiatrists, will display five or more of the follow characteristics.
Frantic efforts to avoid (real or imagined) abandonment
“The core issue of BPD is an inability to regulate moods and behaviours, especially when fearing the loss of a relationship connection,” says psychologist John Vitkus. Efforts to avoid abandonment can include quickly initiating intimate relationships or cutting off contact with someone in anticipation of being abandoned. This might be why an old flame mysteriously dumped you after several seemingly blissful months of dating.
Unstable and intense relationships
Think back to the birthday party example. With BPD, there’s a pattern of tumultuous relationships with family, friends, and loved ones that can swing from extreme closeness and love to dislike and anger (alternating idealisation and devaluation). People with BPD can also have extreme difficulty trusting others, says Noulas, which is never a marker of a healthy relationship.
Distorted self-image
“People with BPD are often overly dependent on others emotionally due to their low self-esteem,” says Noulas. Sometimes they may feel good about themselves and other times they may hate themselves, which can result in frequently changing jobs, friends, and even sexual identity. Talk about exhausting.
A staggering 70% of people with borderline personality disorder attempt suicide.
Impulsive behaviour
Lowered inhibitions can cause people with BPD to act impulsively in ways that are harmful to their physical and emotional wellbeing. This might include binge eating an entire pizza, unsafe sex with multiple partners, driving recklessly, taking drugs, or going on shopping sprees you can’t afford. Several large studies indicate that many people with BPD have an eating disorder or substance abuse problem, says Noulas.
Chronic feelings of emptiness
BPD can be a major downer. “Severe BPD sufferers rate themselves as more miserable than severe depressives and schizophrenics,” says Vitkus. They also talk about feeling empty, as if there’s a void inside them, which may be what causes some of them to fill that void with things like drugs, sex and food.
Recurrent suicidal or self-mutilating behaviour
Many people with BPD engage in self-harming behaviour like cutting or burning themselves. Others often think about suicide or make suicidal gestures or threats, and a staggering 70 percent of people with BPD actually attempt suicide.
⚠️If you're having suicidal thoughts, call Lifeline at 13 11 14. ⚠️
Rapidly shifting between different emotional states
Seemingly small things can send a person with BPD into an emotional tailspin. “I had one couple in my office who was discussing their favourite colours,” says Vitkus. “When the wife [who had BPD] heard that her husband had a different favourite than her, she burst into tears and wailed, ‘I thought you loved me!’” These mood swings usually last a few minutes to a few hours.
Inappropriately intense anger
People with BPD can be horribly cruel, vengeful, and blaming. “I recall one BPD mother telling her son, ‘You should have been an abortion!’,” says Vitkus. “But the strange thing is, after their anger dissipates, they often have no memory of saying or doing these horrible things.” This anger isn’t always directed at someone else, though. People with BPD can be just as angry with themselves.
Feeling paranoid or out of touch with reality
“People with BPD can develop a high sense of paranoia due to their inherent lack of trust in others,” says Noulas. This often occurs during times of stress. Stress can also trigger dissociative states, or moments when you feel like you’re foggy, spaced out, outside your own body, and out of touch with reality.
What causes borderline personality disorder?
The cause of BPD and all personality disorders is still not fully understood, but there’s likely a combination of genetic, environmental and neurological factors at play.
- Genetics and family history. People who have a close family member, such as a parent or sibling with BPD may be at higher risk of developing borderline personality disorder. This could be partly due to genetics, says Noulas. But it could also be that growing up in a household with a family member who’s prone to volatile outbursts, neglect, and verbal abuse primes you for this disorder yourself.
- Environmental and social factors. “We know there’s a significant correlation between trauma, abuse, and abandonment and BPD,” says Noulas. Especially when these occur during childhood. “Because women tend to endure more trauma than men,” Noulas says, “this may be one explanation why women have higher rates of BPD.”
- Neurological factors. Some research shows that, under emotional circumstances, people with BPD have less activity in areas of the brain associated with controlling behaviour and heightened activity in areas of the brain associated with anger and fear. It’s not clear, however, if these are risk factors for BPD or caused by the disorder itself.
How is borderline personality disorder diagnosed?
Someone may be diagnosed with BPD if they meet a certain number of symptoms. However, self-diagnosis is never recommended. An accurate diagnosis can only be made through a clinical interview and exam with a mental health professional such as a psychologist or psychiatrist.
Seeking out a therapist who is experienced in treating BPD specifically may also be important to prevent a misdiagnosis. “Borderline personality disorder is often misdiagnosed as bipolar disorder,” says Vitkus. “Even professionals see the mood swings and understandably think bipolar. One way of distinguishing the two is by asking if the mood swings are triggered by relationship and/or interpersonal issues. If so, it’s more likely that BPD may be the issue. Of course, someone could have both BPD and bipolar disorder.”
How is borderline personality disorder treated?
Therapists used to be at a loss for how to effectively work with people who have BPD, but treatment methods have come a long way over the past few decades. “There’s no set ‘cure’ for BPD,” says Noulas. And medication doesn’t help either. “Rather, people learn skills and ways to manage their emotions, thoughts, and behaviours and apply those skills going forward.”
These skills can be learned through various forms of psychotherapy, or talk therapy. One of the most well-researched, effective treatments is dialectical behavioural therapy (DBT), which was specifically developed to treat borderline personality disorder in the 1980s. DBT typically consists of both group and individual sessions with a therapist over the course of a year in which patients learn skills to regulate emotions, tolerate distress and negative emotions, be mindful and present in a given moment, and communicate and interact effectively with others.
It’s extremely important to note that people with BPD often have additional issues such as depression, PTSD, anxiety or drug addiction that will need to be treated simultaneously in order to help them effectively manage their symptoms. “This makes the treatment more complex,” says Noulas. “But if all disorders are properly treated, the patient has a very high likelihood of achieving emotional stability and being able to move on to a healthy lifestyle.”
Family members and loved ones of a person diagnosed with BPD can also suffer and should consider talking to a therapist about how to deal with their emotions and how to properly interact with someone with BPD. If therapy isn’t an option, Vitkus recommends the book Stop Walking on Eggshells, which outlines in detail the two elements that are most helpful in dealing with borderline personalities: setting limits and maintaining strong boundaries.
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