Borderline Personality Disorder (BPD)
An Overview Of BPD
Around 1 in 100 people live with BPD.
BPD means that you feel strong emotions that you struggle to cope with. You may feel upset or angry a lot of the time.
There are different reasons why people get BPD. A lot of people who live with the diagnosis have had traumatic experiences in their childhood, including being invalidated by caregivers.
If you are someone living with the diagnosis of BPD, it is more likely that you will self-harm. And have challenges with relationships, alcohol or drugs. There is help available.
There are different ways to treat BPD. The NHS should normally offer you therapy - although many with the condition seek private support in conjunction with the NHS.
What Is Borderline Personality Disorder (BPD)?
Everyone has different ways of thinking, feeling, and behaving. It is these thoughts, feelings, and behaviours that make up our ‘personality’. These are often called our traits. They shape the way we view the world and the way we relate to others.
You can think of your traits as sitting along a scale. For example, everyone can feel emotional, get jealous, or want to be liked at times. But it is when these traits start to cause problems, that you may be diagnosed as having a personality disorder.
BPD is a type of ‘personality disorder’.
BPD can affect how you cope with life, manage relationships and feel, emotionally. You may find that your beliefs and ways of dealing with day-to-day life are different from others. You can find it difficult to change them.
You may find your emotions confusing, tiring, and hard to control. This can be distressing for you and others. Because it is distressing, you may find that you develop other mental health problems like depression or anxiety. You may also do other things such as drink heavily, use drugs, self harm or participate is other risky behaviours, to cope.
Research shows that around 1 in 100 people live with BPD. It seems to affect men and women equally, but women are more likely to have this diagnosis. This may be because men are less likely to ask for help and have been known in history to be emotionally more repressed in society. BPD is sometimes called emotionally unstable personality disorder (EUPD). Some people feel that this describes the life experience better.
Some people who live with BPD think that the name is insulting or makes them feel labelled. Doctors or therapists don’t use this term to make you feel judged or suggest that the illness is your fault. It is meant to describe the way it develops. It’s important to remember this is a health condition. And not a judgement of your character or you as a person.
What Are The Symptoms?
Everyone will experience BPD differently. If you live with BPD, you may have difficulties with:
Intense and unstable interpersonal relationships, Including idealisation and devaluation
Risky behaviour, such as unprotected sex & substance use/abuse
Self-harm and Suicidal ideation
Chronically feeling 'empty’
Dissociation. This could be a feeling of being disconnected from your own body. Or feeling disconnected from the world around you
Identity confusion. You might not have a sense of who you are
Fear of abandonment
Intense emotional instability
Not everyone will experience all these symptoms.
Causes & Treatment
There’s no single reason why some people develop borderline personality disorder (BPD). Professionals can’t use things like blood tests or brain scans to help diagnose people.
It is thought that BPD may be caused by a combination of factors:
Genetics – you may be more vulnerable to BPD if a close family member also lives with BPD. There is no evidence though of a particular gene being responsible for BPD.
Brain chemicals – problems with levels of your brain chemicals, particularly serotonin.
Brain development – many people who live with BPD have smaller, or more active, parts of their brain. These parts of the brain are affected by your early upbringing. And can affect the regulation of your emotions, behaviour and self-control. They can also affect you planning and decision making.
Environmental factors – a number of environmental factors seem to be common with people who live with BPD.
These can include:
experiencing long-term fear or distress as a child
being neglected by 1, or both, of your care-givers as a child
growing up with a family member who had a serious mental health condition. Such as bipolar disorder or a problem with alcohol or drugs
Bio Social Theory Suggests:
What Treatment Should I Consider?
There is no medication to treat BPD. But your doctor may offer you medication for the symptoms you experience, if appropriate.
There are lots of different types of talking therapies and your doctor should talk to you about what is available, how it may help you and what type of therapy you would like.
We have included details below of some of the therapies that your doctor may use. But these are not available everywhere. And your doctor may recommend other types of talking therapy.
Your doctor may also think about:
How much BPD is affecting you
How much you are willing to engage with therapy
If you want to change how react to your thoughts and feelings
If you will be able to work effectively with a counsellor
The personal and professional support that is available
The therapy you are offered with the NHS should last at least 3 months. If your doctor decides that talking therapies are not suitable, they should explain why.
Click here for clinical evidence and guidance NICE guidelines
Dialectical behavioural therapy (DBT)
Please see more on the DBT that our therapists offer, HERE.
DBT is a type pf therapy specifically designed to treat people with BPD. The goal of BPD is to help you accept that your emotions are real and acceptable. And to challenge how you respond to those emotions by being open to ideas and opinions which are different to your own.
DBT usually involves weekly individual and group sessions. And you should be given an out-of-hours contact number to call if your symptoms get worse.
DBT is based on teamwork. You'll be expected to work with your therapist and the other people in your group sessions. In turn, the therapists work together as a team.
Mentalisation-based therapy (MBT)
Mentalisation means the ability to think about thinking. This means looking at your own thoughts and beliefs. And working out if they are helpful and realistic.
This type of therapy also helps you to recognise that other people have their own thoughts, emotions and beliefs. And that you may not always understand these. The therapy also helps you to think about how your actions might affect what other people think or feel.
A course of MBT usually lasts around 18 months. You may first be offered MBT in a hospital as an inpatient. The treatment usually consists of daily individual sessions with a therapist and group sessions with other people with BPD.
Some hospitals and specialist centres like you to remain in hospital whilst you are having MBT. But others recommend that you leave the hospital after a certain period of time but remain being treated as an outpatient. This means that you will visit the hospital regularly.
There are different types of arts of creative therapies. These include:
Music therapy, and
Dance movement therapy.
These therapies can be offered individually but they are often done in groups. Sessions are usually weekly. These therapies can be helpful to people who find it hard to talk about their thoughts and feelings.
Therapeutic communities are not a treatment themselves. They are places you can go to have treatment. Most therapeutic communities are residential. They help people with long-term emotional problems, and a history of self-harming, by teaching them skills to help them have better relationships.
These communities often set strict rules on behaviour. For example, no drinking alcohol, no violence and no attempts at self-harming.
You may stay for a few weeks or months, or you may visit for just a few hours a week. You may have group therapy and self-help sessions. You would be expected to take part in other activities to improve your self-confidence and social skills. These activities may include household chores, games and preparing meals.
Therapeutic communities vary a lot because they are often run by the people who use them. And they shape them based on what they want to achieve.
How can I get help if I think I have BPD?
The first step to get help is to speak to your GP.
Your GP will look at different things when deciding how best to help you. So, it can help to keep a record of your symptoms. This can help you and your GP to understand what difficulties you are facing. It may help if you keep a record of:
How distressed you feel
Any risks to yourself or other people
Details of anything you have done to try and reduce your levels of anxiety and distress
Your GP can’t diagnose BPD. Only a psychiatrist should make a formal diagnosis. A psychiatrist is part of the community mental health team (CMHT). If your GP feels that you need more support they will refer you to the CMHT.
You can check what treatment and care is recommended for BPD on the National Institute for Health and Care Excellence (NICE) website. NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at:
The NHS does not have to follow these recommendations. But they should have a good reason for not following them.
People who live with BPD have sometimes been excluded from NHS services because of their diagnosis. But the NHS should not refuse to give you specialist help because of your diagnosis. They should have services to support people with BPD.
This is why many people living with BPD seek private therapy & services for support with their experiencing of living with BPD.
Other Mental Health Conditions
Many people who live with BPD will also experience other mental health problems. Such as depression, anxiety, eating disorders, PTSD and alcohol or drug misuse. People who live with BPD can also be diagnosed with bipolar disorder. The symptoms of bipolar disorder can often be confused with those of BPD.
You can find more information about:
Personality disorders by clicking here
Dissociation and dissociative disorders by clicking here
Self-harm by clicking here
Anxiety disorders by clicking here
Depression by clicking here
PTSD by clicking here
Drugs, alcohol and mental health by clicking here
Bipolar disorder by clicking here
The base of this article and its facts was originally written by "Rethink", View full article, helplines and further BPD support Click Here.
For evidence & research of BPD treatments and their effectiveness, click here