What is Borderline personality disorder

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I was a mental health nurse and also have family who are diagnosed as having a borderline personality disorder. Over the years, I’ve heard all the unacceptable terms being bandied around, not only by the general public but actually by mental health professionals too. Nurses said “she’s just being manipulative,” or “he’s doing his usual, attention seeking,” “She’s just playing up ‘cos she’s got ward round and doesn’t want to go home.” Support staff have been overheard, “bloody drama queen.” or “You’re overreacting again, stop it, calm down.”

I suspect many of you’ve heard of Borderline Personality Disorder (BPD)? Do you know what it is?

Borderline Personality Disorder

Borderline personality disorder is a severe mental illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships with other people.

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It’s called ‘borderline’ because doctors previously thought that it was on the border between two different disorders: neurosis and psychosis. It’s sometimes called emotionally unstable personality disorder (EUPD).

A person with borderline personality disorder may experience episodes of anger, depression, and anxiety that may last from a couple of hours to days. Recognisable symptoms typically show up during adolescence (teenage years) or early adulthood, but early symptoms of the illness can occur during childhood.

  • BPD can be highly distressing for the person affected, and often for their family and friends too.
  • It can be confusing and easily misunderstood, but BPD is a very treatable condition. With the right treatment and support, people with BPD can lead full, productive lives.
  • Around 1 in 100 people have BPD. It is believed to affect men and women equally, though women are more likely to be given this diagnosis.
  • Think of it as emotional dis-regulation. When an air conditioning system is having problems, it may make your home too hot one minute and too cold the next. The temperature regulator within the air conditioning unit clearly has issues if this is happening. BPD is kind of like that when it comes to regulation of emotions.

Borderline Personality Disorder Criteria

The borderline personality criteria are listed in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition:

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  • Significant impairments in function of personality (i.e. poorly developed sense of self, poor self-direction)
  • Impaired interpersonal function – poor ability to empathise and impaired ability to form lasting intimate relationships
  • Pathological personality traits – frequent, intense mood swings; separation insecurity; frequent, short-lived bouts of anxiety and depression. Impulsivity, hostility toward others, recklessness.
  • These impaired abilities and pathological traits occur consistently over time regardless of circumstance or situation.

What symptoms could you expect in borderline personality disorder?

Everyone’s experiences of BPD are different, but you may have problems with some (but not all) of the following:

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  • Feeling empty, low self-esteem
  • Feeling isolated or abandoned by others
  • Paranoia or emotional detachment
  • Getting on with other people
  • Impulsive, risky behaviour
  • Misusing alcohol, drugs or prescription drugs
  • Understanding other people’s point of view
  • Anxiety about relationships, efforts to avoid being abandoned
  • Self-harming or suicidal thoughts
  • Coping with stress
  • Strong emotions that you find difficult to manage
  • Maintaining relationships, work and home

Causes of Borderline Personality Disorder

The exact causes of borderline personality disorder are unknown. As with most mental illnesses, experts believe genetic, familial, and social factors all play roles in its development. People may have a greater chance of developing the disorder if:

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  • One of both parents have borderline personality disorder
  • Disrupted and dysfunctional family life
  • Poor communication within the family
  • Close family member (father, mother, sibling) with BPD or another personality disorder
  • Sexual, emotional, or physical abuse in childhood or adolescence

How do I know if I (or someone I know) have borderline personality disorder?

A mental health professional—such as a psychiatrist, psychologist, or clinical social worker—experienced in diagnosing and treating mental disorders can diagnose borderline personality disorder, based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can also help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illness. This information can help determine the best treatment.

Treatment for borderline personality disorder

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Treatment for BPD in the UK might involve individual or group psychotherapy, carried out by professionals within a community mental health team (CMHT). The goal of a CMHT is to provide day-to-day support and treatment, while ensuring you have as much independence as possible.

Treatment for BPD usually involves some type of psychological therapy which can help you learn to better understand and manage your feelings, responses and behaviour. There are lots of different types of psychotherapy, but they all involve taking time to help you get a better understanding of how you think and feel.

As with any health problem, seeing an understanding GP is a good start. A GP can refer you to a mental health professional or a public mental health service.

Is someone asked you, do you think you could explain Borderline Personality Disorder now? What do you think about the term Personality Disorders?

***Please take any comments about suicide or wishing to die seriously. Even if you do not believe your family member or friend will attempt suicide, the person is clearly in distress and can benefit from your help in finding treatment.