What is borderline personality disorder?

Borderline personality disorder (BPD) is a mental health condition. It affects about 1-4 per cent of people in Australia at some stage of their lives.

The symptoms of borderline personality disorder cause significant distress and can lead to family, social and work problems. BPD causes problems with self-identity, managing emotions, impulse control and relating to other people. Symptoms usually start during the teenage years or early adulthood, but then tend to improve as adults get older.

In recent years there have been advancements and improvements in the treatments for borderline personality disorder. With psychological therapy, full recovery is now possible for many people with this condition.

What are the symptoms?

Many people with borderline personality disorder have low self-esteem and unstable self-identity. They often don’t feel comfortable in themselves and are unsure how to feel and think about themselves, frequently changing how they think and feel about things such as their career and life goals.

There is often a fear of abandonment or rejection, and many people with BPD describe a feeling of emptiness, boredom or feeling emotionally detached. People with BPD are often overly sensitive (their emotions are easily triggered) and have intense reactions when their emotions are triggered. For example, they may easily take offence and have angry outbursts that are out of proportion to the situation. They may feel out of control in these situations.

BPD can also cause problems with impulse control. Impulsive behaviours may involve substance abuse (alcohol or drug abuse), stealing, binge eating, risky sexual behaviour, reckless driving, deliberate self harm (such as cutting or burning) and suicidal behaviour.

Relationships may be intense and unstable. People with BPD may quickly change how they feel about the people in their lives – idolising someone one minute and then intensely disliking them the next. Difficulties relating to others may be accompanied by frequent arguments and feeling suspicious of others when stressed. Other people may interpret the actions of people with BPD as being manipulative or attention-seeking.

What causes borderline personality disorder?

The exact cause of personality disorders is not known. A combination of genetic (inherited) factors and personal life experiences are thought to be involved in the development of borderline personality disorder.

Childhood trauma (including physical abuse and neglect) may contribute to the development of borderline personality disorder in people who are genetically susceptible. Being naturally emotionally sensitive is a risk factor for BPD.

Disruption in the balance of certain chemicals in the body (such as serotonin, oxytocin and dopamine) and changes in certain areas of the brain may play a role in the development of BPD. Some studies have suggested that smoking or regular alcohol intake during pregnancy may increase the risk of BPD in children. Significant stress during pregnancy and in the months after birth has also been suggested as a risk factor for the child.

Complications

Many people with personality disorders also have additional mental health problems, such as anxiety disorders or depression and other personality disorders. Substance abuse (particularly alcohol abuse) and social withdrawal are not uncommon.

How is borderline personality disorder diagnosed?

If you or someone close to you has symptoms that you think may be due to BPD, see your GP (general practitioner). Your doctor will ask about your symptoms and how they impact your life, as well as about your health in general.

If your doctor suspects BPD, they may refer you to a psychiatrist or psychologist for diagnosis and treatment – this may be through your local public mental health service.

There are no specific tests that can help confirm the diagnosis of BPD. However, in cases where there is a sudden change in personality, tests such as a brain scan or urine test may be recommended to rule out other things that could be causing your symptoms.

Treatment for borderline personality disorder

People with BPD have difficulties with how they perceive and interpret things that happen to them, and how they react and behave in different situations. Treatment aims to help people better understand themselves, confront their fears, deal with trauma, overcome emotional problems and improve relationships.

Psychological therapy, where you talk with a psychologist or therapist, is the main treatment for BPD. Sometimes medicines are also prescribed to help with certain symptoms.

Psychological therapy

Psychological therapy for borderline personality disorder should be structured and regular, for a planned period of time. It may be one-on-one therapy with a psychologist, or family or group therapy.

Some of the psychological treatments currently offered for BPD include the following.

• Dialectical behaviour therapy (DBT) is a combination of behavioural therapy and mindfulness. It teaches people skills to help them interact with others, regulate emotions and improve self-awareness. You learn strategies for coping with distress, managing impulsiveness and changing behaviour.
• Schema therapy is a type of psychotherapy that combines techniques from several other therapies, including cognitive behavioural therapy (CBT), psychodynamic therapy and mindfulness.
• Mentalisation-based therapy (MBT) is another type of psychotherapy that aims to help people with BPD better understand themselves and others. It involves identifying your own thoughts and feelings and the thoughts and feelings that may be behind the actions of other people.

Talk to your doctor or mental health specialist about what treatments are available for BPD and which would be most suitable for you.

Medicines

Medicines may be used short-term to treat specific symptoms in some people with BPD. Medication may be needed if there are co-existing problems such as depression or anxiety.

Medicines cannot cure borderline personality disorder, and should only be used together with psychological therapy, not as the main treatment.

Lifestyle measures

Getting regular exercise and eating a healthy diet can help with mental and physical health. Regularly getting enough sleep is also important to help you manage your health in general.

Staying safe

Your doctor, psychologist or therapist will give you a plan to manage your feelings and actions if you have thoughts of harming yourself. You plan should include what to do and who to contact if you are feeling this way.

Support for people with BPD and their families

Having borderline personality disorder can certainly be difficult at times. Family and friends of people with borderline personality disorder can also frequently feel upset, worried, frustrated and confused by their loved one’s behaviour.

Finding out as much as you can about the illness and its effects can help you better understand what’s happening and how to respond. Support from others who are also affected can be of great benefit to people with borderline personality disorder, as well as their families and friends. Talking to others who are affected can make you feel less alone and give you some coping strategies and tips for managing the illness.

There is support available online as well as in person. There are also smartphone apps that can help. Search online or ask your doctor for more information.

Mental health helplines

If you or someone you know is feeling distressed and/or having suicidal thoughts, see your doctor, phone one of these helplines or click on the links below for online web chat counselling or support. Call 000 if life is in danger.

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