What to do if you have borderline personality disorder

Borderline personality disorder (BPD) is a disorder of mood and how a person interacts with others. It's the most commonly recognised personality disorder.

In general, someone with a personality disorder will differ significantly from an average person in terms of how he or she thinks, perceives, feels or relates to others.

Symptoms of borderline personality disorder (BPD)

The symptoms of BPD can be grouped into 4 main areas:

• emotional instability – the psychological term for this is affective dysregulation
• disturbed patterns of thinking or perception – cognitive distortions or perceptual distortions
• impulsive behaviour
• intense but unstable relationships with others

The symptoms of a personality disorder may range from mild to severe and usually emerge in adolescence, persisting into adulthood.

Causes of borderline personality disorder (BPD)

The causes of BPD are unclear. But as with most conditions, BPD appears to result from a combination of genetic and environmental factors.

People with BPD come from many different backgrounds, but most will have experienced some kind of trauma or neglect as children.

When to get medical advice

If you're experiencing symptoms of BPD, make an appointment with a GP.

They may ask about:

• how you feel
• your recent behaviour
• what sort of impact your symptoms have had on your quality of life

This is to rule out other more common mental health conditions, such as depression, and to make sure there's no immediate risk to your health and wellbeing.

You may also find Mind a useful website.

Find out more about how BPD is diagnosed

Treating borderline personality disorder (BPD)

Many people with BPD can benefit from psychological or medical treatment.

Treatment may involve a range of individual and group psychological therapies (psychotherapy) carried out by trained professionals working with a community mental health team.

Effective treatment may last more than a year.

Over time, many people with BPD overcome their symptoms and recover. Additional treatment is recommended for people whose symptoms return.

Associated mental health problems

Many people with BPD also have another mental health condition or behavioural problem, such as:

• misusing alcohol
• generalised anxiety disorder
• bipolar disorder
• depression
• misusing drugs
• an eating disorder, such as anorexia or bulimia
• another personality disorder, such as antisocial personality disorder

BPD can be a serious condition, and many people with the condition self-harm and attempt suicide.

See your GP if you're concerned that you have borderline personality disorder (BPD). They may ask about your symptoms and how they're affecting your quality of life.

Your GP will also want to rule out other more common mental health conditions, such as depression, and make sure there's no immediate risk to your health and wellbeing.

If your GP suspects BPD, you'll probably be referred to your local community mental health team for a more in-depth assessment. Ask if the service you're being referred to has experience of working with personality disorders.

You may also find the Mind and Emergence websites useful.

Community mental health team

Community mental health teams help people with complex mental health conditions such as BPD. However, some teams may focus only on people with psychotic disorders. In other areas, there are complex needs services that may be better placed to help you.

Your assessment will probably be carried out by a specialist in personality disorders, usually a psychologist or psychiatrist.

Assessment

Internationally recognised criteria are used to diagnose BPD. A diagnosis can usually be made if you answer "yes" to 5 or more of the following questions:

• Do you have an intense fear of being left alone, which causes you to act in ways that, on reflection, seem out of the ordinary or extreme, such as constantly phoning somebody (but not including self-harming or suicidal behaviour)?
• Do you have a pattern of intense and unstable relationships with other people that switch between thinking you love that person and they're wonderful to hating that person and thinking they're terrible?
• Do you ever feel you do not have a strong sense of your own self and are unclear about your self-image?
• Do you engage in impulsive activities in 2 areas that are potentially damaging, such as unsafe sex, drug misuse or reckless spending (but not including self-harming or suicidal behaviour)?
• Have you made repeated suicide threats or attempts in your past and engaged in self-harming?
• Do you have severe mood swings, such as feeling intensely depressed, anxious or irritable, which last from a few hours to a few days?
• Do you have long-term feelings of emptiness and loneliness?
• Do you have sudden and intense feelings of anger and aggression, and often find it difficult to control your anger?
• When you find yourself in stressful situations, do you have feelings of paranoia, or do you feel like you're disconnected from the world or from your own body, thoughts and behaviour?

Involving your family

Once a diagnosis of BPD has been confirmed, it's recommended that you tell close family, friends and people you trust about the diagnosis.

There are several reasons for this.

Many of the symptoms of BPD affect your relationships with people close to you, so involving them in your treatment may make them aware of your condition and make your treatment more effective.

Your family and friends can then remain alert for any behaviour that may indicate you're having a crisis.

They may also benefit from local support groups and other services for people in a relationship with a person with BPD.

However, the decision to talk about your condition is entirely your own, and your confidentiality will be respected at all times.