Borderline personality disorder (BPD)

8-minute read

What is BPD?

Borderline personality disorder (BPD) is a common mental health disorder that can be treated. It affects people’s thoughts, emotions and behaviours, making it difficult for them to cope in all areas of life.

We all see the world through different eyes, but a person with BPD has an abnormally distorted view of themselves and the environment around them.

People with BPD feel intense, uncontrollable emotions, which can make them very distressed and angry. They have trouble with their relationships and find it hard to feel comfortable in themselves. They may be very impulsive and appear to lead chaotic lives, act impulsively or intentionally harm themselves as a way of coping.

Borderline personality disorder can be difficult for other people to understand. It can be distressing for the person with BPD and the people around them, and it is often misunderstood.

It is the most common personality disorder in Australia, affecting about 1 to 4 in every 100 people at some time in their lives. It's more common in women, and usually the symptoms appear in the teenage years or early adulthood.

What are the symptoms of BPD?

There are many different BPD symptoms or BPD traits including:

feeling empty inside
low self-esteem
strong, overwhelming emotions and feelings
intense mood swings including outbursts of anxiety, anger and depression
a pattern of tumultuous relationships with friends, family and loved ones
alternating between idealising and devaluing other people
fear of being alone and frantic attempts to avoid abandonment
unstable and distorted self-image or sense of self
feeling neglected, alone, misunderstood, chronically empty or bored
feelings of self-loathing and self-hate
self-harm, such as cutting as a coping mechanism
suicidal thoughts or suicide attempts
impulsive and risk-taking behaviour, such as unsafe sex, illegal drug use, gambling, over eating, reckless driving or over spending
black and white thinking, or difficulty compromising
paranoid thoughts in response to stress
feeling cut off and out of touch with reality

What causes BPD?

As with most mental health disorders, the causes of borderline personality disorder (BPD) are not completely understood.

It is probably caused by a combination of genes and life experiences. Having another mental health condition, being very sensitive, or suffering abuse or neglect during childhood may make some people more likely to develop BPD. But not everyone with these factors will experience BPD and not everyone with these experiences will develop BPD traits.

In some people, a stressful event or relationship breakup may be associated with the development of BPD. During times of stress, many people with BPD experience post-traumatic stress symptoms, such as flashbacks, nightmares, feelings of unreality and panic attacks.

Sometimes negative experiences from the past return as voices or punishing self-talk that feel real and are difficult to ignore

When should I see my doctor?

If you or someone you know has or is suspected of having BPD, it’s important to seek help.

You should see a doctor if you or someone you know is:

in crisis
showing signs of emotional distress (being very sad, angry or anxious)
harming themselves
thinking or talking about suicide

People with BPD are at high risk of self-harm and suicide, although not everyone with the disorder will harm themselves. If you or someone you know has BPD and you think there is any immediate danger of suicide, then please call triple zero (000) and ask for an ambulance. Don’t leave the person alone until help arrives.

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How is BPD diagnosed?

There is no single BPD test. If you think you or someone you know has symptoms of BPD, the first step is to see your doctor.

It may take weeks or months to get a diagnosis. A health professional needs to get to know you properly first.

They will need to do a complete mental health assessment, with questions about the current symptoms, past history such as suicide attempts, medical history, relationships and family background such as childhood trauma.

To be diagnosed for BPD, you need to have at least 5 of the following:

frantic efforts to avoid real or imaginary abandonment
consistently intense and unstable relationships with other people, alternating between idealising them and devaluing them
persistently distorted self-image or sense of self
at least 2 impulsive behaviours that are potentially self-damaging
ongoing self-harming behaviour, suicidal behaviour or threats
intense feelings lasting hours to days
long-term, chronic feelings of emptiness
difficulty controlling intense and inappropriate anger
feeling disconnected from reality, or having paranoid thoughts

Teenagers may start showing the symptoms of BPD, but to be diagnosed they need to have symptoms that are severe enough to persistently interfere with daily functioning for 1 year or longer. A teenager with BPD symptoms has much more severe and long-lasting symptoms than a typical moody teen.

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How is BPD managed?

Once a diagnosis is made for BPD, ongoing treatment is managed by a mental health professional.

The most effective treatment combines support and psychological therapy. Medicine may help in some cases, but it is not the main treatment for BPD. While medicine may help relieve some of the symptoms, it does not improve BPD itself.

Psychological therapy

Psychological therapy is the main type of treatment used for BPD. Examples of therapies that can help include:

Dialectical behavioural therapy (DBT) is a treatment specifically developed for BPD and includes individual and group therapy. Techniques such as mindfulness are used to help manage intense and difficult feelings.
Cognitive behavioural therapy (CBT) can assist people with BPD to work on core beliefs that are negatively impacting their lives.
Other forms of therapy that teach new ways to interact with people or to view yourself or the world.

Medicine

Medicine is not recommended as the main treatment for BPD, though it can sometimes help control symptoms. Medicine may be useful if the person with BPD also has other mental health disorders, such as bipolar disorder, an anxiety disorder or depression.

In severe cases, a person with BPD may need to go to hospital. This is usually only recommended as a short-term measure for those who are at risk of harming themselves or others.

The first step in seeking help and treatment for borderline personality disorder is to visit a doctor who can coordinate a team of mental health professionals, such as a psychologist or psychiatrist to manage the condition. Family and friends of people with BPD may also find therapy useful in helping them cope with caring for their loved one.