As Psychologists, we are able to have a good understanding of someone who has been diagnosed with Borderline Personality Disorder (BPD), and the challenges that come with living with this condition. BPD is a mental health disorder characterised by intense and unstable emotions, impulsive behaviour, distorted self-image, and unstable relationships. Unfortunately, BPD has long been stigmatised and misunderstood, which can make it difficult for those living with the condition to seek help and support. In this article, we will share information on symptoms, causes, diagnosis, and treatment options, and discuss the importance of breaking the stigma surrounding BPD and provide tips for coping with the condition.
Introduction to Borderline Personality Disorder (BPD)
Borderline Personality Disorder is a mental health disorder that affects approximately 1.6% of adults in the United States. BPD is characterised by a pattern of unstable moods, behaviours, and relationships. People with BPD often experience intense emotions such as anger, sadness, anxiety, and shame. They may struggle with impulse control, engaging in risky behaviours such as substance abuse, binge eating, and self-harm. People with BPD may also have difficulty establishing and maintaining stable relationships, and may experience frequent changes in their sense of self and identity.
What are the common symptoms of BPD?
The symptoms of BPD can vary from person to person, but some common symptoms include:
- Intense and unstable emotions
- Fear of abandonment or rejection
- Impulsive behaviours, such as substance abuse, binge eating, or reckless driving
- Unstable relationships, including idealising and devaluing others
- Distorted self-image, including feelings of emptiness and self-loathing
- Self-harm or suicidal behaviour
- Dissociation or feeling disconnected from oneself or reality
Understanding the causes of BPD
The causes of BPD are complex and not fully understood. Research suggests that a combination of genetic, environmental, and neurobiological factors may contribute to the development of BPD. Some potential risk factors for BPD include:
Childhood trauma or abuse:
Childhood trauma is considered one of the risk factors that can contribute to the development of borderline personality disorder (BPD). BPD is a mental health disorder that is characterised by instability in emotions, behaviours, and relationships.
Childhood trauma, which can include experiences such as physical, emotional, or sexual abuse, neglect, or separation from a primary caregiver, can have long-lasting effects on the brain and the development of personality. Trauma can cause changes in the way the brain processes and responds to stress, leading to altered emotional regulation, impulsivity, and difficulty in forming and maintaining healthy relationships.
Additionally, individuals who have experienced childhood trauma may develop maladaptive coping mechanisms, such as self-harm, substance use, or dissociation, as a way of managing overwhelming emotions and memories associated with their traumatic experiences. These coping mechanisms may become ingrained patterns of behaviour that are difficult to change, contributing to the symptoms of BPD.
It’s important to note that not all individuals who experience childhood trauma develop BPD, and there are likely multiple factors involved in the development of the disorder. However, addressing and treating childhood trauma can be an important part of BPD treatment and recovery. Psychological therapies such as Dialectical Behaviour Therapy (DBT) and trauma-focused therapies (such as Schema Therapy) have been found to be effective in treating BPD in individuals with a history of childhood trauma.
Neglect or abandonment during childhood:
Neglect or abandonment issues during childhood can contribute to the development of borderline personality disorder (BPD) through various mechanisms. It’s important to note that not all individuals who experience neglect or abandonment develop BPD, but these experiences can increase the risk.
- Attachment difficulties: Neglect or abandonment can disrupt the formation of secure attachments between a child and their primary caregiver. Secure attachments provide a sense of safety, trust, and emotional support, which are crucial for healthy development. When a child experiences consistent neglect or abandonment, they may struggle to develop secure attachments and have difficulties in regulating their emotions and forming stable relationships later in life.
- Emotional dysregulation: Neglect or abandonment can lead to significant emotional dysregulation in individuals. They may experience intense emotions and have difficulty effectively managing and expressing them. This emotional instability is a core feature of BPD and can manifest as mood swings, intense anger, and feelings of emptiness.
- Fear of abandonment: Neglect or abandonment during childhood can create a profound fear of being abandoned or rejected in individuals. This fear can persist into adulthood and contribute to the intense and unstable relationships often seen in individuals with BPD. They may engage in behaviours to prevent perceived abandonment, such as becoming overly dependent or exhibiting extreme reactions to real or perceived threats of abandonment.
- Identity disturbances: Neglect or abandonment can disrupt the development of a stable sense of self and identity. Without consistent nurturing and guidance, individuals may struggle to develop a cohesive and stable self-identity. This can contribute to feelings of emptiness, a lack of a clear sense of self, and difficulty maintaining a consistent sense of who they are.
It’s important to note that neglect or abandonment is just one potential contributing factor to the development of BPD. BPD is a complex disorder with multiple factors involved, including genetic predisposition, environmental influences, and other traumatic experiences. Therapy, particularly approaches like Dialectical Behaviour Therapy (DBT) and Schema Therapy, can be helpful in addressing the impact of neglect or abandonment on the development of BPD and promoting healing and recovery.
Family history of mental health disorders:
A family history of mental health disorders can increase the risk of developing borderline personality disorder (BPD). Research has found that individuals with a family history of BPD or other mental health disorders such as depression, anxiety, bipolar disorder, and substance use disorders are more likely to develop BPD themselves.
There are several ways in which a family history of mental health disorders can contribute to the development of BPD:
- Genetic predisposition: There is evidence to suggest that genetic factors play a role in the development of BPD. Having a family history of BPD or other mental health disorders may increase an individual’s susceptibility to developing BPD due to shared genetic vulnerabilities.
- Environmental influences: Family members with mental health disorders may also share environmental factors that contribute to the development of BPD, such as childhood abuse, neglect, or trauma. These experiences can lead to difficulties with emotion regulation, relationship problems, and a tendency towards impulsive behaviour, all of which are core features of BPD.
- Learned behaviour: Individuals with a family history of mental health disorders may also learn maladaptive coping mechanisms or ways of relating to others from their family members. This can contribute to the development of BPD symptoms, such as difficulty in forming and maintaining stable relationships, impulsivity, and emotional instability.
It’s important to note that having a family history of mental health disorders does not guarantee that an individual will develop BPD. However, it is a risk factor that should be taken into consideration when assessing an individual’s risk of developing the disorder. Early intervention, such as therapy and support, can be effective in managing and treating symptoms of BPD and improving overall quality of life.
Neurobiological factors, such as abnormal brain chemistry or structure:
Neurobiological factors, such as abnormal brain chemistry or structure, have been found to contribute to the development of borderline personality disorder (BPD). There is evidence to suggest that individuals with BPD have differences in brain function and structure compared to those without the disorder.
Some potential ways in which neurobiological factors can contribute to BPD include:
- Dysregulation of emotion: Neuroimaging studies have shown that individuals with BPD exhibit differences in brain activity in regions involved in emotion regulation, such as the amygdala and prefrontal cortex. These differences may contribute to the intense and labile emotions commonly seen in BPD.
- Impulsivity: Studies have also found differences in brain regions involved in impulsivity, such as the anterior cingulate cortex and the ventral striatum, in individuals with BPD. These differences may contribute to the impulsive behaviour seen in individuals with the disorder, such as substance use, self-harm, and risky sexual behaviour.
- Interpersonal difficulties: There is evidence to suggest that individuals with BPD have differences in brain regions involved in social cognition and processing, such as the mirror neuron system and the insula. These differences may contribute to the difficulties with interpersonal relationships commonly seen in BPD.
- Genetic factors: Some research has suggested that genetic factors may also contribute to the neurobiological differences seen in individuals with BPD. Certain genetic variations may increase an individual’s susceptibility to abnormal brain chemistry or structure, which in turn may contribute to the development of BPD.
It’s important to note that the exact mechanisms by which neurobiological factors contribute to the development of BPD are not yet fully understood. However, understanding these factors can help inform treatment approaches, such as medication and neurofeedback, that target specific neural circuits and improve symptom management in individuals with BPD.
Diagnosis of BPD
Diagnosing BPD can be challenging, as many of the symptoms overlap with other mental health disorders. A mental health professional, such as a Psychologist or Clinical Psychologist, will typically conduct a thorough evaluation and assessment to determine if a person meets the Diagnostics and Statistical Manual of Mental Disorders, fifth edition, text revised (DSM-5-TR) diagnostic criteria for BPD.
The diagnostic process for BPD usually involves a comprehensive clinical evaluation, including a detailed psychiatric history, mental status examination, and psychological testing.
The following criteria must be met for a diagnosis of BPD, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5):
- A pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts.
- Five or more of the following symptoms must be present:
Frantic efforts to avoid real or imagined abandonment.
b. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
c. Identity disturbance: markedly and persistently unstable self-image or sense of self.
d. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
e. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
f. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
g. Chronic feelings of emptiness.
h. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
i. Transient, stress-related paranoid ideation or severe dissociative symptoms.
The symptoms must be long-standing, dating back to late adolescence or early adulthood, and they must not be better accounted for by another mental disorder or medical condition.
It’s important to note that the diagnosis of BPD is often complex, and some of the symptoms may overlap with other mental health disorders. Therefore, an accurate diagnosis requires a thorough evaluation by a Psychologist or Clinical Psychologist who can consider all relevant information and make an informed diagnosis.
Different types of therapy for BPD
Treatment for BPD typically involves a combination of medication and therapy.There are several types of therapy that have been shown to be effective in treating BPD, including:
- Dialectical Behaviour Therapy (DBT): DBT is a form of therapy that focuses on helping people with BPD manage their emotions and improve their relationships. DBT typically involves individual therapy, skills training, and phone coaching.
- Cognitive Behavioral Therapy (CBT): CBT is a form of therapy that focuses on identifying and challenging negative thought patterns and behaviours. CBT can be effective in helping people with BPD manage their emotions and reduce impulsive behaviours.
- Mentalisation-Based Therapy (MBT): MBT is a form of therapy that focuses on helping people with BPD understand and regulate their emotions. MBT can be effective in improving relationships and reducing impulsive behaviours.
- Schema Therapy (ST): ST is based on the idea that problematic patterns of thinking, feeling, and behaviour develop in response to early life experiences, particularly those that involve unmet emotional needs. Schema Therapy involves identifying and changing these maladaptive patterns, called “schemas,” through a combination of cognitive, behavioral, and experiential techniques. These techniques aim to help individuals with BPD to identify their unmet emotional needs, challenge their negative patterns of thinking and behaviour, and develop more adaptive coping strategies.
Medications for BPD
There is no specific medication that has been approved by the FDA for the treatment of Borderline Personality Disorder (BPD). However, medication can be helpful in treating some of the associated symptoms of BPD, such as depression, anxiety, and impulsivity. Medication is typically used in conjunction with psychotherapy, such as Dialectical Behaviour Therapy (DBT) or Schema Therapy (ST).
Some of the medications that may be used to treat BPD symptoms include:
- Antidepressants: Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs), may be helpful in reducing symptoms of depression and anxiety.
- Mood stabilisers: Mood stabilisers, such as lithium or anticonvulsants like valproic acid, may be helpful in reducing mood swings and impulsivity.
- Antipsychotics: Antipsychotics, such as aripiprazole or olanzapine, may be helpful in reducing symptoms of impulsivity, aggression, and anger.
It is important to note that medication alone is not considered a sufficient treatment for BPD. Psychotherapy, such as DBT or Schema Therapy, is the primary treatment approach for BPD, and medication is typically used to supplement the psychotherapy. The decision to use medication as a part of the treatment plan for BPD should be made in consultation with a mental health professional who can evaluate the individual’s specific symptoms and needs.
Self-help strategies for living with BPD
In addition to therapy and medication, there are several self-help strategies that can be effective in managing the symptoms of BPD. These may include:
- Practicing mindfulness and meditation
- Engaging in regular exercise
- Getting enough sleep
- Eating a balanced diet
- Avoiding drugs and alcohol
- Learning healthy coping strategies, such as journaling or deep breathing
Support groups for BPD
Support groups can be a valuable resource for people with BPD, as they provide a safe and supportive environment to share experiences and learn from others. There are several online and in-person support groups specifically for people with BPD and their loved ones. Some of these support groups in Australia include:
Here are some of the options:
- Borderline Personality Disorder Australia: Borderline Personality Disorder Australia is a national organisation that provides information, resources, and support to individuals with BPD, as well as their families and carers. They offer a range of services, including online forums, webinars, and a directory of BPD-specific mental health professionals.
- Spectrum: Spectrum is a Victorian-based organisations that provides support to individuals with BPD and their families and carers. They offer a range of services, including counseling, group therapy, and online resources.
- Queensland Alliance for Mental Health: The Queensland Alliance for Mental Health is a statewide organisation that provides support and advocacy for individuals with mental health conditions, including BPD. They offer a range of services, including peer support groups, counseling, and information and referral services.
- Black Dog Institute: The Black Dog Institute is a national organisation that provides resources and support for individuals with mental health conditions, including BPD. They offer a range of services, including online forums, self-help resources, and educational programs.
- Australian BPD Foundation: The Australian BPD Foundation is a national organisation that provides support and advocacy for individuals with BPD, as well as their families and carers. They offer a range of services, including online support groups, resources, and events.
These are just a few of the many support groups available for individuals with BPD in Australia. It is important to note that support groups are not a substitute for professional mental health treatment, but they can provide valuable peer support and information for individuals with BPD and their families and carers.
- Borderline Personality Disorder Australia: https://www.bpdaustralia.com/
- Spectrum: https://www.spectrumvic.org.au/
- Queensland Alliance for Mental Health: https://www.qamh.org.au/
- Black Dog Institute: https://www.blackdoginstitute.org.au/
- Australian BPD Foundation: https://www.bpdfoundation.org.au/
Breaking the stigma surrounding BPD
Unfortunately, BPD has long been stigmatised and misunderstood, which can make it difficult for people with the condition to seek help and support. Breaking the stigma surrounding BPD starts with education and awareness. By learning more about BPD and sharing accurate information with others, we can help reduce the shame and stigma associated with the condition.
Coping with BPD – Tips for family and friends
If you have a loved one with BPD, it can be challenging to know how to support them. Here are some tips for coping with BPD:
- Educate yourself about the condition and its symptoms
- Practice active listening and validation
- Set boundaries and stick to them
- Encourage your loved one to seek treatment
- Practice self-care and seek support for yourself
Living with Borderline Personality Disorder can be challenging, but with the right treatment and support, it is possible to manage the symptoms and lead a fulfilling life. If you or a loved one are struggling with BPD, know that you are not alone. There are many resources available, including psychological therapy, medication, and support groups. By breaking the stigma surrounding BPD and increasing awareness and understanding of the condition, we can work towards a more compassionate and supportive society for people with BPD.
Contact our clinic today to discuss how our team of Psychologists and Clinical Psychologists can assist you with assessment, diagnosis and treatment of BPD. Phone us on 075574 3888 or email us at email@example.com or Book Online through our website. We’re here for you!