On the Edge - Borderline Personality Disorder

Borderline Personality Disorder (BPD) is one of the lesser known mental health disorders that affects between 1% and 5% of people in the UK.

A person with BPD will feel like they’re on a roller coaster. It affects how a person thinks, feels and interacts with other people, which manifests itself in erratic moods and behaviours and unstable relationships.

Those affected may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality.

With BPD, the brain is on high alert making things feel more scary and stressful than they do to other people. This means the symptoms of BPD are likely to be triggered by events considered normal to most people.

Many of those with BPD have another mental health condition or behavioural problem. Common co-occurring disorders include depression, bipolar disorder, substance abuse and anxiety disorders.

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What are the causes of BPD?

The exact causes of BPD are unclear, however, as with most other personality disorders, the underlying causes are believed to be genetic and environmental.

Genetics is believed to be the most common cause, with a person five times more likely to have BPD if a close relative such as a parent or sibling also has the condition.

Scientists believe BPD may be due to an imbalance of chemicals in the brain called neurotransmitters, responsible for our emotions such as happiness and sadness, hope and fear, relaxation and anxiety.

Adverse life events, particularly those that occur during childhood, are also closely associated with developing BPD. These traumatic events include parental neglect, and emotional, physical or sexual abuse.

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How do you diagnose BPD?

In general, it is believed that about 1-2% of the population at any one time suffers from BPD. Women are diagnosed with the condition about three times more often as men, whilst it appears to become less common among older people.

A diagnosis of BPD is made on a clinical assessment by a mental health professional. Often the professional will ask a series of standard questions to determine whether a person has the condition.

The questions relate to the themes below.

  • Regular feelings of “emptiness”
  • Rapid changes in emotions to extremes such as anger and sadness
  • A constant fear of abandonment by close friends and family
  • A regular sense of insecurity with respect to relationships, with a tendency to lash out or make impulsive gestures to keep people close
  • Feelings about people that can change dramatically without a rationale reason 
  • Engaging in dangerous or unhealthy behaviours such as drug use, binge drinking or unsafe sex
  • Engaging in self-harm behaviours such as attempted suicide

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What are the symptoms of BPD?

There are several symptoms associated with BPD, which can vary from mild to severe. They usually become apparent in adolescence and continue to persist into adulthood.

The symptoms of BPD can be grouped into 5 main areas:

  • Emotional instability: This covers feelings such as a fear of abandonment, chronic feelings of emptiness (attempts to fill this void can lead to extreme behaviours related to drugs, sex and food) and a short temper and explosive anger
  • Disturbed patterns of thinking or perception: This includes extreme emotional swings (between feeling happy and despondent), feeling suspicious or out-of-touch with reality (often struggle with paranoia) and an unclear or shifting self-image.
  • Impulsive behaviour: A person with BPD may engage in risky behaviours such as substance abuse, driving recklessly and shoplifting
  • Self-harm: Suicidal behaviour and deliberate self-harm is common
  • Stained relationships: Those with BPD tend to have intense yet unstable relationships (often short-lived), with the relationship seeming to be either idyllic or horrible, without any middle ground.

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How is BPD treated?

The good news is that most people with BPD can, and do get better, with up to half of people improving over a ten-year period.

When BPD is treated, a person often sees improvement in the other personality disorders they have too (albeit the reverse isn’t always true). Indeed, the long-term prognosis for BPD is better than those for depression and bipolar disorder.

The most fundamental treatment for BPD is psychological therapy, either individually or as part of a group. Psychotherapy helps educate a person about BPD so it can be better managed. Psychotherapy address emotion management, reduces impulsiveness and works on improving relationships.

No medication is currently licensed to treat BPD, albeit a person with BPD may be taking treatment if they have another mental health condition such as anxiety disorder or bipolar disorder. If a treatment is prescribed it will most likely be a mood stabiliser or antipsychotic drug to help with the mood swings and reduce impulsive behaviour.

Medical health professionals also advise on action to improve emotional and physical well-being, as negative emotions are more prominent when we’re feeling low or under stress. Their advice includes getting plenty of sleep, exercising regularly, minimising stressful activities, avoiding mood-changing drugs, eating a balanced and nutritious diet, and practising relaxation techniques.

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If you have any follow-up questions don't hesitate to contact us at help@manbehindthemirror.co.uk

Written by Mike Firth, GP and Medical Director

This article is for informational purposes only and is not a substitute for professional medical advice or diagnosis. Always talk to your doctor about the risks and benefits of any treatment.