What is borderline personality disorder?

Borderline personality disorder (BPD) is a mental disorder that can make it difficult for people to form stable relationships with other people and to control their behaviour and emotions. It usually arises in early adolescence.

The Diagnostic and Statistical Manual of Mental Disorders estimates the ocurrence of BPD in the community to be between 1-6%, of which most are female. [1]

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Causes

The causes of BPD and how a person develops the condition are not yet clear. People who have close family members (parents or siblings) with BPD are at significantly greater risk of developing the condition. Other biological factors as well as early social experiences - especially trauma in early life, such as neglect, abuse, domestic violence and poverty - are likely to be involved.

Trauma

1. Physical injury to the body caused by force or a toxic substance. 2. Psychological damage caused by a severely disturbing experience.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Signs and symptoms

One of the challenges of diagnosing BPD is that most people can occasionally display some of the behaviours described as symptoms of BPD. However, in someone with BPD these behaviours occur much more frequently and severely, and generally in a recurring pattern. Relating to other people and the world can be difficult and this can have a disruptive effect on many aspects of their life, particularly relationships.

People with BPD tend to:

  • Form intense but unstable relationships, in which they may alternate between idealising and devaluing the other person;
  • Make desperate attempts to avoid abandonment by other people;
  • Have an unstable sense of self;
  • Be impulsive in ways that can cause themselves damage or distress (such as substance abuse and difficulty controlling spending or sexual activity);
  • Experience persistent feelings of emptiness;
  • Have very intense but changeable moods;
  • Experience intense or inappropriate anger and have difficulty controlling it;
  • Feel paranoid or, alternatively, detached from themselves and their situation, and;
  • Be more likely to threaten to, or commit, acts of self-harm, including suicide.

Symptoms of BPD tend to arise in early adolescence; younger children are generally not diagnosed with the condition.

A woman looking unhappy and worried.A borderline personality disorder can cause feelings of instability, anger and impulsiveness. 

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Methods for diagnosis

Assessment and diagnosis of BPD can be complex and will generally be performed by an experienced mental health professional, such as a psychiatrist. A general practitioner may make an initial assessment and provide treatment, assistance or referral for any urgent issues that may be related to BPD, such as self-harm.

A full medical assessment helps to determine whether there are any underlying medical conditions that may be contributing to a person's symptoms. Their specialist will ask them about their symptoms.

Family members, a partner or carer can be involved in the assessment and in developing a treatment plan. It can be helpful for them to understand BPD and to learn how best to handle it.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Types of treatment

While there is no cure for BPD, the goal of treatment is to reduce symptoms and behaviours that are distressing, as well as learning how to better manage them.

A combination of approaches, including psychological therapy, various forms of support and, in some cases, medication, have been shown to be the most effective way to treat BPD.

Managing BPD may include treating other mental health conditions and dealing with other issues that may also be causing problems, which can involve a range of healthcare and other professionals.

Psychological therapies

Psychological therapy is sometimes referred to as 'talking therapy' and describes the process of treating a mental illness by helping a person to understand their condition and manage their symptoms.

A wide range of psychological therapies have been shown to be effective for treating BPD. They include cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPP) and dialectical behavioural therapy (DBT).

Some of the ways psychological therapies can help a person deal with BPD include:

  • Developing more effective ways of relating to other people;
  • Learning to better handle emotions and situations that provoke intense reactions;
  • Improving coping and problem-solving skills and strategies;
  • Reducing and better managing anger, and;
  • Learning to better control impulsive behaviour.

A mental-health professional can discuss available therapy options and which ones may be most suitable for a person's needs.

Female patient talking with psychologist.Psychological therapy can help with a borderline personality disorder by providing ways of managing its symptoms. 

Support

Because BPD can affect many aspects of a person's life, including education, work, living arrangements and social life, community support programs can be helpful. BPD support groups can help someone with BPD to connect to other people who have been through similar experiences.

Medications

There are no medications that are recommended specifically for the treatment of BPD. In some cases, medications may be helpful to manage symptoms such as depression and anxiety that may also be problems for people with BPD. A mental health professional can advise which medications may be suitable.

Family education and support

Understanding BPD and how best to manage it can be very helpful for family members, partners, carers and friends of people with BPD. Counselling, information and support are available.

CBT

A psychological or 'talking' therapy that focuses on changing unhelpful thoughts and behaviours that are causing a person distress.

Dialectical behavioural therapy

A form of psychological or 'talk' therapy based on cognitive behavioural therapy, but developed particularly for the treatment of people with borderline personality disorder.

Interpersonal psychotherapy

A psychological or 'talk' therapy that focuses on improving the ways a person relates to other important people in their lives.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Potential complications

BPD can be very disruptive and distressing for some people and affect many aspects of their lives.

Self-harm and suicide

Self-harm and suicide are more common among people with BPD. Self-harm can be any behaviour that is done to deliberately cause injury or harm to oneself. If there is any danger of self-harm or suicide, getting help quickly is important and can help to save lives.  

In situations where there is immediate danger of suicide, call 000 for help.

Other ways of finding help for someone include:

  • Making an appointment for them with their doctor;
  • Taking them to the emergency department of the local hospital;
  • Calling a mental health helpline (see 'Support services' below for numbers), and;
  • Calling mental health professionals, counsellors or caseworkers who already provide care for the person who is thinking about self-harm or suicide.

Other mental health disorders

A range of other mental health disorders can also commonly occur with BPD.

These can include:

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Prognosis

Symptoms of BPD are often at their worst in the early adult years. It is usually in this period that the risk of suicide is at its highest.

Fortunately, symptoms do tend to reduce for most people with BPD as they get older. Most people in their 30s and 40s find that their symptoms are less disruptive and they are better able to handle relationships.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Prevention

No effective methods of prevention for BPD have yet been identified. However, psychological treatment and support for children who experience the following problems may help to prevent BPD:

  • Trauma in early childhood;
  • Difficulty emotionally bonding to their parents;
  • Substance abuse problems, disruptive behaviours or depression, and;
  • Self-harm.

Trauma

1. Physical injury to the body caused by force or a toxic substance. 2. Psychological damage caused by a severely disturbing experience.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Support services

If you or someone you know needs help, please call or visit:

Suicide Callback Service. Website: https://www.suicidecallbackservice.org.au/ Tel: 1300 659 467.

Lifeline. Website: https://www.lifeline.org.au/ Tel: 13 11 14.

Kids Helpline. Website: http://www.kidshelp.com.au/ Tel: 1800 55 1800.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.