“I couldn’t trust my own emotions. Which emotional reactions were justified, if any? And which ones were tainted by the mental illness of BPD? I found myself fiercely guarding and limiting my emotional reactions, chastising myself for possible distortions and motivations. People who had known me years ago would barely recognize me now. I had become quiet and withdrawn in social settings, no longer the life of the party. After all, how could I know if my boisterous humor were spontaneous or just a borderline desire to be the center of attention? I could no longer trust any of my heart felt beliefs and opinions on politics, religion, or life. The debate queen had withered. I found myself looking at every single side of an issue unable to come to any conclusions for fear they might be tainted. My lifelong ability to be assertive had turned into a constant state of passivity.”
Rachel Reiland
Get Me Out of Here: My Recovery from Borderline Personality Disorder

Misdiagnosis of BPD

Borderline personality disorder is often diagnosed when another disorder is causing the symptoms experienced. 

ADHD

OCD

ASD

What is BPD / EUPD?

What causes Emotionally Unstable Personality Disorder?

Genetics

Environment

Brain Chemicals

Brain Development

Genes you inherit from your parents may make you more vulnerable to developing BPD.A study found that if 1 identical twin had BPD, there was a 2-in-3 chance that the other identical twin would also have BPD.

Other studies found overlaps with other mental health conditions such as Bipolar or Schizophrenia. 

 

  • being a victim of emotional, physical or sexual abuse
  • being exposed to long-term fear or distress as a child
  • being neglected by 1 or both parents
  • growing up with another family member who had a serious mental health condition, such as bipolar disorder or a drink or drug misuse problem

 

It’s thought that many people with BPD have something wrong with the neurotransmitters in their brain, particularly serotonin.

Neurotransmitters are “messenger chemicals” used  to transmit signals between brain cells. Altered levels of serotonin are linked to depression, aggression and difficulty controlling  urges.

Researchers have used MRI to study the brains of people with BPD. MRI scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body.

The scans revealed that in many people with BPD, 3 parts of the brain were either smaller than expected or had unusual levels of activity. 

What parts of the brain are affected?

amygdala

hippocampus

orbitofrontal cortex

which plays an important role in regulating emotions; fear, aggression & anxiety

which helps regulate behaviour and self-control

which is involved in planning and decision making

Structural brain abnormalities in borderline personality disorder: A voxel-based morphometry study (nih.gov) focused on analysing MRI scans of borderline personality patients versus the control ‘healthy’ group. The results concluded Loss of inhibitory regulation in these limbic circuits results in disinhibited fear responding, anger and impulsive-aggressive behavior, core characteristics of BPD ().

Symptoms

Borderline personality disorder (BPD) can cause a wide range of symptoms, which can be broadly grouped into 4 main areas.

Emotional instability

Disturbed Pattens of Thinking

Impulsive Behaviour

Intense, Unstable Relationships

The psychological term for this is “affective dysregulation” where BPD patients experience heightened emotions and prolonged periods of distress.

“cognitive distortions” or “perceptual distortions”.  Some beliefs are psychotic, a if you become more unwell. It’s important to get help when struggling with delusions.

An impulse to self-harm and/or a strong impulse to engage in reckless and irresponsible activities which are extermely difficult to control. 

You may feel that other people abandon you when you most need them, or that they get too close and smother you. Externally it appears manipulative, but it is a defense mechanism.

For diagnosis, mental health professionals group the symptoms into 9 major categories. In order to be diagnosed, you must show at least 5 of these symptoms. Furthermore, the symptoms must be long-standing and impact many areas of your life.

Fear of abandonment

Unclear/shifting self image

Explosive anger

Chronic emptiness

Suspicious/out of touch

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Emotion dysregulation

Anger

Sorrow

Shame

Terror

Emptiness

Panic

Insecure

You may have severe mood swings over a short space of time. It's common for people with BPD to feel suicidal with despair, and then feel reasonably positive a few hours later. Some people feel better in the morning and some in the evening. The pattern varies, but the key sign is that your moods swing in unpredictable ways.

Disturbed patterns of thinking

Upsetting, intrusive thoughts

Strange experiences

Polonged abnormal experiences

upsetting thoughts – such as thinking you’re a terrible person or feeling you do not exist. You may not be sure of these thoughts and may seek reassurance that they’re not true

brief episodes of strange experiences – such as hearing voices outside your head for minutes at a time. These may often feel like instructions to harm yourself or others. You may or may not be certain whether these are real

prolonged episodes of abnormal experiences – where you might experience both hallucinations or distressing beliefs no one can talk you out of (e.g believing your family are trying to kill you)

If you have suicidal thoughts...

call your GP or the out-of-hours GP service. If you've taken an overdose or cut or burned yourself, dial 999

call the Samaritans on 116 123 for emotional support 24 hours a day for people experiencing feelings of distress/despair

contact a friend, family member, coworker, neighbour or community member that you trust for support

Discouraged

Petulant

The discouraged form of borderline personality disorder is rooted primary by dependent facets of the condition. So, how an individual thinks, feels, and behaves will see them very much exhibit all the hallmarks or co-dependency. This can often be so much the case that this form of BPD can appear to be dependent personality disorder (DPD). The full nature of the discouraged sub-type is only truly noticed when an individual enters into a co-dependent style relationship with someone whom it’s either inappropriate or rejects their advances. This is usually the case with casual friends and acquaintances or perhaps a girlfriend or boyfriend that they’ve just started dating.

Impairments in Self-Functioning: These might include but are not exclusively limited to poor self-image, persistent self-criticism, chronic feelings of emptiness, and stress-induced dissociative states. There also might be a distorted or unrealistic view of goals, values, career, and outlook.

Impairments in Interpersonal Functioning: related to and have a direct impact on the wellbeing of others. Again, these include but are not limited to decreased empathy, an inability to see other’s point of view and a heightened sense of drama and am extreme aversion to criticism.

  • Extreme loyalty to the point of it being a detriment or biased
  • Easily swayed by the opinion of others and led by a crowd
  • A tendency to be passive even when there is a desire to take the lead
  • Can display false modesty as a result of poor self-esteem
  • The experience of chronic feelings of being vulnerable
  • Excessive dependence on others

Flips from explosive outbursts of anger on one side of the spectrum to feeling unworthy or unloved on the opposite. They often have a strong need to manipulate and control others, which can see them become very possessive and guarding of their inner world and thought-processes. As a result, they can often find themselves stuck in deeply unsatisfying relationships. This can then sometimes lead to situations of substance abuse amongst other self-destructive behaviours.

  • An inability to express your feelings
  • Unpredictable outbursts of anger
  • Feeling unworthy or unloved
  • Extreme fear of abandonment
  • Co-occurring disorders such as eating disorders and substance abuse issues
  • Engaging in self-harm
  • Suspicion of others and paranoia
borderline-personality-disorder
© Leremy / Shutterstock.com

Impulsive

Self Destructive

Of all the four subtypes of BPD, the impulsive form of the condition is by far the most outgoing and charismatic. In some ways, it subverts the expectations of what someone with borderline personality should look like. So much so, this subtype has been compared to histrionic personality disorder according to psychologist Theodore Millon.
  • Being excessively flirtatious with others
  • Exudes a natural magnetism that draws people to them
  • Can often appear elusive and mysterious
  • Very good at surface level interactions but lacks real depth of character
  • Exhibits high levels of energy and can easily get bored
  • Can be extremely thrill-seeking, taking extreme risks to do so
  • Is overtly attention-seeking by nature
Those who suffer from this subtype of BPD are very much ‘on the brink.’ That’s to say that, as the name of this variant implies, they’re extremely volatile and are prone to displaying dangerous and self-sabotaging behaviours. The self-destructive border will either consciously or unconsciously seek to sabotage their own progress just it feels like they’re about to achieve success in whatever area of life they’re striving to make headway in.
  • They will experience intense feelings of self-hatred and self-loathing
  • Can often be prone to attempts of self-harm
  • They often present as being depressed as their baseline emotional state
  • There can be feelings of bitterness
  • Can be prone to suicidal thoughts and tendencies
  • Might be prone to substance abuse issues
  • Will engage in reckless behaviour to impress others
  • Will often find themselves sabotaging their success out of feeling unworthy

Treatments

Psychotherapy

Dialectic behaviour therapy

Mentalisation-based therapy

Therapeutic communities

  • psychodynamic (psychoanalytic) psychotherapy
  • cognitive behavioural therapy (CBT)
  • cognitive analytical therapy (CAT)
  • humanistic therapies
  • interpersonal psychotherapy (IPT)
  • family and couple (systemic) therapy

Structured outpatient treatment developed by Dr Marsha Linehan for the treatment of borderline personality disorder (BPD). Dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD.

Mentalization is the ability to think about thinking. It’s useful for people who suffer from long-term difficulties in relationships and who experience intense emotional distress and overwhelming feelings which may result in destructive behaviours such as self-harm or aggression towards others. 

 

Therapeutic community is a participative, group-based approach to long-term mental illness, personality disorders and drug addiction. The approach was usually residential, with the clients and therapists living together, but increasingly residential units have been superseded by day units

Arts therapy

Care approach programme

Medicine

Art therapy has shown benefits for people with borderline personality disorder and borderline personality traits by alleviating interpersonal difficulties such as affect regulation, an unstable sense of self, self-injurious behaviors, and suicidal ideation

  • CPA is a framework used to assess needs. 
  • Community Mental Health Teams, Assertive Outreach Teams and Early Intervention Teams use CPA.
  • A care coordinator who monitors care and support. They review regularly to see if needs change.

Depending on where you live in the world will impact on the most reccommended medications.  Mood stabilisers or antipsychotics are sometimes prescribed to help mood swings, alleviate psychotic symptoms or reduce impulsive behaviour. Common meds: sertraline, amitriptyline and quetiapine

Self Care

Journalling

Mood log

Mindfulness

Meditation

For people with psychological problems like borderline personality disorder (BPD), various types of expressive writing have been shown to have a positive impact. People have used journaling as a means of expressing their feelings and healing for centuries. If you are struggling with a mental illness, expressive writing may be a useful addition to your therapy.

Daily mood charts act as interventions to help practice recognising the links between environment, thoughts, and feelings. Every day, or more frequently up to every two hours, record emotions experienced, and what was happened. Rate the intensity of feelings. This prompts you to think about emotions, environments and situations that influence you. 

In people with BPD the prefrontal cortex underdeveloped. Repeated mindfulness practice strengthens it. Mindfulness also reduces hyperactivity in the amygdala, the part of the brain that is relatively overactive and is responsible for the intense emotional reactions in people with BPD.

editation training may help individuals with BPD be more effective in applying healthy coping skills in the midst of emotional pain. Mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.

Diet

Exercise

Routine

Environment

Support network

The food choices you make affect your body, and can also affect your mood and your mental health. While changing your diet won’t cure borderline personality disorder (BPD) research shows a link between diet and mental health.

 
If you’re having trouble coping with BPD, physical activity may help you regain control over your emotions and stabilize yourself. Activities like boxing, running, cycling or yoga might be helpful.
 

Adding structure and routine to your daily life can help your overall health and help you manage your symptoms. Eating regular meals, exercising daily and getting proper sleep can help you as you undergo therapy.

 

Growing up in an environment perceived as invalidating is one factor commonly discussed as contributing to the development of borderline personality disorder (BPD). Ensure your home is a safe space with plenty of self-validation reminders. 

A support network describes ‘your team’ – the people who share your life that you can turn to for encouragement, support and personal growth. Having a good support network is a vital; friends, family, coworkers, neighbours or health professionals.