The Impact of Borderline Personality Disorder on Relationships

Borderline personality disorder (BPD) is a mental health disorder that can significantly affect a person’s emotions, moods, thoughts and interactions with others. It can be a hugely debilitating condition that can take a significant toll on the individual and the people around them. Understanding how BPD can affect relationships can help individuals and their loved ones navigate any potential challenges and seek appropriate support.

The National Institute for Health and Clinical Excellence (NICE) estimates that between 0.7% and 2% of the UK population has BPD. Although diagnostic rates are much higher in women compared to men, BPD is thought to affect men and women equally. Undiagnosed BPD and a lack of appropriate treatment can result in significantly worse long-term outcomes and can have a serious impact on an individual’s relationships with themself and other people. A BPD diagnosis and effective treatment can significantly improve an individual’s life and can help them create positive, lasting relationships with others. 

Understanding borderline personality disorder

Borderline personality disorder (BPD) is a type of personality disorder that can result in disordered mood, thoughts and emotions and can affect how an individual interacts with others. BPD can significantly affect the way an individual thinks, perceives, feels or relates to other people. These difficulties can make it hard for a person to cope with their day-to-day life. Many people with BPD experience emotions that are very intense and overwhelming, but also changeable, meaning they can fluctuate between high and low emotions very quickly. It can then be difficult to return to an emotionally stable state.

The symptoms of BPD can typically be categorised into four different groups:

• Emotional instability, also known as affective dysregulation.
• Disturbed patterns of thought or perceptions, also known as cognitive distortions and perceptual distortions.
• Impulsive behaviour.
• Relationships with other people that are intense and unstable.

Also known as emotionally unstable personality disorder (EUPD), the symptoms of BPD can range from mild to severe and can significantly affect many areas of an individual’s life. Different people experience BPD in different ways. Some people with BPD experience difficulties with their sense of identity and their relationships with other people. This distorted perception of self and of other people can affect many areas of the individual’s life, particularly their mental health. It can result in high anxiety levels, symptoms of depression and suicidal thoughts. Suicide is a significant risk for people with BPD, with NICE estimating that up to 10% of people with BPD take their own life. 

The symptoms of BPD typically emerge during adolescence and persist into adulthood. Many people with borderline personality disorder also experience other mental health difficulties or behavioural issues, including:

• The misuse of alcohol or drugs.
• Generalised anxiety disorder.
• Depression.
• Bipolar disorder.
• Eating disorders, such as anorexia or bulimia.
• Another personality disorder.

Some people with BPD are also at higher risk of engaging in self-harm behaviours or attempting suicide. An individual with BPD often experiences difficulties managing their emotions, are more likely to be impulsive and engage in risky or self-injurious behaviours, are more likely to have low confidence and fear of rejection or criticism and may struggle to function in relationships, in the home, in education and at work. 

BPD and relationships

Borderline personality disorder can have a significant impact on various aspects of relationships, often presenting challenges in communication, trust and intimacy. Individuals with BPD may struggle with effective communication due to emotional dysregulation, impulsivity and a fear of abandonment. The intense emotions, quick changes in mood and the difficulties expressing their needs can lead to misunderstandings and conflicts in relationships. 

The symptoms of BPD, such as intense mood swings, impulsivity and an unstable sense of self, can make it difficult for individuals to maintain healthy, stable relationships. Some people with BPD engage in behaviours that can strain relationships and lead to conflicts. Trust issues are also common in individuals with BPD. Many people with BPD have an intense fear of being abandoned or rejected by their partner, which can lead to negative behaviours, such as excessive clinginess, jealousy or possessiveness. These trust issues can strain the relationship and make it challenging for both partners to feel secure and connected.

Additionally, individuals with BPD often crave intimacy and closeness in relationships but may also struggle with feelings of vulnerability and fear of rejection. They may alternate between seeking excessive closeness and pushing their partner away out of fear of being hurt. This pattern of approach-avoidance can make it difficult to develop meaningful intimacy in the relationship.

Living with someone who has BPD can be emotionally exhausting and challenging for a partner. They may experience feelings of frustration, helplessness and burnout in trying to navigate the unpredictable and intense emotions of their loved one. Partners may also feel overwhelmed by the constant need for validation and reassurance from the partner with BPD.

However, having positive relationships is possible for people with borderline personality disorder. There are multiple ways you can work to create strong, healthy relationships, including:

• Be open about your diagnosis
  Because BPD can impact your relationships and can affect the people you are close to, telling them about your BPD diagnosis can be helpful. This ensures they are aware of your condition, can watch out for signs that your symptoms are escalating and you are in crisis and can make your treatment more effective. Someone who is aware of your disorder is more likely to understand and be patient and supportive if you are going through a period of high symptoms.
• Education
  Both partners should educate themselves about BPD to gain a better understanding of the symptoms, triggers and coping strategies. Knowledge about BPD can help reduce misconceptions and promote empathy and compassion in the relationship.
• Effective communication
  Open and honest communication is essential for any relationship, but it’s especially important when one partner has BPD. Encourage each other to express feelings, needs and concerns in a calm and respectful manner. Active listening and validating each other’s emotions can help build trust and strengthen the connection.
• Set boundaries
  Establish clear and healthy boundaries in the relationship to promote mutual respect and emotional safety. Boundaries help both partners understand each other’s limits and preferences, reducing the likelihood of conflicts and misunderstandings.
• Seek support
  Both partners should have access to support networks, including therapy, support groups and trusted friends or family members. Therapy can provide a safe space to explore relationship dynamics, learn effective coping strategies and develop communication skills.
• Validate emotions
  Validate each other’s emotions, even if you do not fully understand or agree with them. Acknowledge and empathise with your partner’s feelings without judgement, criticism or invalidation. Validating emotions can help create a stronger connection and more emotional intimacy in the relationship.
• Practise self-care
  Both partners should prioritise self-care to maintain their own emotional well-being. Engage in activities that promote relaxation, enjoyment and personal growth. Taking care of yourself allows you to show up as your best self in the relationship and better support your partner.
• Celebrate progress
  Celebrate small victories and progress in the relationship. Acknowledge and appreciate efforts made by both partners to communicate effectively, set boundaries and practise self-regulation. Positive reinforcement can motivate continued growth and strengthen the bond between partners.

Diagnosis and treatment of BPD

If you think you or your child may be experiencing symptoms of borderline personality disorder, you should make an appointment with your GP. Your GP may ask you to describe how you have been thinking and feeling, your recent behaviour (including behaviours recognised by you and reported by other people) and how these symptoms have been affecting you. Because BPD is a complex condition and the symptoms can be similar to other mental health conditions, your GP will need to rule out other conditions, such as depression. If your GP thinks you could be experiencing BPD, they will likely refer you to the Community Mental Health Team (CMHT) for adults, or the Child and Adolescent Mental Health Services (CAMHS) for children and adolescents. 

An assessment will likely be carried out by a personality disorder specialist, most likely a psychologist or psychiatrist. You may be diagnosed with BPD if you experience at least five of the following:

• Feelings of worry that people will abandon you.
• Experiencing intense emotions, lasting from a few hours to a few days, or even longer. These emotions can change very quickly (e.g. from positive to negative).
• Feelings of insecurity about who you are. Your sense of self may change depending on who you are with.
• Difficulties with making and keeping stable relationships. Some people with BPD view relationships very positively (as being perfect) or very negatively.
• Feelings of emptiness.
• Behaving impulsively and engaging in harmful behaviours, such as misusing drugs or alcohol, binge eating or gambling.
• Engaging in self-harm as a way to manage your negative feelings.
• Feeling suicidal.
• Having intense anger which is difficult to control.
• Feeling paranoid or dissociating during stressful situations.

To receive a diagnosis, these experiences will have lasted a long time (they are not transient or situational) and will have impacted different areas of your life. 

Once you have received a diagnosis of BPD, your doctor will create a personalised treatment plan. Some people with BPD have mild symptoms or overcome their symptoms; for other people with moderate to severe symptoms, their CMHT may provide treatment and support in their day-to-day life. 

A CMHT may be made up of:

• Psychiatrists (this is usually the most senior clinician in the CMHT).
• Psychologists.
• Counsellors and psychotherapists.
• Community mental health nurses.
• Social workers.
• Occupational therapists.

The psychiatrist will likely create a care programme approach (CPA) which is a treatment package of care for people experiencing significant mental health difficulties. As part of the CPA, your CMHT will assess your health and social needs, create a care plan, appoint a care coordinator who will be your first point of contact, plan regular reviews, list any potential risks and specify what should happen in the event of a crisis. Your care plan may cover your medication and treatment, support at home, support outside the home and support with any housing or financial difficulties. 

Treatment for BPD can vary depending on the type and severity of your symptoms, any other mental or physical health conditions you have and whether any previous treatment has failed. Some treatment options include:

Dialectical behaviour therapy (DBT)

DBT is a type of psychotherapy created specifically for people with borderline personality disorder and can include individual or group sessions. It is based on the idea that two primary factors can contribute to BPD:

• People with BPD may be more emotionally vulnerable. For example, even a small amount of stress can cause extreme anxiety.
• As a child and adolescent, someone with BP may have experienced emotional dismissal, where they were told their emotions were not valid.

These factors can result in a negative cycle, where someone with BPD experiences intense emotions and then feels guilty, worthless or silly. DBT aims to break this negative cycle by focusing on the idea that your emotions are real and valid. It emphasises dialectical philosophy to help you stop seeing yourself, your relationships and the world in a narrow, rigid way – the world is not black and white. The key components of DBT are:

• Mindfulness: Learning to be present in the moment and being aware of thoughts, feelings and bodily sensations without judgement.
• Distress tolerance: Developing healthy ways to cope with stress and intense emotions without resorting to harmful behaviours.
• Emotion regulation: Identifying and understanding emotions and learning strategies to regulate them effectively.
• Interpersonal effectiveness: Developing skills for healthy relationships, including assertiveness, how to set boundaries and effective communication.

Mentalisation-based therapy (MBT) 

MBT is another common treatment option for borderline personality disorder. MBT is based on the theory that people with BPD have a lower capacity to mentalise (to think about thinking). They may find it more difficult to examine their own thoughts and beliefs and assess whether these thoughts and beliefs are realistic and constructive. MBT helps you to recognise your own mental states and the mental states of other people and how your behaviour can impact other people’s mental states. It teaches you how to examine your thoughts and feelings about yourself and other people. It also teaches you how to understand that other people have their own thoughts, feelings, beliefs and mental states and that your understanding of these mental states may not always be accurate. MBT typically lasts for 18 months and may initially begin as daily sessions. Some people with BPD begin MBT as in-patient treatment. 

Therapeutic communities (TCs) 

Therapeutic communities for BPD are specialised treatment settings that provide intensive, long-term, residential care for individuals with severe and persistent mental health issues, including BPD. TCs operate on the principles of community living, mutual support and therapeutic involvement. The goals of a therapeutic community are:

• Stabilisation: Helping individuals manage symptoms such as emotional dysregulation, impulsivity and self-harming behaviours.
• Skill-building: Teaching coping skills, interpersonal effectiveness, distress tolerance and emotion regulation techniques to improve daily functioning.
• Rehabilitation: Supporting individuals in improving their quality of life, relationships and overall functioning.
• Empowerment: Creating a sense of empowerment and self-efficacy in managing their mental health challenges.
• Social support: Providing a supportive environment where individuals can connect with peers who understand their experiences and struggles.

TCs often utilise a variety of therapeutic modalities, including group therapy, individual therapy, psychoeducation, experiential activities and vocational training. Staff members in TCs typically include mental health professionals, counsellors and peers who have received training and have personal experience with recovery. Peer support is usually a key component of TCs, as individuals with similar experiences can offer empathy and encouragement and can help validate your experience.

Art therapy 

Art therapy can be an important part of a treatment programme and may be offered alongside other treatments. Because BPD often involves intense and fluctuating emotions, difficulties with self-expression and challenges in relationships, art therapy offers a non-verbal and creative way for individuals to explore and communicate their emotions, experiences and inner conflicts. As well as art therapy, other creative therapies that may be offered include:

• Dance movement therapy.
• Drama therapy.
• Music therapy.

Coping strategies and support

As well as the treatment options listed above, there are some coping strategies to help you manage your symptoms and improve your quality of life. 

Learn coping skills 

If you are experiencing symptoms of BPD, there are some coping skills that can help you manage your intense emotions and prevent any negative thoughts or behaviours. These can include:

• Say what emotion you are feeling out loud and try to accept this emotion. This can help you to respond more appropriately.
• Implement distraction techniques. Doing something you love or something you know calms you down can distract you from any negative thoughts and feelings.
• Plan techniques for if you are struggling with feelings of self-harm. For example, having a cold shower, rubbing ice on your skin and peeling a plaster off your skin are techniques that can help you not to engage in self-harm.
• Practise self-compassion and treat yourself with kindness.
• Do things that stimulate your senses.

Remember that what works for one person will not work for everyone so you may need to try different coping skills to see what works best for you.

Keep a mood diary 

Writing down your thoughts and moods in a diary can help you to notice patterns of what is triggering your symptoms. Writing down your thoughts also acts as a form of acknowledgement and can help to get the thoughts out of your head, making them less overwhelming. At a later time, you can then read your thoughts over and reflect on them. A mood diary can also be used at times when you are feeling good and your symptoms are not severe. You can record positive actions, things you are proud of and positive thoughts and emotions as a reminder of the progress you are making. 

Create a safety plan 

Develop a safety plan for managing crises or suicidal thoughts. Identify possible triggers, coping strategies, support contacts and emergency resources to use during times of distress. It can be beneficial to share your safety plan with people you trust so they know what to do in times of crisis and how to support you if you are feeling suicidal. 

Challenge negative thoughts

Practise cognitive restructuring techniques to challenge negative thinking patterns and replace them with more balanced and realistic thoughts. Keep a journal to track your thoughts and emotions and identify cognitive distortions.

Engage in self-care 

It is important to prioritise self-care activities that promote physical, emotional and mental well-being. This may include exercise, adequate sleep, healthy eating, engaging in your hobbies, implementing relaxation techniques and spending time with supportive people.

Create a supportive network 

Surround yourself with supportive friends, family members or peers who understand and validate your experiences. Knowing you have someone to speak to at difficult times can make negative thoughts and emotions feel more manageable. Joining a support group for individuals with BPD can also provide a sense of community and encouragement. Some BPD support groups you could join in the UK are:

• Borderline Support UK
• Borderline Arts
• Harmless (for people who engage in self-harm)

Stay committed to your recovery 

Recovery from BPD is a journey that takes time, patience and persistence. Stay committed to your treatment plan, practise coping skills consistently and celebrate progress, no matter how small.

Conclusion

Understanding the impact of BPD on relationships is essential for promoting empathy, support and effective communication. By acknowledging the challenges and seeking appropriate help and support, individuals with BPD can work towards building healthier and more fulfilling relationships.

Although there is no specific cure for BPD, learning to manage your emotions, thoughts, beliefs and behaviours and being aware of your symptoms and things you may struggle with can significantly improve your symptoms and reduce the impact BPD has on your everyday life. Many people with borderline personality disorder live very normal lives, function well within society and have positive, successful relationships with their family, friends and a partner.