The Impact of Borderline Personality Disorder

In the UK, according to the Royal College of Psychiatrists, it is believed that 1 in 20 people suffer with a personality disorder. This is based on a study completed in 2006.

There are several different types of personality disorders and in order to fully understand borderline personality disorder, it’s important to have an understanding of personality disorders in general.

A person who suffers from a personality disorder often finds certain aspects of their life difficult, due to the way their personality develops.

People who suffer from a personality disorder may find the following things difficult:

• Controlling their behaviour and emotions.
• Getting on with others.
• Listening to others.
• Avoiding or staying out of trouble.
• Making or maintaining close relationships.

Generally, a person who has a personality disorder thinks, feels and perceives things differently to the average person, while also finding it extremely difficult to relate to others.

What are the effects of borderline personality disorder?

Borderline personality disorder can impact the people who have this condition in several ways. It can have a negative effect on jobs, school, intimate relationships, social activities and self-image.

These often result in the person:

• Showing regular patterns of job losses or changes.
• Dropping out of or not completing education.
• Having regular involvement in bad or abusive relationships.
• Having relationships that are filled with conflict, including marital stress and divorce.
• Having numerous legal issues, which could result in time in jail.
• Attempting suicide.
• Partaking in risky or impulsive behaviours resulting in sexually transmitted infections, physical fights, motor vehicle accidents and unplanned pregnancy.

In addition to this, people with BPD may also have or develop other mental conditions, which can cause further distress. Conditions such as depression, eating disorders, alcohol or substance abuse, bipolar disorder, anxiety disorders, attention-deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), or other personality disorders can all cause further symptoms.

Borderline personality disorder and depression

Depression and BPD co-exist and present overlapping symptoms, but they are different illnesses. Many people believe that BPD is a type of depression, but this isn’t the case, although depression is common in BPD sufferers. As people with BPD display depressive symptoms, it can be difficult to tell the difference between the two, but it becomes more complex when they co-occur.

If they both occur together, they must be treated together. This is because people who have BPD and depression often find that they do not respond as well to antidepressant medications as those people who have depression and no BPD.

Those with BPD often describe feeling restless, intensely bored, and extremely lonely when they are depressed, but symptoms can vary from person to person. When psychotherapies are used to treat BPD, many people report that their depression also enters a remission.

Borderline personality disorder and eating disorders

It is common for people with BPD to also have an eating disorder, but not much is known about the relationship between the two. Not everyone with an eating disorder has BPD, but again, the two can co-occur.

There are many types of eating disorders, but people who have anorexia, bulimia and binge-eating or purging are found to be at a higher risk of having BPD. As BPD involves impulsive and destructive behaviours, it is believed that sufferers are more at risk of developing an eating disorder. That’s because a sufferer may inflict harm on themselves and it’s common for them to feel under stress. Both are thought to cause eating disorders.

Borderline Personality Disorder and Substance Misuse

There is a common link between BPD and addiction, but they have a very turbulent relationship. While substance misuse is not responsible for causing BPD, it does aggravate it, and evidence suggests it speeds up its progression.

Sufferers who fear abandonment can turn to other substances to ease the pain. Drug and alcohol abuse increases some of the most dangerous BPD symptoms. Feelings of rage and depression can escalate to dangerous levels.

There is an overlap of symptoms between addiction and BPD. If BDP has not been diagnosed but the sufferer already suffers with addiction, it can be difficult to identify due to the similarities.

People who suffer from either condition can have symptoms such as impulsive behaviours, mood swings, deceptive conduct, risky behaviours and unstable relationships. Irritability, anxiety, depression and suicidal tendencies can also indicate addiction as well as impacting BPD.

The symptoms of BPD link into so many other conditions, which makes it difficult to identify. Making a dual diagnosis is important as both conditions can be treated alongside one another.

Borderline Personality Disorder and Bipolar Disorder

Bipolar disorder is characterised by shifts in mood from manic high moods to depressed low moods. Symptoms of bipolar and BPD overlap, and this includes suicidal tendencies, impulsive actions and extreme emotional outbursts

Out of the people who have type 1 bipolar, 10% have a BPD diagnosis. For people with type 2 bipolar, 20% have a BPD diagnosis. When bipolar and BPD occur together, the sufferer will display unique symptoms for each disorder.

Unique bipolar symptoms include:

• Manic episodes.
• Changes in sleep (both quality and quantity).
• Symptoms of mixed episodes – manic episodes and depression.

Unique BPD symptoms to watch out for when a person has/may have bipolar too:

• Intense relationships and the inability to regulate emotions.
• Indications of self-harm.
• Daily emotional changes (often related to work or family stress).
• Intense emotional outbursts (anger, shame or guilt).
• Regularly feeling empty or bored.

Gaining a diagnosis for these two can be difficult, as the symptoms of one disorder mask the other. It can be a long road, but if you suspect that yourself or another person has both disorders, it’s best to speak to a doctor to ask for an assessment for each.

Borderline Personality Disorder, Anxiety and PTSD

It’s thought that around 90% of people with BPD also have an anxiety disorder, but they can actually prevent the likelihood of recovery from BPD. When a person has both disorders, the risk of self-harm and suicide increases.

BPD and anxiety disorders can be treated together, but this must be monitored carefully. Many of the treatments offered to people with anxiety disorders, are not available for people with BPD, due to suicidal and self-harming behaviours.

Anxiety disorders can make the symptoms of BPD worse. Common symptoms of BPD already include emotional instability, cognitive distortions, impulsive behaviour and unstable relationships. All these things can be heightened if the person also has an anxiety disorder.

Unstable relationships and impulsive behaviours that are common in people with BPD place a person at greater risk of experiencing trauma, and the likelihood of developing post-traumatic stress disorder (PTSD), due to the vulnerable situations they put themselves in.

PTSD is a type of anxiety disorder, and many people with BPD are found to suffer from this too. This is often because both things stem from past trauma, and those who have trauma stemming from childhood, are at an even greater risk of developing PTSD.

Borderline Personality Disorder and ADHD

There is also an overlap of symptoms between BPD and attention-deficit hyperactivity disorder (ADHD).

Impulsivity is a symptom of both, but:

• Individuals with BPD have more problems adopting responses from context cues due to their stress-dependent impulses.
• Individuals with ADHD have more impulsivity with their motor skills and struggle to interrupt automatic responses.

If a person suffers from both, it is likely that they have trouble with emotional regulation and impulsivity. Behaviours such as self-harm can also occur in both conditions. Although a person suffering from BPD and ADHD should be treated together, it’s important to recognise that the impulse domains are very different. ADHD does not cause BPD or vice-versa, but it is common for BPD sufferers to have ADHD too.

Borderline Personality Disorder and other personality disorders

The system of diagnosis that psychiatrists tend to use identifies ten types of personality disorders, which are grouped into three categories. Borderline personality disorder falls into the category of emotional and impulsive type of personality disorder.

Other types of personality disorders that fall into this category are:

• Antisocial personality disorder (ASPD).
• Narcissistic personality disorder.
• Histrionic personality disorder.

Other categories are:

• Suspicious – This includes schizoid personality disorder, schizotypal personality disorder, and paranoid personality disorder.
• Anxious – This includes obsessive compulsive personality disorder (OCPD), dependent personality disorder.
• Avoidant personality disorder.

Some people suffer from more than one type, and this is referred to as mixed personality disorder, but sometimes this can be tricky to diagnose.

Since a BPD sufferer has symptoms such as self-harm, suicidal thoughts, struggles with relationships (intense but unstable), and has anger issues along with intense emotions, the symptoms overlap with most other personality disorders. If you have more than one, it can be difficult to diagnose as one disorder may mask the symptoms of another.

What are the impacts of borderline personality disorder on the person?

BPD can co-exist with many other mental health conditions as we’ve explored above. All these things can make the symptoms the person already suffers as part of their BPD, worse. They may already be finding it difficult to cope with life events, their impulses, behaviours and emotions, so the conditions that can often accompany this condition can make everything appear more extreme.

This is why many people with BPD turn to drugs and alcohol or self-harm, as they feel that these things can help them cope. It can be a daily battle to get the condition under control, and therefore many people with BPD have suicidal thoughts or attempt to commit suicide.

The impact of BPD indicates the significance of why it’s viewed as a serious mental health condition.

Dealing with the effects of BPD is difficult, but a person can overcome their issues if they engage with solid therapy and are prepared to work hard. Their future is bright, because remission rates are high.

It’s important to remember that mental illness does not define a person. A person who suffers should be willing to lean into their support network and should not be afraid to ask for help. There are many healthcare and medical professionals, friends and family who are willing to help a person face their BPD challenges, but it’s often a learning curve for both parties.

That’s why it’s important to consider the impact of BPD on family and friends, too.

The impact of borderline personality disorder on the family

We’ve talked about the impact of BPD, and we know that relationships can be difficult for people who have this, but we also need to consider the people around them. When a person has BPD, it doesn’t just affect them, it also affects those around them, such as their loved ones, their family and their friends.

Many people find themselves part of the support network, and having a caring role or involvement with someone who has BPD isn’t easy.

This can cause:

• Feelings of guilt.
• Stresses and strains on the family.
• Feeling responsible for their involvement.
• Broader impacts – the wider lives of the family.
• The carer needing support.

Many people who support their loved ones, family or friends with BPD identify feelings of guilt. As research from BPD suggests that BPD can be caused from childhood trauma, many family members find themselves feeling partly responsible for one reason or another, even if the cause of the BPD was out of their control.

While family members, friends and loved ones always try to be as supportive as possible, if the person with BPD does something negative, such as self-harming, then again, the people who are supporting can experience feelings of guilt. If a person with BPD is supported by another person with mental health issues, the feelings of guilt can become overwhelming.

When you’re watching someone you care about suffer, it’s not easy. In fact, it’s quite distressing. A person who suffers from BPD may already struggle with relationships, and due to their other symptoms, such as feelings of rage, self-harm, suicide and other destructive behaviours, it can make family members feel helpless.

When there is anger and rage along with other destructive behaviours, conflict is caused, and this can create a negative atmosphere. Managing such high-risk behaviours is exhausting, and it can impact on the mental health and wellbeing of the family members. It takes its toll on everyone, both BPD sufferer and carer.

Family and friends often feel the need to intervene when another family member is in distress or crisis. Sometimes they feel a sense of responsibility when it comes to the health and wellbeing of the person who is suffering from BPD.

Clinicians also often rely on the support network to help manage the treatment of BPD. This can involve attending appointments with multiple providers, helping arrange treatment, and providing emotional support too. They may also be relied upon to notice mood and behaviour changes and provide encouragement.

Due to the varying levels of care, they may also have to negotiate some of the details of the larger mental health systems. Although this is a lot to take on, a person who suffers from BPD may need support and family may feel obliged to help.

The stresses and strains of BPD can be a struggle for close and extended family. Due to the intense stress caused, this can have serious consequences. When parents are caring for a young person with BPD, it can put stress on their relationship.

Of course, sometimes people with BPD have siblings too and they can also be impacted. Some find themselves putting distance between themselves and the person who has BPD, as they feel this will allow them to protect themselves, while others may find themselves in a caregiving role.

When close family members find themselves under this kind of stress, extended families often end up getting involved too, which means they’ll be affected. Aunts, uncles, grandparents, cousins and other relatives can also feel the strain if they become part of the support network, caring for the person who has BPD.