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According to Mental Health UK around 1 in 100 people live with borderline personality disorder. It is believed to affect men and women equally, although women are more likely to be given a diagnosis for the condition. According to the NHS, it is estimated that around 1 in 20 people has a personality disorder of some kind. A personality disorder means that a person thinks, behaves and feels differently to typical people. There are lots of different types of personality disorders and they affect people in different ways. Borderline personality disorder is the most frequently diagnosed personality disorder.
Understanding Borderline Personality Disorder
Borderline personality disorder is a type of mood disorder which mainly affects how the person interacts with other people. It is a type of mental health condition which is characterised by instability in interpersonal relationships, self-image and emotions. It is the most commonly recognised personality disorder.
Someone with a personality disorder will differ significantly from an average person, in terms of how they think, perceive things around them, feel and relate to other people. There are many different causes of borderline personality disorder but having experienced trauma during childhood can be a common risk factor. People who have experienced trauma, neglect or invalidating environments during their early years may be at an increased risk of developing BPD, similar to the risks of developing other mental health conditions. There is also evidence to suggest a genetic component to BPD, so people with a family history of the disorder may have a higher risk of developing it themselves.
Some of the common symptoms and features of borderline personality disorder (BPD) include:
- Intense and unstable relationships – people with borderline personality disorder may have difficulty forming and maintaining stable and healthy relationships. They may experience extreme and sudden shifts in how they view other people, either positively or negatively.
- Difficulty in relating to other people – difficulty understanding other people’s points of view.
- Emotional instability – people with BPD often experience intense and rapid mood swings. Their emotions can be extremely reactive, and they may have difficulty with emotion regulation.
- Unstable or negative self-image – people with BPD often struggle with a distorted or unstable self-image. They may feel unsure of their sense of identity.
- Impulsive behaviours – impulsive behaviours such as substance or alcohol abuse, binge eating, reckless driving, and unsafe sex are common behaviours in people with BPD.
- Chronic feelings of emptiness – people with BPD may experience feelings of emptiness. They may try to fill this emptiness with impulsive behaviours or relationships.
- Fear of being abandoned – people with BPD may have an intense fear of being abandoned or rejected by people around them. This can lead to efforts to avoid real or perceived abandonment. This fear can cause difficulties in relationships.
- Self-harming behaviours – some people with BPD engage in self-harming behaviours, as a way to cope with their emotional pain.
- Engaging in self-destructive behaviours – this can involve purposeful actions or behaviour patterns that inflict harm upon yourself, physically, emotionally or psychologically.
- An increased risk of suicide or thoughts of suicide.
- Difficulty in managing feelings of anger – frequent and intense anger, which can be expressed inappropriately.
- Overwhelming mood swings and intense emotions – these may happen for no apparent reason.
With BPD the type and severity of symptoms can vary between people. If you think you may be experiencing symptoms of BPD, it is important to seek professional support for an accurate diagnosis and to access appropriate treatment.
You will need to experience five symptoms in order to get a diagnosis of BPD. A diagnosis may be made based upon:
- A detailed interview with your doctor or mental health provider.
- A psychological evaluation.
- Taking a detailed medical history and examination.
- An assessment of your signs and symptoms.
A diagnosis of BPD is only usually made in adults and not children or adolescents.
Medications for Borderline Personality Disorder
While medication is not the primary treatment for BPD, it can be used in conjunction with psychotherapy and other therapeutic approaches in order to address specific symptoms. Medication can often be a useful tool in managing symptoms in order to stabilise someone enough for them to be able to access appropriate treatment.
- Antidepressants – people with BPD will often have symptoms of depression including feelings of sadness, tearfulness, emptiness or hopelessness.
- Mood stabilisers and anticonvulsants – mood stabilisers have been used effectively to treat disorders, such as bipolar disorder, and to decrease the risk of suicide. Their use can help to regulate intense mood swings.
- Antipsychotic medications – antipsychotics are widely used in BPD, as they are believed to be effective at improving impulsivity, aggressive behaviour, anxiety and psychotic symptoms. In some cases, antipsychotic medications may be prescribed to manage symptoms such as paranoia, dissociation, or brief psychotic episodes.
Psychotherapy and Interventions
Treatment for BPD usually involves some type of psychological therapy, also known as psychotherapy. There are lots of different types of psychotherapy or talking therapies, which are psychological treatments for mental and emotional problems like stress, anxiety and depression. They all involve working with a trained therapist who will help you to understand and cope with the problems you are having. Psychotherapy for BPD should only be given by a trained professional. They will usually be a psychiatrist, psychologist or other trained mental health professional.
Some commonly used psychotherapeutic approaches and interventions for people with BPD include:
- Dialectical Behaviour Therapy (DBT) – DBT is one of the most widely used and researched therapies for BPD. It combines cognitive-behavioural techniques with mindfulness strategies. DBT usually involves weekly individual as well as group sessions. DBT is based on cognitive behavioural therapy (CBT). But it’s specially adapted for people who feel emotions very intensely. The aim of DBT is to help you to understand and accept your difficult feelings, learn skills to be able to manage these feelings, and to help you feel able to make positive changes in your life.
- Cognitive-Behavioural Therapy (CBT) – CBT focuses on identifying and challenging negative thought patterns and behaviours.
- Mentalisation-based therapy (MBT) – MBT is based on the concept that people with BPD have a poor capacity to mentalise, which is the ability to think about thinking. This means being able to examine your own thoughts and beliefs, and assessing whether they are useful, realistic and actually based on reality. The aim of MBT is to improve your ability to recognise your own and other people’s mental states. MBT may be delivered in a hospital, where you would stay as an inpatient. A course of MBT usually lasts about 18 months.
- Supportive psychotherapy – this provides emotional support and guidance without having a specific focus on changing behaviours and aims to offer a safe space for people to express their emotions.
- Therapeutic communities (TCs) – these are structured environments where people with a range of complex psychological conditions and needs come together to interact and take part in therapy. As well as taking part in individual and group therapy, you would be expected to do other activities designed to improve your social skills and self-confidence, such as household chores, meal preparation, games, sports and other recreational activities.
Emerging and Innovative Treatments
Emerging and innovative treatments refer to new and advanced approaches in the field of medicine and healthcare that are still in the early stages of development, testing or adoption.
Emerging and innovative treatments for BPD may include:
- Neurofeedback – some studies have explored the use of neurofeedback in order to regulate brain activity and improve emotional control. However, more research is needed to establish how useful it is.
- Psychedelic-assisted therapy – there is growing interest in the therapeutic use of psychedelics, such as psilocybin or MDMA, being used in combination with psychotherapy for numerous mental health conditions. Research is exploring the potential benefits for BPD, and more research is needed in this area.
- Ketamine infusions – BPD is often seen in combination with major depressive disorder. Intravenous ketamine has recently been recognised as a potential treatment option for major depression. It is where patients are infused with doses of the drug under very close medical supervision.
- Digital therapeutics – mobile applications and online platforms are being developed in order to deliver therapeutic interventions; this includes mindfulness-based and cognitive-behavioural approaches. These tools aim to increase accessibility to mental health care.
Holistic Approaches to BPD Management
It is important for people with BPD to work closely with mental health professionals in order to create a treatment plan that is individual to them. This may include a combination of traditional and holistic approaches. Every person is unique, and the effectiveness of treatment and holistic approaches may vary from person to person. The different treatment options may include:
- Psychotherapy – psychotherapy is a common treatment for various mental health conditions. Dialectical Behaviour Therapy (DBT) is a well-established form of psychotherapy specifically designed for people with BPD as it focuses on teaching skills in mindfulness and emotional regulation.
- Mindfulness and meditation – mindfulness practices can help people to become more aware of their thoughts and emotions, promoting a non-judgemental acceptance of their experiences. Mindfulness is the ability to be fully present, aware of where we are and what we are doing, and to not be overly reactive or overwhelmed by what is going on around us. Mindfulness is a type of meditation that helps you to be intensely aware of your senses and the feeling of being present in the moment without judgement. Mindfulness involves paying attention to what is going on inside our bodies and in our immediate environment, moment by moment.
An important aspect of mindfulness is about reconnecting with our bodies and the sensations we experience. This means being aware of what we can see and touch and the sounds, smells and tastes of the present moment. Much of the research on mindfulness has focused on two types of interventions. Mindfulness-based stress reduction (MBSR) is a therapeutic intervention which aims to teach people how to increase mindfulness through yoga and meditation. Mindfulness-based cognitive therapy (MBCT) is a therapeutic intervention which combines elements of MBSR and cognitive behavioural therapy (CBT) to treat people with symptoms of depression.
- Yoga and tai chi – these mind-body practices can enhance self-awareness, reduce stress, and improve emotional regulation. Tai chi and yoga share many health and wellness benefits. Both can improve your balance, flexibility, body strength, mobility, mood and quality of life.
- Breathing exercises – deep breathing exercises and progressive muscle relaxation can help manage stress and anxiety.
- Regular exercise – physical activity has been shown to improve mood and reduce anxiety. Incorporating regular exercise into your routine can contribute to overall well-being.
- Healthy diet – a balanced and nutritious diet can influence mood and energy levels. Research shows that avoiding excessive caffeine, sugar and processed foods may also contribute to better mental health. Healthy eating has so many benefits; it is not just your physical health that is reliant on what you eat but your mental health as well.
- Art therapy, music therapy and dance movement therapy – these can help by providing alternative ways to express and process emotions.
- Journaling – writing thoughts and emotions in a journal can be a therapeutic way to process experiences and emotions and gain insights into thought patterns.
- Other relaxation and self-care techniques – incorporating activities like reading, taking baths, or engaging in things you enjoy can contribute to overall well-being.
Modern medications and interventions for Borderline Personality Disorder seek to understand and address the complex challenges associated with the condition. As is the case with many mental health conditions, medication alone is not a comprehensive solution, and its effectiveness varies between people. The ongoing research and development of innovative interventions demonstrate a commitment to further our understanding of BPD, how it affects people and improving treatment outcomes, and therefore quality of life.
Personality disorders in general are not always easy to treat. Often people who have a personality disorder do not see their behaviour as being problematic and so may not seek treatment. There still may be some stigma surrounding mental health issues which can also prevent people from seeking the help they need. People with personality disorders may fear being judged, which can discourage them from discussing their symptoms or seeking treatment. People with personality disorders may also deny or minimise their symptoms. This can be a defence mechanism to protect themselves from the discomfort of acknowledging their struggles or facing potential judgement from others.
It is important to seek support from a health professional if you or someone you know is experiencing symptoms of BPD.
MIND also provide a list of useful contacts specifically for people with BPD.