Case Study Triumph Over Borderline Personality Disorder

Borderline personality disorder (BPD) affects millions of people worldwide, and in the UK, around 1 in 100 people live with BPD. People who are affected by the disorder experience a pattern of ongoing instability in moods, behaviour, self-image and functioning which often leads to the individual making impulsive decisions and having unstable relationships. BPD can leave a person in a state of uncertainty and extreme emotion. These intense emotions can cause them to lash out and develop a sense of being on a rollercoaster, feeling helpless, as their likes and dislikes, self-image and even aspirations change so frequently that they appear unclear and confusing. 

Relationships of all kinds – family, friends, romantic, professional/work – are an ongoing challenge, and frequently a source of distress for someone with BPD. They can be demanding of others’ attention and time, eager for connection, but also terrified of being abandoned. All-or-nothing thinking, another characteristic of borderline personality disorder, can quickly strain any relationship, if the person believes that things and people are either all good or all bad. People with BPD also tend to be extremely sensitive, and even small things can trigger intense reactions. This emotional volatility can put a strain on even the most solid relationship, and those who don’t have this disorder sometimes have a hard time understanding the almost constant struggle with intense emotions.

In addition, people with BPD can also struggle with their self-image. They can have a fluctuating and unclear sense of themselves and may struggle with self-identity and self-worth and feel uncertain about their life goals, values and interests. This can manifest in frequent changes in their appearance as nothing appears to satisfy them about their image. They can often feel guilty or ashamed and see themselves as bad. Also, they may fluctuate in their feelings about their own opinions, abruptly changing their attitudes and views. 

Borderline personality disorder is a complex condition and there are lots of disagreements about how BPD should be described and diagnosed, making getting an accurate diagnosis and access to appropriate treatment a challenge for those with the disorder. This happens because the symptoms of BPD are very broad, with some being similar to or overlapping with other mental health conditions, such as: 

• Bipolar disorder
• Complex post-traumatic stress disorder (C-PTSD)
• Depression
• Anxiety
• Psychosis
• Antisocial personality disorder (ASPD)

It is crucial that anyone experiencing the symptoms of BPD gets an accurate diagnosis particularly as undiagnosed BPD can increase a person’s risk for substance abuse, self-harm, or attempted or death by suicide. 

Breaking the dysfunctional patterns of thinking, feeling and behaving that cause someone with BPD distress not only relies on appropriate treatment but it is also helped by the support of others, and by knowing that the condition can improve, thus leading to a more ‘normal’ life. This is why it is important for people to share their experiences of the disorder, to let people know that they are not alone, and that others have gone through and emerged successfully from the disorder. It provides an opportunity to find out about strategies others have used to understand the triggers and coping plans they have put into action to counteract the feelings and behaviours associated with BPD, and to see that people with BPD have gone on to improve their situation, to form positive relationships, and to have satisfying careers.

Understanding borderline personality disorder

Borderline personality disorder (BPD) is a complex mental health disorder affecting many aspects of people’s lives. It is the most commonly recognised personality disorder. BPD affects a person’s mood and how they interact with others, and they have difficulties with how they think and feel about themselves. Experiences of BPD are different for different people. They may experience emotions that are very intense, overwhelming or changeable. They might also experience quick swings between periods of confidence to despair, with fear of being abandoned or being rejected. 

The causes of BPD are unclear, but most mental health professionals agree that it possibly results from a combination of genetic and environmental factors. People with BPD come from many different backgrounds, but most will have experienced some kind of trauma, abandonment or neglect as children.

Borderline personality disorder is diagnosed using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Mental and Behavioural Disorders 10th Revision (ICD-10 F60.3). A person is diagnosed with BPD if they experience a number of the following symptoms in a variety of contexts:

• Feelings of emptiness
• Emotional instability, such as intense sadness, irritability, or anxiety lasting a few hours or, rarely, more than a few days
• Efforts to avoid real or imagined abandonment
• Identity disturbances with unstable self-image or sense of self
• Impulsive behaviour, such as reckless driving, binge eating, substance abuse, or unsafe sex
• Inappropriate, intense anger or difficulty controlling anger
• Pattern of unstable and intense interpersonal relationships
• Recurrent suicidal behaviour, gestures or threats, or self-harming behaviour
• Transient, stress-related changes in thoughts, for example paranoid ideation such as beliefs that others may be trying to hurt or harm them, or dissociation, which is feeling as if they are outside of their body or feeling numb

The earliest symptoms of borderline personality disorder generally appear sometime during adolescence, and most people with BPD are diagnosed as young adults.

The case study subject

Leisha is 26 years old, and was finally diagnosed with BPD at the age of 23 years, having experienced symptoms of the disorder since her late teens. Leisha’s parents divorced when she was 12 years old; her mother left the family home and began another relationship which led to the birth of Leisha’s half-sibling. The result was that Leisha saw less and less of her mother as her new family took up most of her time. 

When Leisha’s behaviour started to change in her mid to late teens it raised concerns at home and at school. She would be feeling ‘normal’ one minute, then experiencing anger or extreme sadness the next. She would say hurtful things that made her feel guilty or ashamed afterwards. At first these behaviour changes were put down to being a teenager; however, other riskier behaviours developed such as frequently getting drunk, and then when she began self-harming, more specifically cutting her arms, her older sister persuaded her to go to see her GP. She was then diagnosed with and treated for anxiety and depression.

However, despite the treatment Leisha was still not doing well – her emotions were completely unstable, her risky behaviours continued, she still had feelings of emptiness, and she began drinking whilst taking her medication which resulted in her being hospitalised for an overdose. 

The hospital referred her to a mental health professional. During assessment, Leisha was asked a series of questions about her interactions and behaviours. The assessment included questions such as:

• Do you have an intense fear of being alone?
• Does this cause you to act out of the ordinary or in an extreme manner in order to avoid being alone?
• Do you have long-term feelings of emptiness and loneliness?
• Has there been a pattern of intense and unstable relationships with people, where you move from loving the person to thinking that you hate them?
• Do you feel that you don’t have a defined self-image or have an unclear sense of self?
• Do you take part in impulsive and reckless activities?
• Have you made suicide threats or attempts in the past, and have you self-harmed?
• Do you experience severe mood swings, which can last for a few hours up to a few days?
• Do you ever have inappropriate and extreme feelings of anger, which you find difficult to control?
• Do you feel paranoid when in stressful situations, or feel disconnected from the world, or from yourself?

Her responses correlated with the signs and symptoms of BPD, and after around five years of experiencing and displaying the symptoms of borderline personality disorder, Leisha was finally diagnosed with the disorder. 

The diagnosis came as both a shock and as a relief, as both Leisha and her close family and friends could now begin to understand the reasons for why she felt and behaved as she did. She could now start to receive the appropriate treatment and support.

Leisha and her mental health professional started having conversations about possible treatment options for BPD; these included:

• Mentalisation-based therapy (MBT) – this can provide a person with the skills to examine and analyse their own thoughts and beliefs. This can give them the ability to better assess their thoughts in daily life, to prevent the impulsive behaviours that they may have previously caused.
• Dialectical behaviour therapy (DBT) – this can be group and one-to-one talking therapy sessions. During the therapy, the person takes the time to address emotional issues related to their borderline personality disorder. They learn how to accept their emotions and recognise them as real and valid. At the same time, they also discover new ways to challenge and respond to these emotions so that they are able to feel and act more positively in the future.
• Cognitive behavioural therapy (CBT) – this aims to help the person to understand how their thoughts and beliefs might affect their feelings and behaviour.
• Cognitive analytic therapy (CAT) – this combines CBT’s practical methods with a focus on the relationship between the individual and their therapist. This can help someone to look at how they relate to people, including themselves and what patterns have developed for them.
• Arts or creative therapies – these aim to help people who are finding it hard to express their thoughts and feelings verbally. The therapy focuses on creating something as a way of expressing their feelings. The courses are run by trained therapists, who can help the person to think about what they have created and whether it relates to their thoughts and experiences.
• Crisis resolution teams – these support people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis such as a suicide attempt. People with BPD often find that simply talking to somebody who understands their condition can help bring them out of a crisis.

No medicine is currently licensed to treat BPD; however, it may be prescribed for someone with a co-existing mental health disorder. Leisha didn’t have a co-existing mental health disorder, so no medication was recommended for her treatment plan at that point. If someone with BPD has another associated mental health condition, such as depression, anxiety disorder or bipolar disorder, mood stabilisers or antipsychotics are sometimes prescribed to help mood swings, alleviate psychotic symptoms or reduce impulsive behaviour.

Getting her diagnosis and being referred to a therapist for treatment did not mean that Leisha’s symptoms and the issues that she was experiencing would disappear overnight, but it was the starting point for treatment and her recovery. There were many challenges to still overcome. 

As people with BPD tend to split the world into good and bad, at first Leisha viewed her therapist as really helpful, offering long-anticipated support. However, as they started to work through issues, Leisha began to feel criticised and had feelings that the therapist was not helping. The therapist was experienced with these issues in people with BPD, and used resources to help to explain to Leisha why she was feeling that way, and to help her to be better equipped to have patience with situations where she felt vulnerable during treatment. Leisha needed to build trust that people offering constructive advice or objective observations were doing so to help her.

The journey to triumph

Leisha was recommended an initial six-week group Mentalisation-Based Therapy. She originally felt hostile to the choice of therapy; she had a notion that group therapy would be full of people that she wouldn’t get on with and wouldn’t feel comfortable opening up in front of. However, she was pleasantly surprised by the experience, although it was challenging at first particularly being open about her intense feelings. The therapy explored difficulties with separation in formative years, something that Leisha identified with, as did others in the group. This made her begin to recognise that she was not the only one who had gone through these feelings, thoughts and behaviours, and recognising this helped her enormously. 

The therapist who facilitated the sessions helped Leisha and the others to feel at ease, reassuring them that it was a safe space to explore their thoughts and feelings and how these affected their behaviour. Leisha recognised others’ experiences with BPD almost mirrored her own and she began to feel less isolated. Following that first breakthrough session, Leisha decided that she would stick with the therapy, even if at times it was uncomfortable, and continued with the sessions after the initial six-week period.

Developing coping skills to better manage emotions when they arise is also an important aspect of BPD treatment. Coping skills are healthier ways of addressing situations and their resulting emotions. There are many types of different coping skills that people use to manage stressful situations and the emotions that result. During her treatment and recovery Leisha tried quite a few with varying degrees of success; some suited her better than others, including:

Exercise – Leisha found that going for a walk when she could feel that her emotions needed regulating, helped. Someone also suggested that she try to combine mindfulness practices whilst she was walking. Mindfulness helps you observe your thoughts without judgement and be more present in the moment. Breathing deeply, remaining present in the moment, and noticing small details of your surroundings – sights, sounds, smells and sensations – helps to restore calmness. Mindfulness means being present and grounded in the current moment rather than fixating on the past or future.

Dealing with her self-harming – during her intense urges to hurt herself, Leisha learnt to distract herself by flicking elastic bands on her wrists rather than cutting. This may not work for everyone who self-harms and others may need to reach out for additional support. There is no magic solution or quick fix for self-harm, and making changes can take time and involve periods of difficulty. Leisha didn’t stop self-harming immediately, but learnt that if she went back to that behaviour, it was not failure, only a glitch in her journey to recovery.

In relationships – whenever Leisha starts to feel that emotions are getting the better of a situation, she removes herself from the situation and waits until the feeling passes, rather than allowing the other person to remove themselves, which may make her feel abandoned; she now feels more in control.

Leisha found that by understanding her illness better through her continuing to attend therapy sessions, learning about others’ lived experiences and employing coping strategies, her symptoms were beginning to ease. Although she knew that recovery was certainly still a way off, she no longer cut her arms, which was an important stage in her recovery. She still has times when she veers between being close and trusting with friends and family, then being suspicious of their feelings and becoming depressed, but these are becoming less and less frequent and she has strategies to employ when this happens.

Two years into therapy Leisha found the job of her dreams, working with an animal charity. She has just celebrated her one-year anniversary, a huge milestone. Before this, her work history had been unsettled, with her often leaving a job within a couple of weeks or months when she felt overwhelmed by her symptoms. Her new employer is aware of her condition and has been able to make reasonable adjustments such as allowing her to work from home some days, to help support her at work. The organisation has many resources in place to support their employees who may be experiencing mental health issues such as a mental health and wellbeing policy, workplace mental health first-aiders, and access to an Employee Assistance Programme (EAP).

Support systems and resources

Support is a crucial aspect for people recovering from borderline personality disorder. Family, friends, mental health professionals and others who have experienced the disorder, all contribute to providing encouragement and emotional stability which are essential for recovery from BPD. 

Once family and friends are made aware of the symptoms of the condition, they can begin to understand what the person is going through, and can learn to be patient and supportive. It is important to be consistent and honest when supporting someone with BPD as they often have a sense of fear and mistrust that they need to overcome. One of the most helpful and healing things a support person can do is to suggest a healthy activity that is mutually enjoyable; healthy relationships and attachments flourish when people experience positive emotions and feel good together.

All relationships bring demands and involve give and take; however, supporting someone with BPD is more demanding than most relationships. Provide the person with BPD the opportunity to make decisions for themselves, convey your confidence in their abilities and ask how you can help rather than doing what you feel is best for them, also be honest about what you can offer in terms of time and resources.

Leisha’s older sister has been a key player in her support system. It was she who first recognised that Leisha was experiencing issues and encouraged her to seek help. She has been unwavering even when Leisha was displaying some of the worst symptoms of the condition. 

Many of Leisha’s friends were understanding and were willing and able to help support her; one or two, however, began to distance themselves. Leisha was beginning to recognise who her true friends were.

Being able to be open about her condition in the workplace has enabled Leisha to form friendships with people who know about what she goes through. The workplace has also been able to offer an Employee Assistance Programme (EAP), which Leisha uses at times when she feels that she needs support getting through a stressful period. 

Group therapy has been the mainstay of Leisha’s recovery, as it is a journey that requires patience, persistence and ongoing self-reflection. Her therapist and the other attendees have been there to provide valuable insight, camaraderie and encouragement by sharing similar experiences and ongoing guidance, support and resources. 

Leisha also found that joining BPD support groups and forums on the internet widened her network of people going through the same experiences as her. She was able to follow their journeys to recovery, the ups and downs, the therapies that they had tried, some successful, some not so successful, and she has even found herself providing encouragement to others on the forums and Facebook groups as she progress in her own recovery.

Lessons learned

Through her recovery, which is still ongoing, Leisha has learnt that with proper treatment, and commitment to getting well and staying well, she can live a full, happy life. One of the first lessons that she learnt quite early in her journey was that she needed to have a good understanding of the condition and how it affected her before she could start to deal with it, although she also realised that she couldn’t do it on her own; she needed the support of friends, family and professionals.

She also learnt through therapy that developing a positive sense of herself would be key to gaining, and retaining, hope for the future. She started setting personal goals which as she achieved them helped to build her self-esteem and gave her a sense of purpose.

A hard lesson to learn was that things wouldn’t change overnight; recovery would be a process that would have ups and downs, but to not let the downs get in the way of progress. She began to develop and adopt positive skills to respond to stressful or unexpected situations and crises. When something may have felt very immediate and intense the moment it happened, she learnt to take a broader view. One way of doing this is to ask yourself how you will feel about the thing that is upsetting you in a week, a month or a year. This helps to gain some perspective on the issue. 

Leisha also learnt that it is really important to have a healthy self-esteem because it affects everything about how she thinks, feels and behaves. Self-esteem has a big impact on a person’s mental health and their future. Self-esteem is about self-worth and how someone feels about themselves. Someone with low self-esteem will probably be low on confidence and more likely to see things in a negative light. If their self-esteem is high then they are better at self-love and more positive about life in general. Things that helped Leisha with her self-esteem included:

• Identifying the negative beliefs that she had about herself, and then challenging them, by writing down other positive things about herself.
• Being kind to herself, such as taking care of her wellbeing by eating healthily, getting enough sleep, and taking time out to relax and do things that she enjoys.
• Giving herself challenges such as joining an exercise class or sorting out her wardrobe, which when completed gave her a sense of achievement.

Since being diagnosed with borderline personality disorder, and entering into therapy and recovery, Leisha’s mantra has been “Recovery is driven by me and how much I engage with the process, and is supported by others around me”. This helps her to remain focused, especially at times when she has been tempted to waiver.

Living a fulfilling life

Leisha has come to terms with her condition and is well on the road to recovery. There have been bumps in that road, but she has become better at recognising and understanding her personal triggers, such as specific situations, emotions or relationships and has developed strategies to cope with these triggers more effectively.

She likes to think that she has now reached a point in her life where she is in control of the way she acts, thinks and feels. She no longer self-harms and has far fewer impulses to behave in ways that are damaging to herself and others. When she does have these impulses, she employs the strategies that she has learnt from therapy and from others who have experienced the same feelings as her. 

She now has the social skills to interact with others calmly. Work has been a huge benefit in this, giving her a sense of acceptance, belonging and independence. Leisha really enjoys her job; it has provided structure to her life, and she gets a real sense of achievement working for a supportive employer.

Living with borderline personality disorder may often still be a challenge, but the condition is treatable and manageable to the point that it no longer affects Leisha’s day-to-day life in the way that it did before diagnosis. She has lots to look forward to, has better relationships with her family and friends, and has made new friends, even forming a romantic relationship which appears to be going from strength to strength. 

She possibly will always retain some of the traits of BPD, but she doesn’t allow them to rule her and she remembers that she is not alone; if she needs inspiration, she gets that from others who have recovered or who are on the road to recovery from borderline personality disorder. 

Conclusion

Whilst Leisha’s experiences are unique to her, as are the experiences of anyone with borderline personality disorder, there are many similarities that people with the same condition may identify with. Neither is Leisha’s success an exception; her story is just one of many success stories of people who have struggled with and triumphed over BPD. She has had her ups and downs throughout her journey, but the ups have outweighed the downs, and have provided her with the determination that she will triumph over the disorder. 

Anyone who is experiencing borderline personality disorder or who may be supporting someone with BPD may benefit from contact details of organisations that Leisha found. These include but are not limited to:

• Borderline Support UK CIC – a community interest company led by individuals who have personal experience with borderline personality disorder (BPD).
• Talking about BPD
• The Student Room BPD chat
• Rethink Mental Illness
• Borderline Arts – uses the arts to raise awareness of borderline personality disorder and reduce stigma.
• Harmless – user-led organisation that supports people who self-harm, and their friends and family.
• Shout 85258 (text SHOUT) – confidential 24/7 text service offering support if you are in crisis and need immediate help.