Borderline Personality Disorder: Living on the edge

Bipolar Disorder

Borderline Disorder – What is it?

Affecting around 6% of the population, Borderline Personality Disorder (BPD) makes reference to the fact that until it was recognised and classed as a separate disorder in 1980, it was thought that sufferers were ‘on the border’ between psychosis and neurosis. Historically BPD tended to be misdiagnosed as another condition (such as depression, anxiety or even bipolar disorder) hence there was little in the way of effective treatment for sufferers. However, the news for people suffering from BPD today is much better with evidence-based treatments, such as Psychoanalytic Psychotherapy, proving to be an effective treatment option.

So what is Borderline Personality Disorder? This is a serious condition characterised by a person’s inability to regulate or manage their emotions effectively, often outbursts of anger are present.  Sufferers may also be plagued with disturbed thinking patterns and/or skewed perceptions about the world around them. Typically, people with BPD can also display a tendency toward impulsive, risky or even life-threatening behaviours (such as dangerous driving, self-harm, drug use or other extreme activities). In addition, people with Borderline Personality Disorders tend to have very intense but frequently changeable relationships.

What are the symptoms of Borderline Personality Disorder?

As outlined above the symptoms of BPD broadly break down into four categories: emotional instability, distorted thinking patterns, impulsive behaviours and unstable or volatile relationships with others.

Emotional Instability

Everyone experiences emotions – sometimes we may be happy, scared, sad, angry, hopeful or any one of dozens of different ways of feeling. People with Borderline Personality Disorder struggle to regulate their emotional states, frequently displaying extreme swings in mood (say from happy one minute to blackly despondent soon after without any reason why). Unfortunately, those with BPD generally tend to suffer more of the emotions we commonly ascribe to being negative; these include anger, rage, panic, sorrow, shame, terror, resentment and/or guilt. More seriously people with BPD can have strong suicidal feelings of despair which, although these pass in time, can feel overwhelming.

Finally, people with BPD may also experience a terrible ‘empty’ feeling which can be permanently present or may come and go. Sometimes sufferers can describe this as a feeling of not knowing who they are. In general, the common symptom of emotional instability is typified by the wild and unaccountable mood swings which sufferers of Borderline Personality experience on a regular basis. 

Disturbed thinking &/or perceptions

One of the most distressing symptoms of BPD is characterised by distorted ways of thinking and perceiving the real world. By this we mean that a sufferer may have upsetting or scary thoughts, such as believing they are a bad person, being unsure of what is real and what isn’t or similar delusions. Sufferers can also harbour unwarranted suspicions, such as firmly believing that their family or loved ones are trying to kill them or become paranoid that they are being watched by others.

Typically such extreme symptoms are an indicator that the sufferer is getting much worse and hence qualified medical help should be sought straight away.

Risk taking, danger & impulsive actions

Borderline Personality Disorder can be characterised by the person frequently taking risks which others would consider abnormal, even reckless, or by exposing themselves to unacceptable levels of real danger.  While some people are what might be described as ‘thrill-seekers’ this is often within the healthy borders of behaviour – For example, not everyone wants to go sky-diving or cliff jumping but these are not considered generally abnormal.

On the other hand, BPD sufferers may start to take absurdly dangerous or highly risky actions in their day to day life without knowing why. At the lower end of the spectrum, this can involve impulsive actions, such as binge drinking, taking illegal drugs, going on wild spending sprees, gambling excessively or having unprotected sex with complete strangers. More extreme actions would be behaviour such as trying to cross a busy road with their eyes closed or driving in a manner which is wildly dangerous to themselves and others (in a cross-over with the delusional symptoms described above).

Included in these symptoms is the fact that people with Borderline Personality Disorder may attempt to self-harm – Normally, this takes the form of cutting or burning themselves but can escalate into serious attempts at suicide.

Difficulties with relationships

Typically, people with BPD have great difficulties sustaining normal relationships. These problems can range from excessive fear or anxiety that someone will leave them, through to intense anger with a partner, verbal abuse or even violence. For people with Borderline Personality Disorder, there is a strong tendency for relationships to be an unrealistically “Black and white” problem – either the relationship is wonderful and they are hopelessly smitten or everything is irretrievably bad: the other person is hated and everything is terrible. Consequently, relationships tend to be classified as “love/hate” affairs. 

Other unstable relationship symptoms can include not wanting to be left alone by their partner, texting or calling them at inappropriate times (such as the middle of the night), perhaps even physically clinging onto them or threatening to do themselves harm if the person leaves.

What causes Borderline Personality Disorder?

The base cause of Borderline Personality Disorder is strongly linked to developmental & environmental causes, as well as some genetic predisposition and other biological factors.

In general, BPD is usually due to the sufferer receiving disorganised, insufficient or even abusive care while a child. In these circumstances, the sufferer may have experienced unpredictable events on a more than normal basis. For example, being left alone a lot, sudden changes in the primary carer’s mood, not receiving an explanation for major life events or being exposed to traumatic experiences around care with no warning. Because of these factors the child not only becomes primed to experience high cortisol levels (Cortisol is one of the body’s main stress hormones), but also has insufficient experience of regulating their own emotions. Further to this, the child may well have not learned how to feel safe with another person or lacked certainty about the role and stability of their own emotions.

Fundamentally, BPD develops due to the sufferer not experiencing love as a child. Without this essential part of their emotional development, their emotions could be said to be still in a ‘child-like’ state. For example, Borderline Personality Disorder is characterised by reactions which reflect the very early stages of childhood, when children have not yet developed the emotional maturity or control of older children.  Typically, these are child-centric emotions such as impulsivity (or a lack of comprehending danger), angry outbursts (much a child would have a tantrum), a great need or dependence on another person (as a child would for its parents) and an intense fear of being left alone. Put in this way it is very easy to see the connection between the child and the adult they will grow into.

With knowledge of the above, it becomes very apparent why someone suffering from Borderline Personality Disorder feels the way that they do. In essence, it is hard for them to live in the skin of a grown up while still retaining all the raw emotional needs and lack of control of an infant.  Because of this, people with BPD re-enact these needs to try to ‘fix’ the past. Unfortunately, it is never enough and others will always fail to meet the sufferer’s needs or expectations.

Treatment for Borderline Personality Disorder

Thankfully, there are effective treatments available which can greatly assist sufferers. Unlike many other disorders, medication is not effective in treating the causes or symptoms associated with Borderline Personality Disorder. No drugs have yet been proven effective in tackling the root cause although a doctor may prescribe sleeping pills or a mild tranquiliser if you are currently having a crisis. Instead, talking treatments are considered the current ‘gold-standard’ of helping sufferers.

The most effective talking treatment starts with Psychoanalytic Psychotherapy. Over time this allows the sufferer to experimentally learn that their therapist is a reliable new role-model in emotional containment and reliability. With guidance and therapy, the patient can start to integrate these behaviours and ways of thinking into his or her own inner world, allowing them to finally gain the ability to ‘self-soothe’ – an ability which was so absent during their childhood.

In such treatment, Mentalisation is essential – This is where the therapist gently invites the client to learn how to reflect on themselves, including their own actions and thoughts, as well as understanding the mental processes of other people. This development of a sense of difference between own and other’s mind leads to an appreciation of the fact that other people may not necessarily know what the patient needs without being specifically told. In addition, it acclimatises the patient to the understanding that other people may have very different ideas, needs, wishes, desires and thoughts from their own and equips them with the ability to start learning about dealing with these in a normal manner.

Tell us your experiences with Borderline Personality Disorder

We would be delighted to hear your own personal experiences with BPD – either as a sufferer yourself or if one of your family or friends has been diagnosed with this condition. Sharing your story, experiences and successes can help others find the strength and courage to finally address the anxious rollercoaster of emotional turbulence and despair which is central to this serious and much misunderstood mental illness. Leave your comments, tips and observations below.

 Alternatively, why not get in touch with us now to arrange a friendly, no obligation chat about how talking treatments could help you or someone you love afflicted with Borderline Personality Disorder.

Thank You!

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