Borderline personality disorder

Borderline personality disorder (BPD) is a type of mental health condition. People with BPD experience distressing emotional states, difficulty with relationships, and self-harming behaviour.

About 1–4% of the population will develop BPD at some time in their lives. Women are more likely than men to be diagnosed with BPD.

Symptoms of borderline personality disorder (BPD)

People with BPD experience strong, negative emotions can that can be difficult to manage. They also have difficulty relating to other people and the world around them. Difficulties that people with BPD may experience include:

• near-constant, overwhelming emotional pain
• feelings of emptiness
• idealising or devaluing other people
• fear of abandonment
• impulsive or risky behaviours – such as spending sprees or engaging in unsafe sex or substance abuse
• intense outbursts of anger
• difficulties with self-image and self-esteem
• self-harm and suicidal ideation.

‘Extreme’ behaviour and BPD

People living with BPD may show behaviour that seems extreme, such as intense changes in mood and repeated self-harm. There may be a variety of reasons for such behaviour. Many of these behaviours occur in an attempt to deal with strong, negative emotions and thought patterns. Many people living with BPD struggle to regulate their emotions and thought patterns, and may turn to ways of coping that often have negative consequences in the long-term.

Extreme behaviours in relationships are often efforts to manage anxiety about relationships, and to avoid real or imagined abandonment. They are often dismissed as 'attention-seeking' or manipulation. However, these behaviours are symptoms of the disorder and require professional help. Family and other carers of people with BPD also need education and support.

Causes of BPD

The causes of BPD are not fully understood, but may involve a combination of:

• trauma and environmental factors – for example, the person may have experienced trauma or loss. Traumatic experiences in early life are very common in people living with BPD.
• biological factors – for example, structural and functional changes in the brain
• genetic factors – for example, where a close family member, such as a parent or sibling, also lives with BPD

Treatment can reduce BPD symptoms

Treatment can help people manage, reduce or even eliminate symptoms of BPD. Treatment is often long-term and is best when provided by mental health professionals who are trained in treatments for BPD.

Current effective treatments for BPD

Currently, the most effective treatments for BPD are:

• psychotherapy – a mental health professional talks with the person about their symptoms, and they discuss ways to cope with them. Evidence-based psychological therapies for people living with BPD include dialectical behavioural therapy, schema therapy, mentalisation-based therapy, psychodynamic therapy, and cognitive analytic therapy.
• medication – there is no medication that specifically treats symptoms of BPD, but medication may help reduce associated symptoms such as depression.

Treatment can usually be provided in the community. However, if a person living with BPD is at risk of harming themselves or others, they might need to stay in hospital in the short-term.

It’s also important for people living with BPD to look after their physical health through a trusted GP. Many people also benefit from accessing peer support services and support groups.

Treatment of associated conditions

BPD often occurs with:

• suicidality
• post-traumatic stress disorder
• mood disorders (for example, bipolar disorder and depression)
• eating disorders
• alcohol or drug abuse.

Treatment and supports should be personalised to the individual. Sometimes this might mean prioritising one area over another. For example, if a person is experiencing a depressive episode and is suicidal, it is important to focus on keeping that person safe before focusing on underlying concerns.

Where to get help

• Your GP (doctor)
• SANE Help Centre Tel. 1800 18 7263 Monday to Friday, 10 am – 10 pm
• SANE peer support moderated forums
• Beyond Blue Support Service Tel. 1300 22 4636
• Lifeline Tel. 13 11 14
• Kids Helpline Tel. 1800 55 1800
• Project Air Strategy