Below are the symptoms of borderline personality disorder according to recent government guidelines, A doctor will diagnose borderline personality disorder in persons who have five or more of these symptoms and if the symptoms have a significant impact on them.
- having emotions that are up and down (for example, feeling confident one day and feeling despair another), with feelings of emptiness and often anger
- difficulty in making and maintaining relationships
- having an unstable sense of identity, such as thinking differently about yourself depending on who you are with
- taking risks or doing things without thinking about the consequences
- harming yourself or thinking about harming yourself (for example, cutting yourself or overdosing)
- fearing being abandoned or rejected or being alone
- sometimes believing in things that are not real or true (called delusions) or seeing or hearing things that are not really there (called hallucinations).
Note: People with borderline personality disorder have high rates of other mental health related problems, such as depression, anxiety, eating disorders and substance misuse (drugs or alcohol).
The question of ‘personality disorders’ is controversial, as what some experts term as ‘personality’ others regard as ‘the self’; so any suggestion that a person’s self is disordered, damaged or flawed can be distressing. It’s worth remembering that aspects of almost any type of personality can be found within the pages of the diagnostic manuals. What matters is that you get the help you feel you need. If after reading this post you feel you may have BPD, talk to someone who is medically qualified – be very wary of making a self-diagnosis!
What are the typical feelings and experiences of people with BPD?
Some people with BPD may find themselves having a series of unstable and intense relationships, or clinging too long to damaging relationships, perhaps because of feeling insecure, alone or lacking self-worth.
People with BPD may find social relationships difficult because of their poor self image, feelings that they don’t fit or don’t belong, and moods and feelings which change rapidly. A feeling common to many people with BPD is a deep sense of emptiness. Here is how one person described it:
“Feeling bereft and lifeless – with a void I can’t fill no matter how much food I put down or activity, exercise, self harm and constant thinking I’ve gone through. I try to keep busy to combat the emptiness but it only masks it. The best antidote is to try to experience life and relationships more fully then store the better memories.”
Some people are tempted to harm themselves when their emotions become intensely painful and hard to cope with or express.
Many of those with BPD will sometimes feel suicidal and may attempt suicide.
“When it was really bad, I would be in so much emotional pain that suicide seemed like the only way I could find any release. My attempts at overdosing kept failing: I was secretly screaming for someone to just listen to me and show me a way out. But in the end, if they wouldn’t or couldn’t be bothered to help me I would rather have been dead than carry on as I was – I just didn’t care about anything, apart from getting rid of the pain.”
Research shows that people with BPD are more likely to have suicidal thoughts and make suicide attempts compared to people with other psychiatric diagnoses. If this applies to you, or someone close to you, it is important to know where to turn to for help.
How Common is BPD?
BPD is thought to affect less than one per cent of the general population. It’s been estimated that three-quarters of those given this diagnosis are women. It’s a condition that isn’t usually diagnosed until adulthood.
What Causes BPD?
The causes of BPD are unclear. Most researchers think that BPD develops through interacting factors, such as temperament, childhood and adolescent experiences. Difficult life events such as the early loss of a parent, childhood neglect, sexual or physical abuse are common in people diagnosed with BPD, though this is not always the case, and people with other diagnoses may also have survived this kind of trauma.
In addition, the problems associated with BPD may become much worse following a stressful experience; for example, after the break-up of a relationship or the loss of a job.
What helps people with BPD?
- People with BPD have a strong need to feel accepted, heard and understood.
- They need a sense of safety; for instance consistent people and places where they can become attached while working through their difficulties.
- There are a growing number of talking therapies that may help, when a person is ready and able.
- Medication has helped some people to cope with difficult thoughts and feelings.
- People with BPD may need a swift response when in crisis, whether it is in the day or at night.
- Specialist NHS services can be accessed via the Community Mental Health Team, some in collaboration with social services, and some run by voluntary or independent organisations.
How can family and friends help?
- People with BPD can have very low self-esteem, and it can help if you remind them of good things about themselves.
- A person with BPD is likely to feel emotionally unstable, so it helps if you can keep stable. You may need to find more support for yourself.
- Your loved one may have more than average changes of mood and attitude, and feelings of being abandoned or let down by you. Try not to take this personally.
- Try to keep in mind that the person you care about wants very much to be loved and cared for but may not know how to ask for help.
- If the person you care about is not receiving any help or therapy then you could help them find information about therapies that might work for them.
- You cannot give someone else a sense of self-worth. People with BPD have to find their own way to this, through therapy and hard work. But you can support and encourage them as they go through this process, which is likely to take time.
- Learn as much as you can about the disorder and find out whether there are any groups to support families and friends, as well as the person with BPD.
How can I help myself?
There are many things that people with BPD can do to help themselves cope better. Here are a few things people have found helpful:
- Get involved in a physical activity such as walking, cleaning, dancing, anything that can distract you from your present emotions.
- Play music that creates a very different feeling to the one you are struggling with, e.g. happy music if you are feeling sad, relaxing music if you are anxious.
- Phone someone. Just talking to someone you trust can be a big help when you are struggling with strong feelings. Call a supportive friend or family member or a helpline.
- Spirituality. Prayer or meditation might help if you are religious or spiritual, and is worth trying even if you are not. Take some quiet time in peaceful surroundings or read something uplifting.
- Acknowledge your emotions. Notice the emotion you are having, and let yourself experience it as a wave, without trying to block it, suppress it, or hold on to it. Try to accept the emotion for what it is.
- Ride it out. Strong emotional reactions (and the urges to self harm, binge or drink) usually last for a few minutes and then begin to subside. Set a timer for 10 minutes and practice riding out the emotion.
- Breathe deeply. Sit or lie somewhere quiet and bring your attention to your breathing. Breathe evenly, slowly, and deeply, letting your stomach rise and fall with each breath.
- Have a warm bath or shower. Add some scented bath salts or candles and allow the warm water and pleasant fragrances take you into a different emotional space.
- Grounding exercises. Sounds, sights, smells and sensations can help you come back into the present, for instance: take a deep breath, and then start to mentally list the things you see around you; listen to the sounds you hear around you, how they rise and fall and change; take hold of an ice cube and hold it in your hand until it starts to cause mild discomfort; or snap a rubber band against your wrist.
- Help someone else. This can be as small a thing as smiling at the shop assistant at the supermarket checkout.
Can I recover from BPD?
There is evidence that BPD symptoms may get better over time, with or without treatment. Research suggests that the majority of people diagnosed with BPD improve in the long term (10 to 15 years), with 50 to 75 per cent no longer showing enough symptoms to meet the criteria for the diagnosis.Remember that recovery may not be about getting rid of all symptoms and that people can learn to manage their condition better, gain control and aspire to a life worth living.
Where can I find further help?
The starting point
Begin by visiting your GP. If he or she thinks you have BPD, you should be offered an appointment with your local Community Mental Health Team. Their role is to assess your needs and develop a care plan with you, which could include some of the therapies or treatments described in this booklet. They will also look at what support you may need to cope.
At times of great distress, you may feel you need to go to a place of safety or feel concerned about the safety of someone you care for who has BPD. If you (or the person you care for) have previously used services, you/they may already have a care plan and a contact person to call. Otherwise you can:
- make an emergency appointment with your doctor or call your doctor’s surgery out-of-hours service if the emergency is at night or the weekend
- call your mental health worker or care co-ordinator if you have one
- call your local mental health crisis team (see below)
- go to the accident and emergency department at your local hospital
- call 999.
Mental health crisis team
Most areas have a mental health crisis team; contact details are through your local council. They are available 24 hours a day, seven days a week and will:
- respond to a crisis within four hours wherever possible
- carry out assessments under the Mental Health Act 1983
- provide support and short-term help until another team is available or the help is no longer needed.
If you need help in a crisis and are assessed as a danger to yourself or to others you may be admitted compulsorily under the Mental Health Act.The Mind rights guides explain your rights with regards to mental health law (see ‘Further reading’)
What I needed was human contact and reassurance. Once I got to talk to someone on the crisis team and they put in place a follow-up meeting, I immediately felt that I would be able to cope better and not let my ever-changing emotions get out of control. I just wanted some understanding and to know someone cared.
In some areas there are crisis houses which may be run by social services or voluntary organisations and are free to those offered a place. They usually take referrals from other services or allow people to refer themselves. Crisis houses do not admit people who are subject to the Mental Health Act.
A crisis house may have day services and beds for limited stays, plus various types of therapy and support, practical help with welfare benefits, housing issues, and training in life skills and problem solving. They link closely with other local services.
There may also be an out-of-hours telephone helpline. See Mind’s online factsheet Crisis services for more information.