Living with borderline personality disorder can be incredibly distressing and the suicide rates are dangerously high. Here is everything you need to know about BPD.
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a condition that is characterised by instability. Our relationships are turbulent, our emotions are volatile and intense, and our self-identity is constantly wavering. It is a condition that causes intense inner turmoil, often resulting in self-destructive behaviours, self-harm and suicide attempts.
- Around 1 in 100 people have BPD, making it the most common personality disorder
- Up to 76% of people with BPD report childhood sexual abuse
- BPD is often a co-occurring disorder, which means it exists alongside other mental illnesses. Common co-occurring conditions include depression, anxiety, substance abuse, bipolar disorder and PTSD.
- 75% of borderlines will make at least one suicide attempt in their lifetime
- Up to 10% of people with BPD will die by suicide
Here are some of the common symptoms of borderline personality disorder.
Borderlines are extremely reactionary. Small negative things can trigger intense emotional turmoil, which is why we can seem blissfully happy one minute and hysterically suicidal the next.
Marsha Linehan describes a borderline’s emotional vulnerability as the psychological equivalent to third-degree burn victims. She says, “They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”
Unstable, toxic and co-dependent relationships are a defining feature of BPD. People with BPD fall in love quickly, but romantic relationships are often turbulent and intense, falling victim to destructive behaviour. Irrational paranoia, clinginess, emotional outbursts and splitting often leads to the breakdown of relationships with significant others, friends and even therapists.
Fear of Abandonment
The prospect of being abandoned by loved ones is a very real and intense fear for people with BPD. It’s a fear that plagues us silently every single day as we battle with the belief that everybody will leave us eventually.
Even just perceived abandonment – like an unanswered text or unenthusiastic reply – can trigger intense fear.
When abandonment feels particularly imminent, our fear can display itself through explosive anger, manipulation, threats of suicide, invasions of privacy, withholding possessions and physically trying to stop the person from leaving.
Distorted or Unstable Self-Identity
Borderlines often struggle with an unstable sense of self, meaning that we struggle to relate to an authentic personality. We may frequently change jobs, aspirations, friendship groups, romantic partners, religions, music tastes, sexual identity – anything to try and find our ‘true’ selves.
This lack of a coherent identity can leave us feeling insecure, inauthentic and ’empty’. It can also lead to social anxiety.
Episodes of emotional intensity are often undercut with periods of chronic emptiness. The severity of this emptiness can range from having ‘brain fog’ and feeling void of a personality, to feeling as though you don’t exist at all.
Impulsive, Self-Destructive Behaviours
Our intense emotions, unstable identity issues and chronic feelings of emptiness can lead us to engage in reckless, self-destructive behaviours. Excessive spending, drug-misuse, risky sex, binge eating and self-harming are some of the behaviours that borderlines use to combat and cope with their mental distress. We are also prone to impulsive suicide attempts.
Borderlines can be distrustful and paranoid. Our disturbed patterns of thinking and low self-esteem can lead us to believe that friends and family secretly dislike us, are planning to abandon us or are conspiring against us in some way.
BPD is thought to be caused by a combination of biological and environmental factors.
Genetics – You are more likely to develop BPD if you have a close family member (often a parent or sibling) who suffers from the condition.
Brain abnormalities – Research shows that people with BPD have significantly different anatomy and functionality in the areas of the brain that controls emotional regulation, self-control and decision making.
Environmental – Around two-thirds of people with BPD have experienced some sort of childhood abuse, with sexual abuse being most prevalent. Parental neglect, abandonment and unstable family relationships are all commonly reported by people with BPD.
BPD is difficult to diagnose and can go undetected for many years, especially if you suffer from co-occurring disorders.
If your medical provider suspects BPD, you will generally be asked a series of assessment questions relating to the symptoms mentioned above.
Unfortunately, BPD is often diagnosed after a significant mental breakdown or suicide attempt.
The Stigma Surrounding BPD
BPD is a very misunderstood condition. The negative stereotypes are plentiful – we are overdramatic, promiscuous, manipulative, violent – totally incapable of compassion and holding down steady relationships. Representations of us in the media – think Fatal Attraction’s Alex – only further perpetuate such stereotypes.
Even mental health professionals are known to stigmatise patients with BPD. According to The Mighty, therapists have been known to turn away borderlines under the belief that they are untreatable, manipulative, clingy, attention-seeking or just plain ‘exhausting’.
These harmful stereotypes can have a detrimental effect on people living with borderline personality disorder. It can prevent them from seeking help, deepen feelings of self-hatred, negatively impact career opportunities and leave us feeling alienated and prejudged.
Even just the term ‘personality disorder’ makes us feel fundamentally flawed, which is why many people chose not to use the term.
Treatment and Recovery
The good news is that, contrary to popular belief, borderline personality disorder IS treatable. It is also possible to completely recover – with proper treatment, most people do not meet the criteria for BPD after 5 years.
Dialectical Behaviour Therapy (DBT) is a specialised therapy derived from CBT (Cognitive Behavioural Therapy). It is designed specifically for people who struggle with intense, unstable emotions.
Unlike CBT, it focuses strongly on self-acceptance and interpersonal skills. The four main types of skills that DBT focuses on are mindfulness meditation skills, distress tolerance skills, emotional regulation skills and interpersonal effectiveness skills.
You can find out more about treating borderline personality disorder with BPD here.
Mentalisation-based therapy (MBT) is a type of psychotherapy that focuses on developing a person’s mentalisation skills – the ability to think about thinking.
Impulsive borderlines struggle to evaluate their distressing thoughts, jumping into self-destructive behaviour like self-harm and substance abuse. MBT helps you to take a step back from these distressing thoughts, providing you with essential self-awareness skills.
MBT is also useful at transforming suspicious or paranoid thinking. It encourages people with BPD to acknowledge that our interpretation of people’s thoughts, emotions and desires can be skewed, particularly when we are in high emotional states.
For more information on MBT, DBT and other types of therapy, you can visit the NHS website.
There are no specific medications used to treat BPD. However, for people with co-existing disorders like depression, anxiety or bipolar disorder, medication can be very helpful.
Remember, treatment works best when you:
- Strictly follow your treatment plan (including medication if required)
- Are open and honest with your therapist
- Commit to engaging with any group work or after-session activities
- Consistently practice self-awareness skills
Self-Care Tips For BPD
Living with borderline personality disorder is mentally and emotionally draining. It is really important to look after yourself and practise self-care even on the bad days. Here are some things that I personally do to manage my BPD on a day-to-day basis.
Have a self-care routine
Every day can be a struggle when you have BPD. Looking after your self-care needs can help to make each day just that little bit easier. Create a self-care checklist and fill it with activities that target each of the five different areas of self-care (physical, emotional, intellectual, social and environmental).
Mindfulness is a great emotional regulation tool if you struggle with instantly overwhelming emotions. It encourages you to take a step back from the chaos in your mind, acknowledging and accepting your negative emotions without allowing them to overwhelm you. I find it makes my intense emotions a lot less scary!
Make a self-care toolkit
A self-care toolkit is a box or collection of feel-good items that you keep safe and handy for those really tough mental health days. Some suggestions for your own self-care toolkit could be a colouring book, scented body lotions, a comfy pair of slippers or your favourite packet of sweets.
Keep a journal
Research shows that journaling and expressive writing are excellent coping mechanisms for overwhelming emotions. Not only does it provide us with a healthy outlet, but it can encourage us to challenge and analyse confusing emotions, giving us clarity and self-awareness.
Have a safety plan
When you’re living with borderline personality disorder, intense emtions can lead to impulsive and self-destructive behaviours like self-harm and suicide attempts. Having a safety plan can help to prevent this.
Devise a clear, simple plan that you or your loved ones can refer to in times of crisis. For example, it might consist of three steps like this:
1 – If I’m feeling extremely low, I’m going to try some of these self-care activities to make myself feel better.
2 – If that doesn’t work, I’m going to talk to a loved one / call Samaritans for support and advice.
3 – If I feel I am in crisis, I am going to contact my local mental health charity, crisis team or GP.
Tips For Dealing With Intense Emotions
Living with borderline personality disorder means constantly internalising intense emotions like anger, frustration, despair and anxiety. It is common for people with BPD to turn to impulsive behaviours like drug abuse, binge-eating or self-harm in order to cope. However, these methods are often very dangerous and cause significant mental health damage.
Here are some of the things I do to calm down my overwhelming emotions.
If you’re feeling angry or frustrated
- Hit or scream into a pillow
- Do some vigorous exercise – jogging works especially well for me!
- Crazy-dance to loud music
- Do a physical household activity – I am all about cleaning my house from top to bottom!
If you’re feeling sad or depressed
- Do something creative – draw, write music, colour in a mandala colouring book, anything that provides you with some release or escape
- Go for a walk
- Treat yourself to a sweet snack
- Cuddle a pet or soft blanket
If you’re feeling anxious or overwhelmed
- Have a warm bath, complete with essential oils and bath bombs for ultimate relaxation!
- Try some of these grounding techniques – holding ice cubes, playing mental category games and using the 5,4,3,2,1 method all work very well for me. Check out Healthline’s 30 grounding techniques to see what works best for you.
- Write all of your worries down in a journal
- Repeat some positive affirmations
Disclaimer: I am not a medical health professional, nor do I claim to be. Any advice I give is drawn from my own experiences living with borderline personality disorder. Always visit your GP or a mental health professional if you feel as though you’re in a crisis. You can check out some great mental health resources here!