Borderline Personality Disorder (BPD)

What is Borderline Personality Disorder (BPD)?

Individuals with Borderline Personality Disorder (BPD) display a pattern of behaviour involving impulsivity and instability in their interpersonal relationships, moods and self-image. Their relationships with others are usually intense but can be stormy and may include over idealisation of friends, lovers or even therapists. Sometimes these relationships are delusional and result in disappointment or anger that triggers their shift in mood from intense feelings of joy to rage. The opposite is also possible in other situations. Individuals with BPD struggle to form an identity and self-image. At times, they may believe they are attractive and healthy, but other times they may experience a highly negative self-concept and feel an intense emptiness. 

 

Individuals with BPD have difficulties accurately interpreting signs of various emotions, especially anger. They may have the tendency to believe that someone is angry at them when faced with a neutral expression. This might be due to their fear or rejection or abandonment possibly resulting from traumatic childhood experiences. In addition to their unstable image of self, they are often engaged in dichotomous and extreme “black and white” thinking. Some examples are: 

 

“My life is going great” VS “Nothing is working out, I’m going to fail regardless” 

“Our relationship is perfect, he will love me forever” VS “He hates me, he is going to leave me” 

 

To cope with this fear, they might test their close relationships and act impulsively. Such behaviours may range from unsafe sex to self-harm (though attempting suicide is less common). This polarised way of thinking does not allow for a middle ground, which often damages one’s physical and mental health, sabotages one’s career and causes disruptions to relationships. These damages are likely to lead to a higher frequency of negative thinking, leading to more attempts of their coping mechanisms which are usually self-destructive. 

 

Signs and Symptoms of BPD

In order to be diagnosed with BPD, you must exhibit at least five out of nine of these symptoms.

  • Fear of abandonment (and frantic efforts to avoid abandonment) 
  • Unstable relationships (ideal VS disappointment) 
  • Unclear of shifting self-image
  • Impulsive, self-destructive behaviours (e.g. drugs, reckless driving, binge eating) 
  • Suicidal threats and self-harm 
  • Extreme mood swings
  • Chronic feelings of emptiness
  • Inappropriate or uncontrollable anger
  • Feelings of paranoia or dissociation (losing touch with reality)

 

Risk factors

  • Genetics, brain structure and function
    • Having a family history of BPD may cause an individual to face higher risks of developing BPD
    • Differences in brain structures affecting regulation of emotions and impulsiveness. 
  • Environment
    • Parenting (adverse child experiences like abuse, neglect, abandonment, etc.)
    • Culture (e.g. interpreting facial expressions, access to resources) 
    • Social factors (e.g. poverty, parental separation) 

 

Treatments and therapies

Psychotherapy is the first-line treatment for people with BPD. Two examples of psychotherapies used to treat BPD include Dialectical Behaviour Therapy (DBT) and 

Cognitive Behavioural Therapy (CBT).

  • Dialectical Behaviour Therapy (DBT)
    • helps individuals to be more mindful, aware, attentive and accepting of their emotions and situation
    • introduce techniques on how to stabilise and and regulate emotions, cope with self-destructive behaviour tendencies 

Ultimately with DBT, individuals should experience less mood swings and “black and white” thinking and engage in more helpful coping methods. They should also have better interpersonal relationships with others. 

  • Cognitive Behavioural Therapy (CBT)
    • helps identify and modify inaccurate core beliefs (for themselves and others) especially for their fear of abandonment 

Reduces emotional volatility, self-destructive behaviour and unstable relationships. 

 

BPD is a challenging disorder to treat due to the strong effects of negative core beliefs and seeking professional help is highly recommended to identify the most suitable type of therapy to follow through. 

 

How to support a friend or your loved ones with BPD?

Those suffering from BPD may be suicidal when faced with relationship problems or when immersed in extreme negative thinking. Look out for tell-tale signs to prevent further self-harm or reckless behaviour. It may be difficult to remain calm and understanding when they are agitated, but it is important to provide them the support and empathy they need and encourage them to seek professional help. 

 

Figure 1: Overview of BPD (Suendermaan, 2019)

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