Borderline Personality Disorder

What is Borderline Personality Disorder?

A personality disorder consists of patterns of thinking and behaviour that differ from sociocultural norms, which cause impairment and distress. Borderline personality disorder (BPD) is characterised by changing moods, self-image, and behaviour, which has an impact on interpersonal relationships, interests and values, as well as long-term plans. Since BPD is defined by these patterns, rather than changes in mood, it is not a mood disorder even though people with BPD may experience periods of anger, anxiety, and low mood.

At the core of BPD is a fear of abandonment, which may result in attempts to avoid real or perceived abandonment. This fear can lead to feelings of loneliness even within interpersonal relationships. If a person with BPD displays impulsive behaviour, it may be in response to these anxieties. 

The behaviours associated with BPD can be classified into four groups:

• Emotional dysregulation. This includes highly reactive moods, outbursts of anger, and high sensitivity to rejection. 
• Cognitive and perceptual distortions, or accurate and negatively biased thoughts. This includes distressing thoughts, suspiciousness, and may include psychotic-like symptoms such as auditory hallucinations, especially in times of stress. 
• Impulsive behaviour, including substance abuse, impulsive sexual behaviours, self-harm, or suicide attempts.
• Unstable interpersonal relationships. Opinions of others can fluctuate often. Relationships with loved ones alternating between closeness and dislike. Everyday events such as temporary separations can trigger fears of abandonment, which can lead to feelings of distress and anger.

However, not every person with BPD has the same experience – the severity and type of symptoms differ from individual to individual.   

How Therapy Can Be Helpful

It is likely that BPD is caused by a combination of biological and environmental factors. Research has shown that sizes of parts of the brain that are important for the regulation of emotion and behaviour, or the activity in these areas, are often different for people with BPD. Environmental factors can also have a significant influence on the development of BPD. Many people with BPD have reported being abused or neglected as a child. These factors may result in a greater sensitivity to loss, and difficulties with emotion regulation. 

It is often difficult to distinguish typical variations in personality from personality disorders. What often makes this more complicated is the fact that symptoms of BPD may overlap with a mood disorder or substance abuse. In fact, a significant number of people with BPD are also diagnosed with another disorder. When a diagnosis is made, it is carefully done by a professional, taking both the individual’s history and their responses to the interview into account. 

While it could take several years, the appropriate treatment can help to alleviate symptoms and improve the quality of life of a person with BPD. The therapeutic relationship with the therapist, together with the safety created in sessions, could also serve as a new and corrective experience for the person with BPD. Trusted family members or friends can help by being patient and providing support throughout this period. Dialectical Behaviour Therapy is a form of psychological therapy based on Cognitive Behaviour Therapy, incorporating additional treatment elements to give more emphasis to acceptance, mindfulness, and emotion regulation. It has been found to be effective in the treatment of BPD. When medication is prescribed, it is usually used to complement psychological therapy by treating specific symptoms or treating co-occurring disorders.