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Borderline personality disorder (BPD) is now more commonly referred to as emotionally unstable personality disorder (EUPD). In this article, we refer to BPD.

What is a personality disorder?

The term personality refers to patterns of thinking, feeling and behaving. We’re all different and have unique aspects of our personality. Some of us lean towards being introverted while others are extroverts, we might be adventurous or cautious, high energy or less so. Personality is extremely complex and it’s impossible to describe someone with just one word.

Because personality is intrinsically connected to identity, the term personality disorder can feel negative to someone living with a personality disorder, of which there are ten known types. People with a diagnosis of a personality disorder often report feeling judged for not relating to the world as some others do, but the term personality disorder is not a moral or character judgment. In clinical terms, personality disorder simply means that some aspects of someone’s personality is causing them ongoing difficulties in their day-to-day lives. Importantly, these patterns can be changed with the right kind of help and support.

Who is affected by BPD?

It’s believed that between 0.7% and 2% of the UK adult population meets the diagnostic criteria for BPD. Although available data suggests that BPD is more common in women who account for 75% of all diagnoses of BPD. Men may be less likely to seek help and treatment for symptoms, thus the true gender split is difficult to ascertain.

Many more people are on a spectrum so might not meet the criteria for diagnosis but still find that their lives are negatively impacted by some of the behaviours and feelings associated with BPD.

Symptoms of BPD often start in adolescence and continue into adulthood. Their impact can range from mild, to moderate, to severe. The intensity may also vary over the course of a lifetime.

Symptoms of BPD

There are four main components to BPD.

1. Emotional instability (also known as affective dysregulation)

If you’re living with BPD, you may experience a range of extremely intense and difficult emotions such as:

  • Uncontrollable rage resulting in the destruction of relationships or property
  • Deep despair
  • Shame
  • Anxiety to the point of terror
  • Intense fear (particularly if you feel as if you might be abandoned by someone you care about)
  • An unstable sense of self
  • Chronic feelings of emptiness and loneliness.

You might also experience very unpredictable and severe mood swings over a short space of time. It’s also not uncommon to feel suicidal with despair at one point only to feel reasonably positive a few hours later. Everyone is different – you might feel better in the morning or in the evening, or you might find that there is no pattern to your moods. Whatever is true for you, the key sign is that your moods swing in unpredictable ways. This can feel exhausting and frightening, and as if you’re on a rollercoaster over which you have little control.

2. Disturbed patterns of thinking or perception (also referred to as cognitive distortions or perceptual distortions)

Different types of painful thoughts can affect people living with BPD which can include:

  • Believing that you’re a worthless or bad person.
  • Feeling as if you don’t exist when you’re alone.
  • An unstable sense of identity. For this reason, you might regularly change partners, friends, jobs, religions, beliefs, or hobbies hoping to find out who you are.
  • Feeling suspicious or paranoid, you might constantly question other people’s motives and assume that you can’t trust anyone which in turn harms your interpersonal relationships and sense of self-worth.
  • Feeling out of touch with reality, particularly when under stress. You might lose touch with reality for a period of time (known as dissociation), or you might temporarily question what is real and what is not.
  • Some people with BPD may also experience hearing voices from time to time – this is frightening and very stressful.

3. Impulsive behaviour

For many people living with BPD, impulsive behaviour is common and can include:

  • An impulse to self-harm especially when under emotional stress or depressed.
  • A strong and sometimes uncontrollable impulse to engage in harmful activities such as shoplifting, binge drinking, binge eating, using recreational drugs, going on spending sprees you can’t afford, or having unprotected sex with strangers.

Impulsive behaviour is often followed by a deep sense of shame and regret.

4. Intense but ultimately unstable relationships with other people.

You might find that the majority of your relationships are very intense but short-lived. You may fall in love quickly, believing that each new person is the one who will make you feel whole, only to be quickly disappointed. Your relationships with partners, friends, colleagues, and family may go from perfect to terrible very quickly without any middle ground. Your partners, friends, colleagues, or family members may feel like they rarely know where they stand with you as you swing between idealising them and devaluing them.

You might also find it difficult to take a step back when someone unintentionally upsets you and may consider that the relationship has been irreparably broken because of a perceived slight. It is for this reason that you might find your relationships don’t last very long and you’re continually searching for the perfect person who can be everything to you.

If you live with BPD, you may feel that other people abandon you when you most need them. Or conversely, you might feel fear when people get too close and smother you. This fear of abandonment can lead to feelings of intense anxiety and anger. You may make frantic efforts to prevent being left alone including:

  • Constantly texting or phoning a person even if they’ve asked you not to.
  • Physically barring someone from leaving you.
  • Telling the person you feel is abandoning you that you will harm yourself if they leave you.

Where to get help if you think you might have BPD

If you’re concerned that you might have BPD, your GP is the best place to start. He or she will ask about your symptoms and how they’re affecting your quality of life including your work, your relationships, and your overall wellbeing.

Your GP will also want to rule out other more common mental health conditions such as depression or anxiety, and make sure there’s no underlying physical cause for your symptoms. If your GP thinks that you might have BPD, it’s likely that you’ll be referred to a specialist service for a more in-depth assessment.

What causes borderline personality disorder (BPD)

Treatments for borderline personality disorder (BPD)