Borderline Personality Disorder

Information about Borderline Personality Disorder – its presentation, symptoms and treatment.

Borderline Personality Disorder beliefs, emotions and behaviour

People with Borderline Personality Disorder may struggle to have a strong, stable identity.  They often have fears of abandonment or being alone, making them more sensitive to possible criticism.  Thoughts about themselves and others will change quickly and can seem contradictory, moving between admiration and disapproval.  They don’t know ‘who they are’.

Schema therapy is an evidence based treatment that could help with borderline PD.

Missing Interpersonal Ability:

Stability of self-image; Empathy

This personality type is characterised by someone who shows impulsive and sudden changes in mood and behaviour.  They will often appear low in mood and lethargic but will then have unexpected outbursts.  Individuals with BPD are likely to be naturally emotionally sensitive, and be quicker to react to situations.  The person may be argumentative, irritable and quick to offend.  However they are likely to also become dependent on others as they are unsure about themselves.  Whilst they regularly need attention and affection their behaviour may be volatile and unpredictable which can lead to a cycle of rejection.  They may use self-harm or addictive behaviours to try and manage their changing emotions.  At times of significant crisis the person may make suicide attempts.

It is called borderline in the DSM V because it was originally thought that people were on the ‘border’ of psychosis and neurosis

Thom feels that he is never fully appreciated by anyone and no one understands him.  As a young child, he was seriously neglected by his mother, being left for long periods on his own.   His dad left when he was five, but Thom was subject to physical abuse from him before this.  As he grew up he had few friends, and he used to fall out regularly with those he did have. At the age of 12 he started to hurt himself, he thinks this was to get his mother’s attention but also to let out all the overwhelming feelings he had. 

As an adult, Thom has had many relationships. These start out well and he can fall deeply in love, but then starts to feel fearful that his partner will leave him.  He is a kind, funny individual who can attract other people easily.  This leads him to swing between desperately needing the person and doing things to push them away – such as having other sexual encounters or not talking to them for days.  He can see that this behaviour is unhelpful, but his emotions become so strong that he feels like it is not in his control.   Thom describes a feeling of emptiness inside of him and struggles to know who he is or what he wants in life.  He deals with his excess in emotion by drinking and using drugs and continues to self-harm.  He has attempted suicide on three occasions. 

example presentation

Diagnostic Criteria for Borderline Personality Disorder

In the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 5) it states that 5 out of the following 9 symptoms must be present for the diagnosis to be made:

1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
3. Identity disturbance: markedly and persistently unstable self image or sense of self.
4. Impulsivity in at least two areas that are potentially self- damaging
5. Recurrent suicidal behaviour, gestures, or threats, or self- mutilating behaviour.
6. Affective instability due to a marked reactivity of mood
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Treatment

There are a number of therapies which are noted in the NICE guidelines for Borderline Personality Disorder as having growing evidence of being effective treatments. These include Dialectical Behaviour Therapy, CBT, Cognitive Analytical Therapy and Schema Therapy.

Individuals who find themselves in regular crisis, with ongoing destructive behaviour, self harm or suicidal ideation, would benefit from DBT as this offers strategies to manage these. If you are currently in this position, please contact your GP or local Crisis team for urgent support. They may be able to refer you to specialist Personality Disorder services in your area.

Schema Therapy and Cognitive Analytical Therapy may be most beneficial when someone feels in control of crisis urges. These can help individuals to understand the origin of their Personality Disorder, and help to develop further strategies to manage this.