Borderline | Emotionally Unstable
Contradictory, impulsive and sensitive
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 perceived 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, 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.
I am bad, vulnerable, and don’t know who I amBeliefs about self
Others are dangerous and hurtfulBeliefs about others
The world is a confusing, ever changing placeBeliefs about the world
Diagnostic Criteria for Borderline Personality Disorder
The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 5) specifies 5 out of the following 9 symptoms must be present for the diagnosis to be made:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
- Identity disturbance: markedly and persistently unstable self image or sense of self.
- Impulsivity in at least two areas that are potentially self- damaging
- Recurrent suicidal behaviour, gestures, or threats, or self- mutilating behaviour.
- Affective instability due to a marked reactivity of mood
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
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.