Living with BPD is extremely difficult for individuals who suffer from it (I would know), yet it is still not very well understood and there is so much stigma attached to it. My hope is that raising awareness of BPD can help to reduce some of this stigma by increasing understanding.
So what is BPD? BPD, which stands for borderline personality disorder, is a personality disorder that is characterised by factors such as difficulty controlling emotions, lack of stability and unstable relationships. It is sometimes also referred to as emotionally unstable personality disorder, or EUPD for short.
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Symptoms of BPD
Symptoms of BPD usually begin in adolescence and are long-standing with a significant impact on an individual’s life and the lives of those around them. You must show at least five or these symptoms to have a diagnosis of BPD.
Fear of abandonment
This may result in frantic efforts to prevent being abandoned such as clinging, begging, or controlling behaviours. In contrast, you may also feel that others are smothering or controlling you which can provoke intense anger or fear.
Relationships are usually highly intense and short-lived. Typically there is a pattern of idealisation followed by devaluation e.g. “I hate you, don’t leave me”.
Unclear sense of self
Sufferers of BPD have a very unclear self-identity and may struggle to know who they are. They may frequently change jobs, friends, partners, religion, values, goals, and sexual identity.
Impulsive self-destructive behaviours
A tendency to engage in harmful sensation-seeking behaviours when upset such as excessive spending, binge eating, driving recklessly, shoplifting, unsafe sex, and excessive alcohol or drug consumption.
Self-harm and suicidal ideation
Self-harm is very common in individuals with BPD, particularly cutting. Sufferers may also express a desire to die and/or have attempted suicide.
Uncontrollable mood-swings are perhaps the most prevalent symptom. Sufferers have a tendency to quickly go on a downward spiral in response to a trigger that is hard to get out of. However, they can just as quickly come back up again after a few minutes or hours.
Sufferers may also express a feeling of numbness, which they may try to fill with sensation-seeking behaviours.
Individuals with BPD may have a short temper and experience intense frustration. They may “act out” either inwardly or outwardly.
Paranoia/loss of reality
BPD sufferers may experience dissociation in response to stress. When this happens they may feel foggy, spaced out or as though they’re not in their own body.
BPD is rarely diagnosed on its own. Common comorbidities include:
- Substance abuse
- Eating disorders
Comorbidities often improve with treatment of BPD, because more often than not they stem from this underlying condition. However underlying BPD may remain if misdiagnosed or mistreated.
Causes of BPD
Most mental health professionals agree that borderline personality disorder is caused by a combination of biological factors and environmental factors.
Childhood trauma is very common in individuals with BPD and might include sexual abuse, physical abuse, emotional abuse, neglect or exposure to a family member with a severe mental illness.
Research has shown that there are brain differences in people with BPD which causes them to be “on high alert”. The fight-or-flight response may be easily triggered and can interfere with the rational brain.
In many people with BPD, scans have revealed that parts of the brain were either smaller or had unusual levels of activity e.g.
The amygdala – important role in regulating emotions, especially negative ones
The hippocampus – helps regulate behaviour and self-control
The orbitofrontal cortex – involved in planning and decision making
The development of these parts of the brain is affected by early upbringing, which might again suggest brain differences like this occur as the result of childhood trauma.
Treatment for BPD
Dialectical behavior therapy (DBT)
The most commonly used therapy for borderline personality disorder is DBT. The goal of DBT is to introduce two essential concepts that may have been disturbed by maladaptive childhood experiences.
These two concepts are:
Validation – the acceptance that one’s emotions are valid, real and acceptable
Dialectics – a philosophical belief that most things in life are rarely “black and white”
The goal of DBT is therefore to help you break the cycle of seeing the world and your relationships in a very rigid way which is unhelpful and can lead to many of the symptoms we see in BPD.
Schema-focused therapy is based on the belief that we develop ways of interpreting the world in early life, which we call “schemas”.
When our childhood needs, such as the need for safety, acceptance and love, aren’t met then we may develop what’s known as maladaptive schemas. These schemas are very common with individuals with BPD and can be very self-destructive.
Schema therapy works to examine the maladaptive schemas and create new healthy coping strategies with individuals with BPD.
Read more about how schema therapy works for BPD.
Medication for BPD
There is currently not a medication specifically for borderline personality disorder.
However, medication may be used to help with symptoms and comorbidities and therefore individuals with BPD may be put on antidepressants (SSRIs), anti-anxiety medications or mood stabilizers.
This will not help with the underlying root of BPD but may help individuals cope better with symptoms.
Self-help for BPD
From my experience in BPD recovery, most of the help received has to come from the self. You can have all the medication and therapy in the world, but unless you make that decision within yourself to want to get better, it won’t happen.
More info on BPD
If you want more information and resources regarding borderline personality disorder, I have a BPD resources page full of helpful resources to aid in awareness and recovery.
I hope this post has provided some insight into borderline personality disorder symptoms, causes and treatment.
If there is anything you feel relevant to add please leave a comment below!