Borderline personality disorder (BPD)

Borderline personality disorder (BPD) is a mental health disorder marked by abnormal behaviour and unstable moods.

BPD’s causes are unclear. They are suspected to be a combination of genetic and environmental factors. Traumatic events from childhood are often associated with developing BPD. An estimated 8 out of 10 people with BPD reportedly experience parental neglect or physical, sexual or emotional abuse during their childhood.

A person with BPD traits is typically unstable, has impulses to self-harm and has very intense relationships. People with BPD are likely to also suffer from depression, anxiety disorders, hallucinations, substance abuse, eating disorders and suicidal behaviour.

BPD is a relatively common mental health condition, believed to affect more people than schizophrenia and bipolar combined.

What are its symptoms?

According to the Diagnostic and Statistical Manual of Mental Disorders V (known as the DSM-5 and published by the American Psychiatric Association), at least five of the criteria below in this symptoms checklist must be present for a diagnosis of BPD:

  • Frantic efforts to avoid real or imagined abandonment
  • A pattern of unstable and intense relationships, alternating between idealisation and devaluation
  • Persistently unstable self-image or sense of self
  • Impulsivity in at least two areas: spending, sex, substance abuse, binge eating, reckless driving
  • Recurrent self-mutilating behaviour or suicidal threats
  • Episodic dysphoria (despair/depression/rage), irritability or anxiety
  • Chronic feelings of emptiness
  • Inappropriate, intense, unpredictable anger or difficulty controlling anger
  • Transient, stress-related paranoid ideation or severe dissociative symptoms (that is, disconnecting from reality/reporting events differently from the way others experienced them).

The DSM-5 is often used to diagnose mental health conditions and by medical insurance companies to reimburse for treatment.

How is it diagnosed?

A BPD diagnosis is usually made in adults, not in children or teenagers.  This is because what appear to be BPD symptoms may go away as children get older and become more mature.

A diagnosis is based on an assessment:

  • An interview and examination by your doctor in which he/she will ask you questions about your symptoms and medical history, and conduct a medical exam
  • A psychological evaluation by a psychiatrist

What are your treatment options?

BPD can be a serious condition, and many people with the condition self-harm and attempt suicide.

The prognosis is reasonably positive over time, and psychological or medical treatment can help.

Treatment options include:

1. Psychotherapy

  • Cognitive Behavioural Therapy (CBT)
  • Dialectical Behaviour Therapy
  • Schema Focused Therapy

Therapy can be provided one-on-one with a psychologist or via a group. Therapist-led group sessions may teach people with BPD how to interact with others and to express themselves effectively.

2. Medication

Many people with BPD are treated with medication as well as psychotherapy. While medications don’t cure BPD, some may be helpful in managing symptoms. Medication can help reduce symptoms such as anxiety, depression, or aggression.

Medication can, however, cause different side effects in different people. People who have BPD should talk to their prescribing doctor about what to expect.

Can it be prevented?

As the exact causes of BPD are still largely unknown, there is no guaranteed formula to avoid the disorder.

As the development of BPD is associated with a history of childhood abuse, however, prevention and early appropriate treatment of abuse are often considered in preventing this disorder.

Certain steps that may help include:

  • Validating a person’s emotions
  • Maintaining a stable environment
  • Being present
  • Reinforcing positive behaviour
  • Being supportive and patient

Children and teenagers who learn that their feelings are valid may have a better chance of not developing the disorder. Early intervention is key.

For more info

South African Depression and Anxiety Group

South African Federation for Mental Health

The accuracy of this information was checked and approved by physician Dr Thomas Blake in December 2015