Borderline Personality Disorder

September 12, 2021

Team Mindsum

About the author: This article is written by our team of researchers and writers. Our content is published after careful review and approval by the editorial board.

What is Borderline-Personality Disorder (BPD)?
Causes of BPD
Symptoms of BPD
Managing BPD
What types of professionals are involved?
The journey of recovery
How can I support my child with BPD?
Useful resources

What is Borderline Personality Disorder?

‍Borderline personality disorder (BPD) is a type of personality disorder, where the person has difficulties in their mood and relationships with others.

It can be quite hard for a mental health professional to confirm a diagnosis of BPD in children or young people, as they are still developing. But, if the symptoms are persistent at a young age and can only be explained by the BPD criteria, it could be diagnosed.

Causes of Borderline Personality Disorder

‍There is no specific cause for BPD. It is likely due to a combination of genetics and environmental influences. However, a history of trauma and neglect is quite common. These experiences might cause the person to develop unhelpful beliefs about themselves and others around them. These might include:

Feeling invalidated or unsupported as a child
Family instability
Severe neglect
Emotional, sexual, or physical abuse
Losing a parent

Not all people with BPD will have a traumatic history though, some people might still have BPD despite growing up in an environment without stressful situations.

Symptoms of Borderline Personality Disorder

BPD is a complex disorder that can include a variety of symptoms. If the person has at least 5 of the following symptoms, they can be diagnosed with BPD:

Constant feeling of emptiness
Going through extreme emotions (e.g., anger, sadness, anxiety, irritability) from day to day or within a few hours
Constant worrying about being abandoned by others and rash actions to avoid being abandoned
The lack of a strong sense of self (e.g., they change depending on who is around)
Impulsive behaviour that could cause harm (e.g., reckless driving, binge eating, substance use)
Suicidal feelings or self-harm
Intense anger that is difficult to control
A pattern of constantly having problems in relationships with others
Paranoid delusions or detaching from emotions and others around, during times of high stress
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Managing Borderline Personality Disorder

Psychological therapies are used as the main form of management for borderline personality disorder (BPD). Some of these types of therapy will be discussed below.

Dialectical Behaviour Therapy

Dialectical behaviour therapy (DBT) is a type of therapy that focuses on helping people with BPD manage their emotions and change destructive ways to more useful ways of behaving. This therapy can be provided individually and/or within a group. Research has shown that DBT can be effective in treating symptoms of BPD in young people.

The idea behind DBT is to help people with BPD by using two concepts, which include validation and dialectics.

The therapist will work with the person to help them accept their own emotions and acknowledge that these are valid. The person will also learn to develop more openness to other opinions and ways of viewing situations. One of the main goals of DBT is to help the person see things differently from their “black and white” view.

Mentalisation-based Therapy

Mentalisation-based therapy (MBT) is a type of talk therapy that focuses on helping people to understand their mental states and those of others, and how this relates to behaviour. This therapy can be provided individually and/or within a group. Research indicates that MBT can help to reduce symptoms of BPD in young people.

The idea behind MBT for people with BPD is to help them expand their awareness of mental states and situations, especially when interacting with others.

The therapist might work with the person to recognise their mental states and to become more aware of others’ mental states through mentalisation. The person will have the opportunity to assess the validity of mental states. This will help them to respond more helpfully, as opposed to reacting impulsively in different situations.

Art Therapy

Art therapy is a type of therapy that uses creativity to help the person with BPD express their emotions. This can be especially helpful for the person who finds it difficult to voice how they feel. Research suggests that art therapy can have many benefits for people with BPD.

Art therapy might involve different forms of art such as painting, sculpting, and the use of music.

Therapeutic Communities

Therapeutic communities (TCs) are environments that are structured and designed to bring together people with complex psychological conditions, such as BPD. Research has shown that TCs can be effective in helping people with mental health issues to improve their overall quality of life and social engagement.

The TC might include a residential setting with a specialised programme, where the people involved can take part in different types of therapy and other activities.

Activities might involve chores, meal preparations, games, physical exercises, and community meetings. The aim is to help people with BPD learn helpful skills and how to be part of a community.

Other Psychological therapies

Many other types of psychological therapies could be used to treat BPD. These might include cognitive behavioural therapy, cognitive analytic therapy, schema-focused therapy, interpersonal psychotherapy, and psychodynamic therapy.

Medication

Medication is not recommended for the symptoms of BPD. However, the person with BPD can be prescribed medication for the treatment of other mental illnesses (e.g., anxiety, depression) they might have, alongside BPD. Medication might also be prescribed in crises, to help the person calm down.

Admission to hospital

‍In crises, the person might need to admit to the acute psychiatric or emergency services, if they are self-harming or experiencing psychotic symptoms. This is where they will receive care that is focused on helping them calm down and ensuring their safety.

What types of professionals are involved?

‍Different professionals may or may not be involved in the treatment process of BPD. These might include counsellors, psychotherapists, doctors/psychiatrists, mental health nurses, support workers, social workers, cognitive behavioural therapists and occupational therapists. These terms might be confusing, but the main difference is in the training that each of these professionals has received.

Counsellors

Compared to psychotherapists, counsellors tend to have shorter training and they help people deal with their issues on a more short-term basis. There may be school-based counsellors available that children and young people can approach at their schools. Here at Mindsum, we have counsellors who are available to provide support.

Psychotherapists

Psychotherapy training is longer. Psychotherapists can also give counselling but their approach to talking therapy is more in-depth, exploring the history and causes of certain behaviours and emotional issues. Here at Mindsum, we have psychotherapists who are available to provide support.

Cognitive Behavioural Therapists

These are therapists who have been trained in Cognitive Behavioural Therapy using this model to form an idea of a patient’s mental health difficulties and to treat them. They learn about how behaviours, physical feelings and cognitions all interact to create a vicious cycle, aiming to break this vicious cycle through CBT focusing on the here and now.

Doctors

These are professionals who are trained in medicine. This will likely be the family GP, who might find it necessary to prescribe certain medications that might help the person cope with other issues, such as health problems.

Psychiatrist

These are professionals who are also trained in medicine. However, they also specialised in the field of psychiatry. Psychiatrists will prescribe certain medications that will help the person cope with other mental illnesses or calm the person down during a crisis.

Mental health nurses

Nurses trained in mental health might also be involved. If the person is in a hospital setting or is seen by a crisis team due to self-harm or suicide, a mental health nurse might help to give treatment by administering medication.

Support workers

Workers trained in helping vulnerable people to live better lives might also be involved with the person. This might be within a community setting or a crisis. Their role is to provide emotional and practical support (e.g. helping parents to cope, helping with paperwork, and making child-care arrangements).

The journey of recovery from borderline personality disorder

‍Therapy for BPD can vary in length depending on the person's needs and how they live their life. Usually, a complete course of therapy for BPD can last up to one year or longer. The management of BPD can look different for each person. However, some things are expected when going through therapy for this disorder.

Assessment

This is an important phase, where the therapist and/or other mental health experts will get a feel of what is going on. The therapist might need to diagnose whether the person has BPD. This process can be quite complex, and it can take some time before a diagnosis can be confirmed. At this stage, the therapist will need to ask many questions. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful.

Therapy sessions

Therapy sessions will take place individually and/or within a group setting. An important aspect of therapy sessions is the relationship that the therapist will build with the person. This will create a safe space to encourage them to explore their difficulties. The sessions will equip the person to manage their emotions by developing more productive ways of reacting to themselves, certain situations, and other people.

Progress and setbacks

When having treatment for BPD, there will be progress and setbacks. It is important not to feel discouraged when this happens, as this is normal when dealing with a complex mental illness, such as BPD. These situations provide opportunities to discover new ways to move forward together with the mental health experts involved in the treatment.

Ending therapy

The therapist will eventually prepare the person for the end of therapy. The end of therapy will take place once the person has made a lot of progress and has reached their treatment goals. This phase might not be easy for a person with BPD, as they might easily feel rejected or abandoned. However, a skilled therapist will help the person to develop as much resilience as possible, so that they can feel more confident to cope without the therapist.

Follow up

There might be an agreement with the therapist to have a follow-up meeting once therapy is over. This is to check how the person is coping. If they are doing well, there will be no need for more support. But if they continue to have challenges, this will be an opportunity to have extra support.

How to support a child/young adult with BPD?

It can be challenging when you have a loved one who suffers from BPD. Fortunately, there are some things that you can do to help. These are discussed below.

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Understand BPD and DBT

It is a good idea to read as much information on BPD as you can. Understanding BPD and how it works will help you to recognise the ways that your loved one is affected, and the ways that you can help. It can also be helpful to learn skills from DBT to support your child with, this allows for better communication.

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Be dependable and trustworthy

Try to stick to your promises and commitment towards them. Remind them that you are there for them, whenever they need you.

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Show acceptance

Let them know that they are accepted. Whilst the diagnosis of BPD can be really helpful it is important to recognise that the child/young person is more than this ‘label’ and the stigma that it can bring. Avoid being judgemental or critical about their difficulties. Here are 20 things not to say or do to someone with BPD.

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Help them to find the right support

You might:

Help them to book an appointment with a GP or therapist
Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)
Encourage them to keep attending sessions and to not give up
Give them small reminders to do their homework assigned by the therapist

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Create boundaries for them

Boundaries are really important in any relationship but especially for those with BPD. It is important to introduce boundaries slowly to allow for adjustment to them and to not overwhelm everyone with change. Ensuring that everyone agrees on what the boundaries are and understand why they are in place, can also help these boundaries be maintained.

Stay calm

Managing your reaction in conflict is also a key part of communicating with someone who has BPD. Reacting in a harsh or confrontational way to someone who has BPD can trigger them leading to escalation within arguments. Staying calm will enable the conversation to continue constructively so that both parties can continue to express how they feel.

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Be open to listen

Take the time to just sit with them and listen because a marker of BPD is feeling emptiness and worthlessness. You do not always need to give advice and have all the answers. It is more important that your loved one feels heard by you. This will help to create a safe space for them, where they can feel comfortable sharing their difficulties out loud.

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Look after yourself too

You need to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your well-being too. To do this you might:

Get other family members also involved in supporting your loved one
Schedule some time off for yourself
See a professional that can support your mental health
Have a support network that you can also lean upon