Borderline personality disorder (BPD) - also called emotionally unstable personality disorder - is a mood condition that can affect how someone interacts with other people. Yet despite BPD affecting an estimated one in 100 people, according to the charity Rethink Mental Illness, it is still commonly misunderstood. People with BPD may struggle with the way they think and feel about themselves and other people, which can impact many aspects of their lives.
Meg, 28, was diagnosed with BPD earlier this year after struggling with her mental health since 2009, which led to her taking time off from university.
"For years no one really knew what was wrong. I had horrible mood swings and suicidal tendencies," she says. "I sought out medical help and was able to get in with a psychiatrist who referred me to a free counsellor and nurse practitioner and they all work together to help me. It was them who determined I had borderline personality disorder.
"BPD does affect my day-to-day life. My mood can change in an instant and it's the anger that really is detrimental at times," Meg explains. "I have a wonderful husband who is very supportive but sometimes my illness does come between us. I have difficulty being alone and he travels for work often."
Meg explains that what happens during the day will determine her mood for the next few days.
"I've learned to identify my triggers and, being a writer myself, I write down my moods and triggers so I can better understand myself and what bothers me," she adds.
What is BPD?
"People experiencing a personality disorder may experience difficulties in how they think and feel about themselves and others," says Antonis Kousoulis, associate director of research and development at the Mental Health Foundation. "These difficulties are ongoing and problematic, negatively affecting their well-being, mental health and relationships with others.
"It is difficult to find a comprehensive definition for these conditions, which include borderline personality disorder (BPD), as the concept of personality and self are difficult to define," he says.
This means personality disorders can often go unrecognised and undiagnosed for a long time, Kousoulis explains.
However, the symptoms can be broadly characterised by several criteria: emotional instability, disturbed patterns of thinking or perception, impulsive behaviour and intense yet unstable relationships with others. People with BPD may feel angry or upset a lot of the time.
BPD can affect how someone copes with life events, their emotions, and their behaviours or impulses, and it can also impact the way they connect with others. It can also affect their sense of individual identity, so people may not really know 'who they are'.
"As a result, individuals with BPD may feel isolated and alone with true feelings that people who surround them can't really understand them," Kousoulis says. "Individuals with these disorders are at a higher risk of suicide, with higher levels of self-harm and drug/alcohol abuse being reported by individuals as methods of coping with these difficult and overwhelming emotions and feelings.
"There is also a higher risk of experiencing other mental health conditions, such as depression, with BPD and it can be particularly difficult to sustain a stable job."
Why do some people disagree with a diagnosis of BPD?
It's important to note that while some people find a diagnosis of BPD helpful as it may help them understand their difficulties, other people disagree with the term and the system of diagnosing personality disorders.
Some people feel labelled or upset by the diagnosis, may experience stigma, or would rather see their experiences as a result of difficult life events instead of a medical problem. Others argue that BPD is an unhelpful diagnosis because it can be misdiagnosed, as some symptoms are similar to other mental health problems.
What causes BPD?
"Early childhood traumatic experiences such as abuse, parental neglect, inconsistent care and bullying have been associated with the disorder," he says.
"Although biological factors such as chemical imbalances and genetics play a role, the environmental factors mentioned above have more influence on the development of this illness.
"Early negative experiences affect a person's emotional learning and processing, manifesting in disordered behaviour and further affecting their experiences."
What treatment is recommended for BPD?
Many people with BPD can benefit from psychological or medical treatment. Adimulam says there is no one way to treat it, and your GP may recommend different therapies together.
Treatment for BPD usually involves some type of psychological therapy, which will help people better understand how they think and feel.
"Various psychological approaches such as cognitive behavioural therapy, cognitive analytical therapy and dialectic behavioural therapy (DBT) have been researched and they are the mainstream psychological therapies," says Adimulam, adding that different therapies work for individual patients.
DBT focuses on two factors which can contribute to BPD - emotional vulnerability, and whether the person grew up in an environment where emotions, such as anxiety, were dismissed.
Mentalisation-based therapy is based on the notion that people with BPD struggle to examine their own thoughts and beliefs to assess whether these are realistic or useful.
Arts therapy may be recommended, where patients learn to express emotions through art, theatre or music. A GP may recommend a therapeutic community, an environment where people come together to take part in therapy.
"Medications such as antidepressants, antipsychotics and mood stabilisers are of modest effectiveness and treating psychiatrists need to take a lot of caution to avoid treating too much with medication," Adimulam says. "A clear and rational explanation about the role of medication needs to be given to the patients."
The charity Mind can offer support, advice and guidance for people with BPD. It can be common for people with BPD to struggle with suicidal thoughts and it is important to tell someone.
In the UK, you can call your GP and ask for an emergency appointment, ring the Samaritans helpline on 116 123 or speak to trusted family and friends. You can also call the NHS helpline out of hours on 111.
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