Getting to know Borderline Personality Disorder
What is Borderline Personality Disorder?
BPD is a mood disorder and affects how a person interacts with others. It is one of the most commonly recognised personality disorders. Someone with a personality disorder will significantly differ from an average person in the way they think, perceive, feel, or relate to others.
The symptoms of BPD can be organised into four main groups consisting of:
· Emotional instability – the psychological term for this is affective dysregulation.
· Disturbed patterns of thinking or perception – cognitive distortions or perceptual distortions.
· Impulsive behaviours.
· Intense, yet unstable relationships with others.
Emotions If you do have BPD you might experience a range of intense negative emotions including:
· Long-term feelings of emptiness and loneliness
· Severe mood swings over a short period of time
It’s common for people with BPD to feel suicidal and despair then within few hours feel reasonably positive about life. The pattern varies, some people feel better in the morning and some people feel better in the evening, it changes between people but the key sign is that their mood swings in unpredictable ways.
Disturbed thinking patterns Different types of thoughts can affect people with BPD such as:
· Upsetting thoughts – thinking you’re a terrible person or feeling like you do not exist. You might not be sure of these thoughts and may seek reassurance that they’re not true.
· Brief episodes of strange experiences – such as hearing voices outside your head for minutes at a time. These might often feel like instructions to harm yourself or others. You may or may not be certain whether these are real.
· Prolonged episodes of abnormal experiences – you might experience both hallucinations (voices outside of your head) and distressing beliefs that no one can talk you out of (such as believing your family are secretly trying to kill you).
These behaviours may be signs of psychotic episodes and mean you’re becoming more unwell, it is extremely important to get help if you are struggling with hallucinations and delusions.
Impulsive behaviour People with BPD experience two main types of impulses that are particularly difficult to control. These include:
· An impulse to self-harm – this includes cutting yourself with razors or burning your skin with cigarettes; in severe cases where you feel intensely sad and depressed, this impulse can lead to feeling suicidal and you may attempt suicide.
· A strong impulse to engage in reckless, risky, and irresponsible behaviours and activities- such as binge drinking, drug misuse, going on gambling sprees, or having unprotected sex with strangers.
If you do feel suicidal or impulses to self-harm please get help as soon as possible by using the Samaritans help-line or go to A&E. When engaging in risky/reckless behaviours there are ways to deal with these impulses without harming yourself.
Unstable relationships If you have BPD you might feel that people abandon you when you need them, or that they get too close and smother you. When people fear abandonment, it can lead to feelings of intense anxiety and anger. You may make frantic efforts to prevent being left alone, such as:
· Constantly texting or phoning a person
· Suddenly calling that person in the middle of the night
· Physically clinging on to that person and refusing to let go
· Making threats to harm or kill yourself if that person ever leaves you
Alternatively, you might feel like others are smothering, controlling, or crowding you, which also provokes intense fear and anger. You may react in ways that will make people want to go away such as emotionally withdrawing, rejecting them, or verbally abusing them. These two patterns can result in an unstable “love/hate” relationship with certain people.
Many people with BPD are stuck with a very ridged “black and white” view of relationships. Either a relationship is perfect and that person is wonderful, or that the relationship is doomed and that person is terrible. People with BPD seem unable or unwilling to accept any sort of “grey area” in their personal life and relationships. For a lot of people that have BPD, emotional relationships (including relationships with professional care givers) involve “go away/please don’t go” states of mind which is confusing for both them and their partners. Sadly this leads to ended relationships.
Everyone is different, so the symptoms of a personality disorder may range from mild to severe and will normally emerge during adolescence years and persisting into adulthood.
What causes borderline personality disorder?
The causes of BPD are uncertain, but like most conditions BPD appears to result from a combination of environmental and genetic factors. Things such as traumatic events that occur in childhood are associated with developing BPD. Many people with BPD will have experienced parental neglect or physical, sexual, or emotional abuse during their childhood.
Genetically, you may be more vulnerable to inheriting BPD from your parents. A study has found that if one identical twin has BPD, there was a 2-in-3 chance that the other identical twin will also have BPD.
Problems with brain function and development
BPD could also be down to problem with brain function. It is thought that many people with BPD have something wrong with their brain chemistry, in particular the neurotransmitters for serotonin. Neurotransmitters are “messenger chemicals” used by your brain to transmit and communicate signals between brain cells. Altered levels of serotonin have been linked to depression, aggression, and difficulty controlling destructive impulses.
Researchers have used MRI scanners to study the brains of people with BPD. MRI scans make use of strong magnetic fields and radio waves to produce a detailed image of the inside of the body. Scans have revealed that many people with BPD, three areas of the brain were either smaller in size than expected or had unusual levels of activity.
These parts included:
· The Amygdala – this area plays an important role in regulating emotions, especially the more negative emotions such as fear, aggression, and anxiety.
· The Hippocampus – is an area of the brain that helps regulate behaviour and self-control.
· The Orbitofrontal Cortex – which is involved in planning and decision making.
Issues with these parts of the brain may well be a huge factor in contributing to symptoms of BPD. The development of these areas is affected by your early upbringing. These parts of your brain are also responsible for mood regulation, this may account for some of the problems people with BPD have in close relationships.
Several environmental factors seem to be common and widespread among people with BPD which includes:
· Being a victim of emotional, physical, or sexual abuse
· Being exposed to long-term fear or distress as a child
· Being neglected by one or both parents
· Growing up with another family member who had a serious mental health condition, such as bipolar disorder, or a drink or drug misuse problem.
A person’s relationship with their parents and family has a strong influence on how they perceive the world and what they believe about other people. Unresolved fear, anger, and distress from childhood can lead to a variety of distorted adult thinking patterns such as:
· Idealising others
· Expecting others to be a parent to you
· Expecting other people to bully you
· Behaving as if other people are adults and you’re not
Please see your GP if you’re concerned that you may have borderline personality disorder. They may ask you about your symptoms and how they’re affecting your quality of life. Your GP will also rule out other more common mental health conditions like depression and make sure there is no immediate risk to your health and wellbeing.
If your GP does suspect you have borderline personality disorder, you’ll most likely be referred to your local community mental health team for a more in-depth assessment, you should ask if the service you’re being referred to has experience of working with personality disorders.
Community mental health teams help people with complex mental health conditions such as BPD. However, some teams may only focus on those with psychotic disorders. In other areas, there are complex needs services that maybe better placed to help you.
Your assessment will most likely be carried out by a specialist in personality disorders, usually a psychologist or a psychiatrist. The assessment uses internationally recognised criteria to diagnose BPD and a diagnosis can usually be made fairly quickly depending on the answers given.
Once diagnosed with BPD it is highly recommended that you tell close family, friends, and people you trust about your diagnosis. There are several reasons for this. Lots of the symptoms of BPD affect your relationships with people close to you, so involving them in your treatment may make them aware of your condition and help make your treatment more effective.
Your family and friends can also remain alert for any behaviour that may indicate you’re about to or are having a crisis. They may also be able to benefit from local support groups and other services for people in a relationship with a person with BPD. At Teenage Mental Health we run a fortnightly parental support group for anyone who needs support during a time they might feel alone and unsupported.