Borderline personality disorder

The causes of BPD and how a person develops the condition are not yet clear. People who have close family members (parents or siblings) with BPD are at significantly greater risk of developing the condition. Other biological factors as well as early social experiences - especially trauma in early life, such as neglect, abuse, domestic violence and poverty - are likely to be involved.

Signs and symptoms

One of the challenges of diagnosing BPD is that most people can occasionally display some of the behaviors described as symptoms of BPD. However, in someone with BPD these behaviors occur much more frequently and severely, and generally in a recurring pattern. Relating to other people and the world can be difficult and this can have a disruptive effect on many aspects of their life, particularly relationships.

People with BPD tend to:

• Form intense but unstable relationships, in which they may alternate between idealizing and devaluing the other person;
• Make desperate attempts to avoid abandonment by other people;
• Have an unstable sense of self;
• Be impulsive in ways that can cause themselves damage or distress (such as substance abuse and difficulty controlling spending or sexual activity);
• Experience persistent feelings of emptiness;
• Have very intense but changeable moods;
• Experience intense or inappropriate anger and have difficulty controlling it;
• Feel paranoid or, alternatively, detached from themselves and their situation, and;
• Be more likely to threaten to, or commit, acts of self-harm, including suicide.

Symptoms of BPD tend to arise in early adolescence; younger children are generally not diagnosed with the condition.

A borderline personality disorder can cause feelings of instability, anger and impulsiveness. 

Methods for diagnosis

Assessment and diagnosis of BPD can be complex and will generally be performed by an experienced mental health professional, such as a psychiatrist. A general practitioner may make an initial assessment and provide treatment, assistance or referral for any urgent issues that may be related to BPD, such as self-harm.

A full medical assessment helps to determine whether there are any underlying medical conditions that may be contributing to a person's symptoms. Their specialist will ask them about their symptoms.

Family members, a partner or carer can be involved in the assessment and in developing a treatment plan. It can be helpful for them to understand BPD and to learn how best to handle it.

Types of treatment

While there is no cure for BPD, the goal of treatment is to reduce symptoms and behaviors that are distressing, as well as learning how to better manage them.

A combination of approaches, including psychological therapy, various forms of support and, in some cases, medication, have been shown to be the most effective way to treat BPD.

Managing BPD may include treating other mental health conditions and dealing with other issues that may also be causing problems, which can involve a range of healthcare and other professionals.

Psychological therapies

Psychological therapy is sometimes referred to as 'talking therapy' and describes the process of treating a mental illness by helping a person to understand their condition and manage their symptoms.

A wide range of psychological therapies have been shown to be effective for treating BPD. They include cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPP) and dialectical behavioral therapy (DBT).

Some of the ways psychological therapies can help a person deal with BPD include:

• Developing more effective ways of relating to other people;
• Learning to better handle emotions and situations that provoke intense reactions;
• Improving coping and problem-solving skills and strategies;
• Reducing and better managing anger, and;
• Learning to better control impulsive behavior.

A mental-health professional can discuss available therapy options and which ones may be most suitable for a person's needs.

Psychological therapy can help with a borderline personality disorder by providing ways of managing its symptoms. 

Support

Because BPD can affect many aspects of a person's life, including education, work, living arrangements and social life, community support programs can be helpful. BPD support groups can help someone with BPD to connect to other people who have been through similar experiences.

Medications

There are no medications that are recommended specifically for the treatment of BPD. In some cases, medications may be helpful to manage symptoms such as depression and anxiety that may also be problems for people with BPD. A mental health professional can advise which medications may be suitable.

Family education and support

Understanding BPD and how best to manage it can be very helpful for family members, partners, carers and friends of people with BPD. Counselling, information and support are available.

Potential complications

BPD can be very disruptive and distressing for some people and affect many aspects of their lives.

Self-harm and suicide

Self-harm and suicide are more common among people with BPD. Self-harm can be any behavior that is done to deliberately cause injury or harm to oneself. If there is any danger of self-harm or suicide, getting help quickly is important and can help to save lives.

In situations where there is immediate danger of suicide, call 911 for help.

Other ways of finding help for someone include:

• Making an appointment for them with their doctor;
• Taking them to the emergency department of the local hospital;
• Calling a mental health helpline (see 'Support services' below for numbers), and;
• Calling mental health professionals, counsellors or caseworkers who already provide care for the person who is thinking about self-harm or suicide.

Other mental health disorders

A range of other mental health disorders can also commonly occur with BPD.

These can include:

• Depression;
• Anxiety;
• Eating disorders, particularly bulimia nervosa;
• Bipolar disorder;
• Substance abuse;
• Attention deficit hyperactivity disorder (ADHD), and;
• Post-traumatic stress disorder (PTSD).

Prognosis

Symptoms of BPD are often at their worst in the early adult years. It is usually in this period that the risk of suicide is at its highest.

Fortunately, symptoms do tend to reduce for most people with BPD as they get older. Most people in their 30s and 40s find that their symptoms are less disruptive and they are better able to handle relationships.

Prevention

No effective methods of prevention for BPD have yet been identified. However, psychological treatment and support for children who experience the following problems may help to prevent BPD:

• Trauma in early childhood;
• Difficulty emotionally bonding to their parents;
• Substance abuse problems, disruptive behaviors or depression, and;
• Self-harm.

Support services

If you or someone you know needs help, please call or visit:

National Suicide Prevention Lifeline. Website: Lifeline Call: 1-800-273-8255

We can all help prevent suicide. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.