Borderline personality

About the Condition

Borderline personality disorder is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes a pattern of unstable intense relationships, distorted self-image, extreme emotions and impulsiveness. With borderline personality disorder, you have an intense fear of abandonment or instability, and you may have difficulty tolerating being alone. Yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though you want to have loving and lasting relationships. Borderline personality disorder usually begins by early adulthood. The condition seems to be worse in young adulthood and may gradually get better with age. If you have borderline personality disorder, don’t get discouraged. Many people with this disorder get better over time with treatment and can learn to live satisfying lives. Borderline personality disorder affects how you feel about yourself, how you relate to others and how you behave. Signs and symptoms may include:

  • An intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
  • A pattern of unstable intense relationships, such as idealizing someone one moment and then suddenly believing the person doesn’t care enough or is cruel
  • Rapid changes in self-identity and self-image that include shifting goals and values, and seeing yourself as bad or as if you don’t exist at all
  • Periods of stress-related paranoia and loss of contact with reality, lasting from a few minutes to a few hours
  • Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship
  • Suicidal threats or behavior or self-injury, often in response to fear of separation or rejection
  • Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety
  • Ongoing feelings of emptiness
  • Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights

Some factors related to personality development can increase the risk of developing borderline personality disorder. These include:

  • Hereditary predisposition.You may be at a higher risk if a close relative — your mother, father, brother or sister — has the same or a similar disorder.
  • Stressful childhood.Many people with the disorder report being sexually or physically abused or neglected during childhood. Some people have lost or were separated from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health issues. Others have been exposed to hostile conflict and unstable family relationships.
  • Personality.Personality traits that include impulsiveness and aggression may play a role in the development of borderline personality disorder.

About the Author

Claire is 37 years old, based near London with a diagnosis of BPD with a long history of self-harming, suicide attempts, alcoholism and eating disorders; all as a way of managing the intense emotions rising out of difficulties handling life with the condition. She feels the normal stresses and strains of adult life so powerfully she often feels raw and unable to cope in a mature manner and resorts to these destructive coping mechanisms to numb the pain. Currently on three medications for the disorder, including antidepressants and mood stabilisers, she is trying to hold down three voluntary jobs and work out what to do when she grows up. She has previously had Compassion Focussed Therapy (CFT) and Cognitive Behavioural Therapy (CBT), three inpatient stays and is hoping to start Dialectical Behavioural Therapy in the near future.

She  speaks four European languages and loves animals & classical ballet, has an MA in Translation and a background of technical support work in the suburbs and The City, which she has been forced to leave due to work stress and anxiety. She has suffered extreme low mood and low self-esteem since her teens, despite minimal trauma in her life growing up. She lives with her beautiful black and white moggie and is working hard to forge a life out the other side of BPD.

Questions and Answers

Borderline

Can a BPD person be avoidant of life first and foremost, to avoid BPD traits being triggred?

Many people with BPD can identify triggers that make them feel and act worse; memories of traumatic events, anxiety about social situations, exposure to drugs or alcohol, perceived episodes of abandonment or rejection or criticism from loved ones are just some common triggers. Extreme emotional reactions, addictive behaviours or impulse control could be visible symptoms or a new path of rumination could be triggered, starting a downward spiral.

It can be very tempting for loved ones and even therapists to suggest avoiding these things entirely but, how realistic is that? These things occur all the time in everyday life and you would end up shutting yourself away from the world, with loneliness possibly exacerbating the illness. This is not uncommon at all in people with BPD but there are other ways. Resorting to life of enforced agoraphobia is not the way to go.

Therapy can suggest several way to handle feelings that arise and impulse control\handling cravings. Acknowledging the thoughts and feelings and allowing them to ebb and flow without acting on them, nor judging them is commonly recommended, for example.

There may be times in your life when you are embarking on a new course of therapy or work and you may feel particularly raw and vulnerable so it would be advisable to minimise triggers but it is not sustainable to live your life this way. Telling friends and family how you are feeling is advisable so they can be more supportive during this time but you do need to find ways to manage in the long term. DBT provides many tools to get through life and is highly recommended for sufferers of BPD.

CLW

Can a BPD person be extremely private and go to great pains to hide her/his true emotions to avoid being exposed, vulnerable or obliterated?

In oh so many ways! I might even go so far as to say that this is at the root of many of the typical BPD symptoms. The majority, but not all, of BPD sufferers have been abused in some way. Many of those will have kept this secret hidden for many years. Maybe it was the most awful situation of a parent sneaking into their room at night, blaming themselves, calling themselves dirty, not daring to share with a sibling or friend because of the repercussions. Maybe it was something more banal like being teased at school and being determined not to show the bullies you were upset in case it got worse. These will have lead the person in question to bottle up fears, anger, tears and pain. Sometimes relief can be found in damaging behaviours like self-harming… Somehow seeing and feeling physical pain is a release and it is much easier to handle something tangible. Other risky behaviours like unsafe sex, shoplifting or speeding can a release in the same way and are mostly unpremeditated; low self-esteem and reduced respect for their own life are common.

What starts off in childhood or adolescence becomes the standard way to handle emotions. Although people with BPD are often very emotional, these emotions are often internalised so much that it is impossible to even know what they are. I used to cut pretty much every day because I felt like there was a knot inside me and that’s the only way I could release it. I know realise that it was anxiety over exams, problems with friends, parental relationship breakdown, bullying etc. – generalised anxiety really – but no one ever saw me cry! That’s just me, other people are different but please be aware…

Being deeply empathetic, they may also go out of their way to help other people, always being the “shoulder to cry on” and not wanting to let anyone down. Feeling that other people’s issues are way more important\more serious than mine was a common thought I had (and still do). I found my parent’s break up extremely difficult but felt I couldn’t allow myself to be upset about it because my best friend’s dad died. That is serious but it doesn’t mean I wasn’t entitled to be upset too.

Sometimes “least said, soonest mended” really is the wrong way forward as the pain will resurface in another way. The people who don’t talk about their pain may be feeling it more deeply than anyone you know.

CLW

Can BPD make me avoid confrontation because a non-approving interaction would be too devastating?

My instinctive reaction to this is, yes. Very much so. Many people without BPD find confrontation awkward but someone with the disorder is more likely to exercise extreme behaviour to avoid the risk of loss. Abandonment issues can be very strong for the sufferer. Imagine I have an issue with my partner; it could be something small like not liking the way he leaves the lid off my shower gel (I’m actually using a personal example here) or it could be something more serious like feeling that he puts his friends before me or I could be suspecting him of cheating. The thing is, my fear of an explosive argument makes the severity of the issue irrelevant. I am worried that he will be upset at me raising the issue, no matter how tactfully it is done and that we will have a big row. I therefore sweep the issue under the carpet, smile and say there is nothing wrong and get on with having a nice evening together. My feelings and worries become irrelevant because I put them down. I project my feelings onto him (imagining how I would feel if he confronted me about the same issue) and decide that our happiness together (and particularly his happiness) are more important than my own.

By not trusting him with the small things, a feeling of resentment builds up and it is quite likely that my suppressed feelings will suddenly burst out and I will “have a go at him” about an accumulation of small things. It will be difficult to explain that the issue all started a while back about something unrelated and will likely escalate out of control. All my original fears of losing him will suddenly become real and I will panic and cling on, trying desperately to undo what I have said. This all stems out of a fear of abandonment; I don’t want him to leave.

Naturally, similar situations can happen with other personal relationships, perhaps family or at work. It is better to address the small issues before they escalate. If something like this happens in a work scenario, it will be harder to undo and will subsequently be a blow to my, already fragile, self-esteem.

Not everyone with BPD will react the same and many people have different issues with anger but this is my personal experience. Avoidance is a very real thing for me.

CLW

Can BPD make me feel like one is ‘not allowed’ to go, say, outside or to a public event or certain places? OR that if one goes somewhere, one is ‘ruining’ everything by doing so?

This is a difficult one. I can only speak for myself and the huge anxiety that I feel when I encounter other people. There’s a meme I love that says “I love routine, until I’m bored, then I love excitement, until I’m overwhelmed then I love routine”. That sums up how I feel every day.

The feelings rotate very quickly. That is a very typical characteristic of BPD and is even why many people, myself included, can be diagnosed with bipolar as well as BPD. I miss my friends but as soon as I see them, I want to be at home with my duvet.  I can’t cope with being alone and I can’t handle being with people.

Parties where I “sort of” know people are the worst. You know the type – you’ve met everyone in the room at least once before, can’t remember where thay work, if they’re married, what they like to do… The idea of making small talk with lots of people and trying to make a good impression is way worse than the dentist or a job interview. This has been particularly exacerbated recently as my career has gone down the drain, I have gotten divorced, moved in with my father and feel like I have nothing interesting to contribute, while all of my friends are at their best, with children and husbands and successful careers. I makes me retreat further into myself and batters my self-esteem further still. Yet people who meet me for the first time say I’m gregarious… Guess I just put on my mask well.

The strange thing is that I can operate when I have a “script”. I delivered a presentation to the board of directors of The Bank of New York without a meltdown, when I was 18! Without an issue. How on earth?!? It’s friends and family that make me nervous.  Strangers are fine. Different people have different triggers.

CLW

Can BPD make me feel like one is constantly ‘in trouble’?

Unfortunately, one of the symptoms of BPD is impulsive behaviour. Personally, I am the cleanest cut person you could ever meet (I never handed my homework in late, I am pedantic about grammar etc.) but I get totally random thoughts to suddenly do things that aren’t me at all. They seem to come out of nowhere! I can’t tell you more here but, needless to say, I am a trustworthy person whose impulses have led to me having a criminal record.

There is a second side to this and that is the concept of constantly feeling like you have done something wrong; a perpetual “guilty conscience” if you will. One of my most dreaded phrases is “We need to talk”. No matter how impeccably I have been behaving, when I have done everything I said I would, my home is tidy, my work is up-to-date, my loved ones cared for, there is still that nagging feeling that I have said or done the wrong thing.

I am also very bad at ruminating and was even prescribed mood-stabilisers “off label” to calm my constantly racing thoughts. One silly comment I make can haunt me for days and I still beat myself up over the slightest little remark or thing I did, even back to my childhood. There is nothing we can do to change the past other than focusing on doing the right thing in the present and trying hard to let go of these mistakes. For the most part, they are things that other people can objectively say “I doubt they even noticed” but I know that the tone of voice etc. is very important to me. The other day, I asked a friend to remove a Facebook post of mine that he had publicly shared because I didn’t want a potential employer to stumble across it. I knew that I would have been more than a little upset that I had to be told if this had been the other way around so I was extreme in my apologies and reassurances to him. I doubt he even thought twice about it!

This side of my BPD has frequently led me to “self-medicate” in the past, turning to a drink just to shut off the thoughts inside my head. With prescribed medication and therapy there are techniques to improving this and that is important to know. It’s not as simple as just “stopping thinking about it” but it can be achieved. There is hope.

CLW

Can BPD make me need and want people to acknowledge one in public while simultaneously being terrified one will be judged or attacked?

Again I speak from personal experience when I say, most definitely.

Throughout my life I have been a high achiever. Straight A student through school, got into my first choice university, studied hard got a good bachelor’s degree and then master’s. Got promoted rapidly at work, always striving to be the best at everything I do. I also did all sorts of extra-curricular activities, ballet, horse riding, swimming and received good marks in my exams. I was also bullied because I spoke up in class, was teacher’s pet. Rushed home to vacuum the house, scrub the floors, feed the cats, walk the dog before my parents got home and shut myself away in my room crying and cutting my arms on a daily basis while struggling to control my eating so that I was anorexic. I couldn’t accept failure in anything. Finally my inability to switch off after work lead to me increasing my alcohol consumption from the odd glass of wine with my husband to a bottle a night, just so I could get my mind to stop racing and get some sleep. I started to lose jobs, my marriage fell apart. I felt like the perfect world I had created for myself came tumbling down around me.

All of these were coping mechanisms. I couldn’t handle the occasional “B” grade. It made me a failure. Losing jobs even more so.

I had friends as a teenager who couldn’t stand up in front of class for fear of being ridiculed but I just got on and did it anyway, wracked with nerves but never showing it. I had a job aged 17 years old, presenting a new telecoms system to the board of directors of the Bank of New York. Real fear inducing stuff but I had to do it. My ego wouldn’t let me fail. I was a complete paradox in every way.

My parents never pushed me at school, it was me who put unrealistic expectations on myself and, naturally, I couldn’t always achieve 100% at everything. The more you try to do, they more likely it is there will be something you are unable to. I still tend to take the approach that something is worth doing properly or not doing at all. I hated P.E and accepted I would fail but, if something mattered to me, it was 100% or nothing.

I seek out friends who appreciate my skills, I crave being told I am good at things, kind, intelligent. I still have an inner mantra of “fat, stupid, ugly”. Not being appreciated still cuts like a knife but it does get easier the better you understand yourself, and your illness. Meds can help but there is this self-aggrandizing nature to BPD that you need to work through in therapy. Time is the key.

CLW

Can BPD make one feel like communicating with others is like breathing?

Communicating with others is fundamental to living as humans in the modern world. Yes, we can shut ourselves away and isolate, but this is a generally unhealthy thing to do and cannot be sustained for protracted periods without aggravating the illness. Because communicating is so vital, isolation can feel like the easy solution to prevent the rollercoaster ride of emotions that follows from, even basic interactions. This unfortunately over aggrandises social anxiety. All the feelings and emotions of being a human are generally amplified in BPD and one needs to start with baby steps, small trips out or phone calls to break the isolation. Please seek therapy if you cannot confront the world; no one is expecting you to tackle world peace in early recovery but,  eventually, contact with friends, family and strangers will become easier and revert to something like that child-like breathing we experienced once again.

CLW

Can BPD make one feel like one can only think of oneself due to constant emotional torment?

Being called selfish is the worst insult I have ever had levied at me. I consider myself empathetic and go out of my way to be kind, polite and make thoughtful gestures wherever I can.  I am also very concerned about whether I have unintentionally upset someone. My words as well as my actions can be impulsive. Many, many times a day, I say something and then chastise myself severely for the fact that it may have come out the wrong way and someone I love (or a stranger!) could have been hurt by my words or consider me thoughtless. In analysing this, I will often ask my friends and family if the thought I had offended said person. The answer is almost always “no” but is often followed with “I doubt he even noticed, the world doesn’t revolve around you, you know”. I know it doesn’t but I reflect excessively on my impact on the world and the people in it.

Furthermore, I should add, the majority of people with BPD are very empathetic. They feel other people’s pain deeply because they know what it feels like themselves. Unfortunately this often rebounds on them and they can be seen as selfish. Can you imagine going through life trying not to upset anyone – ever?

Here is where it backfires. Unfortunately, lying is common among people with BPD but, mostly, it is because they don’t want to hurt anyone, and (I hate to say it) deal with the repercussions. Learning to express oneself is an important of CBT and DBT and therapy can really help to improve things. A patient with BPD hates themselves enough, please don’t bring them up on every little lie: We feel it in the bottom of our heart and hate ourselves already. Your understanding of why we might do it can go a very long way and potentially reduce such situations in the future.

CLW

Can BPD make you have ‘approval addiction’?

Addiction of any kind is very common with BPD and can range from the obvious alcohol and drug issues to addiction to certain behaviours that release endorphins. Sex, self-harm, love, approval… there are many types of addiction.

Approval is actually very specific however and ties in closely with fear of abandonment. When feeling overwhelmed with worry about being left (by a partner, a group of friends or even in a work setting), someone with BPD will really go the extra mile to prevent this from happening. This can even be so far as to lie that what was said was never intended, saying anything in a panic. Self-harming behaviour has been known to be used as a threat by some individuals. I hate to include this because it does feed into the stigma but is not unheard of.

When the feared abandonment does not come to pass, the warm, fuzzy endorphin rush can be a real high. The sufferer is overwhelmed with love and feels wanted and needed. I will confess to having said to a (now ex) partner that I wanted to end the relationship; at the time, I was 100% sincere but as soon as I saw his tears, I knew that was the wrong decision and I just wanted to make it better. This sort of behaviour can often occur if the sufferer is feeling unwanted or neglected and is rarely a conscious choice they would make if their mind were not clouded with overactive thoughts.

When I was at my absolute lowest weight, in the midst of anorexia, I couldn’t’ believe a word anyone said about my weight but it still soothed me a little to hear phrases like “you look like a Belsen victim”. These were not compliments but were what I needed to hear at that time.

This all paints a confusing mixture of messages but I would say “approval addiction” is a very real phenomenon. These things are hard to say out loud (or to a keyboard). I can only speak for myself with any certainty but I know that to hurt others, is the thing that hurts me most in the world. Being genuinely loved a cherished is a feeling I want time and time again. Self-validation rather than seeking it from others is far healthier, but, if you have someone with BPD you care about, don’t forget to let them know from time to time. Those words will mean more to them than anything else in the world.

CLW

Can BPD make you look up to or even parentify others and think that others know ‘how the world really is’? Without splitting?

Splitting is a term that describes difficulty with the ability to hold opposing thoughts, feelings, or beliefs about oneself or others. In other words, positive and negative attributes of a person or event are not joined together into a cohesive set of beliefs. It’s both a distorted way of thinking and a coping mechanism used to keep yourself from feeling hurt or rejected. It is one of the nine diagnostic criteria used to diagnose BPD and is very common indeed. Understanding that good people sometime do bad things is key to making progress in handling this destructive thought process.

There is nothing wrong with admiring someone (and we all do it, be they Kate Moss or our friends) but for people with BPD this can easily become a slippery slope. This is something that will be looked at during Dialectical Behavioural Therapy (and possibly other therapies, this is the gold standard but by no means the only therapy out there) and is something that will require hard work in your own time.

Certain words can alert you to the fact that you are beginning to view someone (or something) in this way and you should be mindful of applying them to people. Unfortunately, the higher the pedestal you put someone on, the further they have to fall and hurt you in the process!

  • Always
  • Never
  • Impossible
  • Awful
  • Perfect
  • Ruined
  • Terrible

If you find yourself looking at friends or family in these terms, it is time to take a step back. Speak to your therapist, practise some mindfulness (I find ballet, long walks and colouring very helpful) and try to take a more balanced view of the situation. It is possible to retain these kind of relationships but even parents make mistakes and we still love them! Try to remember that and be ready to work hard on your relationships… Often it will feel like you’re doing all the work, but most people are getting through this difficult world as best they can, and you are the only one who can change you.

CLW

How is borderline personality disorder diagnosed?

Unfortunately, borderline personality disorder is often underdiagnosed or misdiagnosed.

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect borderline personality disorder based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with borderline personality disorder, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional’s attention.

No single test can diagnose borderline personality disorder. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with borderline personality disorder showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe borderline personality disorder showed a more intense emotional response than people who had less severe borderline personality disorder.