Borderline Personality Disorder (BPD)

YouTube video courtesy of interviewer Anthony Padilla

  • About BPD

    BPD is a serious and misunderstood disorder that manifests differently in each person. It’s the most common personality disorder. It’s like being born without an emotional skin; no barrier to ward off real or perceived emotional assaults.

    People with BPD have difficulty regulating or handling their emotions or controlling their impulses and often have an intense fear of being abandoned. This combination of lack of emotional regulation and need for stable relationships can lead to trouble with maintaining healthy relationships, a positive self-image, and can lead to unpredictable behaviour, self-harm, and suicidal thoughts and/or actions.1 They are highly sensitive to what is going on around them and can react with intense emotions to small changes in their environment.

    Onset is said to be in adolescence and early adulthood and may improve with age.2

    The severity and the specific combinations of BPD symptoms may differ from person to person and may fluctuate over time. Common symptoms 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

    What causes BPD?

    As with other mental health disorders, the cause of BPD is not fully understood. Current understanding is that a person’s genetic inheritance, biology and environmental experiences all contribute to the development of the disorder.

    Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly. Some factors related to personality development can increase the risk of developing borderline personality disorder.

    Many people with the disorder report experiencing abandonment or loss of a parent in childhood, being sexually or physically abused, or being an emotionally sensitive child in an invalidating environment (exposed to hostile conflict and unstable family relationships).

    How can I support a family member or friend with BPD?

    Validate their experience and listen without judgment. Support their efforts to seek professional help, and educate yourself about BPD.

    What is Emotional Dysregulation?

    Emotional Dysregulation is the inability of a person to control or regulate their emotional responses resulting in reactions that are unconventionally accepted. Their reactions may be perceived as inappropriate for the circumstance.

    Emotional Dysregulation is a symptom of several mental illnesses, including BPD.

    1, 2 Mayo Clinic. Borderline Personality Disorder. 2020. Mayo Clinic.
  • Diagnosing BPD

    How can I tell if I or someone I care about has BPD?

    Only a licensed health care professional such as a psychiatrist, psychologist or clinical social worker experienced in diagnosing and treating mental disorders can diagnose emotional dysregulation disorder thorough interview and discussion about symptoms.

    Co-Occurring Disorders

    Borderline personality disorder affects 6% of the U.S. population (~14 million Americans; 50% more people than Alzheimer’s disease and as many as Bipolar and Schizophrenia combined (2.25%)). Borderline personality disorder often occurs with other illnesses. This is called co-morbidity or having co-occurring disorders. This can make it hard to diagnose, especially if symptoms of other illnesses overlap with the BPD symptoms.

    According to the largest national study done to date of mental disorders in U.S. adults—about 85% of people with BPD also suffer from another mental illness. Over half the BPD population also suffers from Major Depressive Disorder. When depression and BPD co-occur, the depression often does not lift (even with medication), until the borderline personality disorder symptoms improve.

    Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, substance abuse, or eating disorders. In men, BPD is more likely to accompany disorders such as substance abuse or antisocial personality disorder.

    In addition, one may have other mental health disorders, such as those listed below including the estimated percent of people with BPD who have them:

    • Major Depressive Disorder – 60%
    • Dysthymia (a chronic type of depression) – 70%
    • Substance abuse – 35%
    • Eating disorders (such as anorexia, bulimia, binge eating) – 25%
    • Bipolar disorder – 15%
    • Antisocial Personality Disorder – 25%
    • Narcissistic Personality Disorder – 25%
    • Self-Injury – 55%-85%
    • Other personality disorders, incl. PTSD, ADHD
  • BPD Stigma

    What Does “Borderline Personality Disorder” Mean?

    Historically, the term “borderline” has been the subject of much debate. BPD used to be considered on the “borderline” between psychosis and neurosis. The name stuck, even though it doesn’t describe the condition very well and, in fact, may be more harmful than helpful.

    The term “borderline” also has a history of misuse and prejudice—BPD is a clinical diagnosis, not a judgment. Current ideas about the condition focus on ongoing patterns of difficulty with self-regulation (the ability to soothe oneself in times of stress) and trouble with emotions, thinking, behaviors, relationships and self-image. Some people refer to BPD as “Emotion Disregulation.”

    Within the Health Care Community there is reluctance around labeling an adolescent with emerging BPD traits. This limits the introduction of coping skills and intervention to alleviate early symptoms. Eventually unaddressed symptoms may escalate requiring crisis intervention, and that treatment may not necessarily be effective or foster hope.

    Some therapists are reluctant to treat people with BPD because they are seen as being resistant to treatment and because of their emotionally demanding behaviour. Their tumultuous relationships, mood swings and suicidal gestures can provoke anger and frustration in the therapist. The limited number of subject matter experts also experience high level of burnout.

    Advocacy groups have also identified lack of funding for research on BPD, and exclusion of BPD from research studies. In the US $300 million a year is raised for Schizophrenia research vs. $5 million raised for BPD

    The result is limited skilled professionals trained in Dialectical Behavioral Therapy (DBT). The most effective known treatment for BPD. To those impacted and their loved ones:

    • Formal and informal policies of programs excludes many stepping forward for help
    • Increased wait times for treatment
    • Loss of hope, as the condition worsens and therapy seems out of reach
    • Experimentation with various drugs and drug combinations, negatively impacts quality of life
    • Many impacted by the disorder give up on the system and may choose to self medicate as a means of coping

    Within the community at large negative and blaming attitudes toward those with substance use and mental health challenges (concurrent disorders) are often internalized, leading to lower self-confidence and reluctance to seek and receive appropriate help.

    Made to feel that they will never be accepted in society; shame, as well as prejudice and discrimination when seeking support, health care, housing, employment or other services often leads to social isolation, poverty, depression, and loss of hope for recovery.

    • There may be difficulty finding the services needed because the counseling is not available in their language.
    • Newcomers to Canada may experience greater stigma because of their culture and what is considered acceptable within that culture. Sometimes even asking for help can be difficult for someone whose culture does not encourage counseling or outside help.
    • Given the cause of BPD discussed earlier, many may be reluctant to seek help knowing the cause of the problem may be attributed to tribe or community members that they may still have a sense of obligation to engage with or are reliant on for support and/or identity; and they may be further rejected for living their truth.
  • There is Hope

    Are There Treatments For BPD?

    We encourage you to always consult with a healthcare professional as to what the best treatment is for you.

    Officially recognized in 1980 by the psychiatric community, BPD is more than two decades behind in research, treatment options, and family psycho-education compared to other major psychiatric disorders.

    BPD has historically been met with widespread misunderstanding and blatant stigma... However, evidenced-based treatments have emerged bringing hope to those diagnosed with the disorder and their loved ones.

    • Dialectical behavior therapy (DBT) focuses on the concept of mindfulness, or paying attention to the present emotion. DBT is the most studied treatment for BPD and the one shown to be most effective. 1 in 5 seek help, 4 of 5 benefit from treatment.
    • Under stress, some symptoms may come back. When this happens, people with BPD should return to therapy and other kinds of support.

    What types of treatments are available in Ontario?

    Usually treatment for BPD involves:

    • Education with discussions on what is known about BPD and its causes, what kinds of treatments are available, how to self-manage BPD and how to prevent relapse.
    • Specialized therapy such as Dialectical Behaviour Therapy (DBT).
    • Prescription medication.

    Coping and support

    Symptoms associated with borderline personality disorder can be stressful and challenging for you and those around you. You may be aware that your emotions, thoughts and behaviors are self-destructive or damaging, yet you feel unable to manage them.

    In addition to getting professional treatment, you can help manage and cope with your condition if you:

    • Don't blame yourself for the disorder, but recognize your responsibility to get it treated
    • Learn about the disorder so that you understand its causes and treatments
    • Consider involving people close to you in your treatment to help them understand and support you
    • Build a support system of people who can understand and respect you
    • Learn to recognize what may trigger angry outbursts or impulsive behavior. Work with your mental health provider to develop a plan for what to do the next time a crisis occurs
    • Reach out to others with the disorder to share insights and experiences
    • Keep up a healthy lifestyle, such as eating a healthy diet, being physically active and engaging in social activities
    • Manage intense emotions by practicing coping skills, such as the use of breathing techniques and mindfulness meditation
    • Set limits and boundaries for yourself and others by learning how to appropriately express emotions in a manner that doesn't push others away or trigger abandonment or instability
    • Seek professional help and stick to your treatment plan — attend all therapy sessions and take medications as directed

    Preparing for your appointment

    You may start by seeing your primary care doctor. After an initial appointment, your doctor may refer you to a mental health provider, such as a psychologist or psychiatrist. Here's some information to help you prepare for your appointment.

    What you can do

    Before your appointment, make a list of:

    • Any symptoms you or people close to you have noticed, and for how long
    • Key personal information, including traumatic events in your past and any current major stressors
    • Your medical information, including other physical or mental health conditions
    • All medications you take, including prescription and over-the-counter medications, vitamins and other supplements, and the doses
    • Questions you want to ask your doctor so that you can make the most of your appointment

    Take a family member or friend along, if possible. Someone who has known you for a long time may be able to share important information with the doctor or mental health provider, with your permission.

    Basic questions to ask your doctor or a mental health provider include:

    • What's likely causing my symptoms or condition?
    • Are there any other possible causes?
    • What treatments are most likely to be effective for me?
    • How much can I expect my symptoms to improve with treatment?
    • How often will I need therapy sessions and for how long?
    • Are there medications that can help?
    • What are the possible side effects of the medication you may prescribe?
    • Do I need to take any precautions or follow any restrictions?
    • I have these other health conditions. How can I best manage them together?
    • How can my family or close friends help me in my treatment?
    • Do you have any printed material that I can take? What websites do you recommend?

    Don't hesitate to ask questions during your appointment.

    What to expect from your doctor

    A doctor or mental health provider is likely to ask you a number of questions. Be ready to answer them to save time for topics you want to focus on. Possible questions include:

    • What are your symptoms? When did you first notice them?
    • How are these symptoms affecting your life, including your personal relationships and work?
    • How often during the course of a normal day do you experience a mood swing?
    • How often have you felt betrayed, victimized or abandoned? Why do you think that happened?
    • How well do you manage anger?
    • How well do you manage being alone?
    • How would you describe your sense of self-worth?
    • Have you ever felt you were bad, or even evil?
    • Have you had any problems with self-destructive or risky behavior?
    • Have you ever thought of or tried to harm yourself or attempted suicide?
    • Do you use alcohol or recreational drugs or misuse prescription drugs? If so, how often?
    • How would you describe your childhood, including your relationship with your parents or caregivers?
    • Were you physically or sexually abused or were you neglected as a child?
    • Have any of your close relatives or caregivers been diagnosed with a mental health problem, such as a personality disorder?
    • Have you been treated for any other mental health problems? If yes, what diagnoses were made, and what treatments were most effective?
    • Are you currently being treated for any other medical conditions?
YouTube video courtesy of
YouTube video courtesy of

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