Borderline personality disorder (BPD) is characterised by a person’s difficulty managing their emotions and impulses, relating to people and maintaining a stable self-image. BPD can be highly distressing for the person affected, and often for their family and friends too. There is a common misconception that BPD is a rare, untreatable condition. In fact, borderline personality disorder is a common and treatable mental illness and the prevalence may be as high as 5.9% of the population.
Diagnosis of BPD is likely if 5 or more of the following 9 criteria are apparent over time:
- Frantic efforts to avoid being abandoned by other people (even if they are only imagining that other people are abandoning them);
- Repeatedly having intense and unstable relationships with other people (such as intensely disliking someone that they previously idealised);
- Identity disturbance. Being very unsure of who they are and what to think about themselves;
- Acting impulsively in ways that could be very risky (such as spending money, risky sexual behaviour, substance abuse, reckless driving or binge eating);
- Repeatedly harming themselves or threatening to commit suicide;
- Affective instability. Experiencing intense emotional ‘lows’, irritability or anxiety for a few hours or days at a time;
- Chronic feelings of emptiness;
- Experiencing unusually intense anger or difficulty controlling anger;
- Transient, stress-related paranoid thoughts or experiencing strange feelings of being detached from their own emotional or physical situation.
BPD is diagnosedprimarily in females (75%). Typical onset of symptoms usually occurs in early adolescence or early adulthood. While BPD’s causes are not yet fully understood, it is likely to be a combination of biological and life factors. Up to 85% of people with BPD also suffer from another mental illness, most commonly Dysthymia (70%), Major Depressive Disorder (50-60%), and substance abuse (35%).
Small setbacks can trigger big emotions. Someone with BPD may not have the right skills to recognise state and self-soothe to support emotional de-escalation. Common misconceptions of BPD are that the behaviours are ‘attention seeking’ or manipulative, or that BPD sufferers do not really want to get help, which can be harmful and invalidate their emotional experience.
BPD is a polarised disorder and psychological therapies are considered the most effective treatment option. Specifically, Dialectical Behaviour Therapy (DBT), a modified version of Cognitive Behaviour Therapy (CBT), has been designed to treat borderline personality disorder, as well as a range of other behaviours including suicidal and self-harm behaviours, substance use, depression and eating disorders.
DBT is structured therapy that is designed to assist people to balance opposing views and decrease presenting symptoms. Individuals obtaining DBT therapy for BPD or other mental health issues should expect a very structured approach to psychological interventions. DBT therapy is not a short-term (< 10 sessions) intervention and will require commitment for long-term skills practice and application in everyday life.
A strong treatment alliance and sense of trust held between the therapist and the client is crucial to realise treatment outcomes. Arguably, this stands true for the treatment of all mental illness. DBT therapy will support with distress tolerance, emotional regulation, interpersonal effectiveness and mindfulness skills to enable a person to move away from a chaotic life towards one that they would find more personally meaningful, balanced and fulfilling.
Written by Kasia Gordon of Cause Effect Psychology
Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK. Lindenboim N. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006; 63: 757–766.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Clinical Practice Guideline for the Management of Borderline Personality Disorder (NHMRC 2012)