What is Borderline Personality Disorder?

A quick summary about Borderline Personality Disorder, or BPD, one of the many personality trait-based DSM diagnoses. In this video I try to show some of the difficulties of living with BPD, as well as a bit about treatment of the condition.

Questions and corrections always welcome in the comments.

For those interested in the DSM classification, I've left out two diagnostic elements in this video - dissociation/paranoia, and suicidal/self harm behaviours.

What is Borderline Personality Disorder?

It’s estimated that one in a hundred people have borderline personality disorder, or BPD. In this video, we’ll talk about the challenges people with BPD face, the features that characterise the condition, and how people can recover from it.

People with BPD face issues such as
Feeling a desperate and urgent need to avoid being abandoned by other people - even if the abandonment is only imagined
Having intense and unstable relationships, repeatedly
Idealising people, then intensely disliking or devaluing them, in relatively short intervals
A chronic feeling of emptiness
Uncertainty of self - what psychiatrists call an ‘unstable self-image’
Repeatedly acting in impulsive and risky ways
Feeling rapid fluctuations in mood

To add to these challenges, BPD is currently under-recognised, and the availability of specific services is limited. The reason may include the social stigma of mental health conditions, or the challenges that health professionals face in treating BPD.

Think of these factors, then consider how that might affect a relationship between a health professional and a person with BPD.

If you know or have known someone with BPD, you might struggle to find empathy towards them. You might have good reason - they might have hurt you. It’s important not to blame the person in such situations. It’s not their fault, after all. So what is the cause of BPD? Well, it isn’t fully understood. Currently, a combination of biological factors and early-life experiences, such as trauma, is thought to contribute to the development of BPD.

Diagnosis
The psychiatrist’s manual of diagnosis - the DSM - encourages diagnosis of personality disorders based on the following:
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture, manifested in two (or more) of the following areas:
- cognition (i.e. ways of perceiving and interpreting self, other people, and events)
- affectivity (i.e. the range, intensity, lability, and appropriateness of emotional response)
- interpersonal functioning
- impulse control.
The pattern must be inflexible and pervasive, lead to clinically significant distress or impairment, be of long duration, with onset that can be traced back at least to adolescence or early adulthood.
Meanwhile, the possibility that these symptoms are part of another mental disorder, or caused by substance abuse must be ruled out.

In terms of BPD specifically, these elements will be characterised by a pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity.

It’s important to remember that diagnosis of BPD can be a double-edged sword. On the one hand, it can help people to identify their worrying behaviour, and work to improve their lives. On the other hand, it can expose the person to discrimination. A 2010 Australian Senate Committee on Mental health stated that “an end to marginalisation of the disorder within the community and the mental health sector, is urgently needed.”

Management
Many people with BPD will have the following treatment goals:
To regulate their emotional world
To find a sense of purpose in life
Development and maintenance of strong relationships

The best treatment results have been shown with Dialectical Behavioural Therapy. Dialectical means ‘concerned with opposing forces’, which here are “acceptance” and “change”. It involves working with a therapist to both accept the person as they are, and to appreciate the importance of change in recovery.

Given that a person with BPD experiences significant issues regarding real or perceived abandonment, and may also experience intense and uncontrollable mood swings - the challenge is considerable for treating health professionals, particularly if they are untrained in BPD. It is the responsibility of the health professional, however, to stay calm in difficult situations, as the maintenance of a strong therapeutic relationship is integral to positive treatment of BPD.