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Borderline personality disorder

What is Borderline Personality Disorder (BPD)?

Borderline Personality Disorder is a condition that affects a person’s thoughts, emotions and behaviour. It has this name because it used to be thought to be on the “borderline” between neurosis and psychosis, but it can also be called Emotionally Unstable Personality Disorder. We all have a mixture of personality characteristics, and sometimes these can be helpful and sometimes these can cause us problems – in Borderline Personality Disorder, the personality characteristics have an overall negative impact on the person’s life.

In some circumstances it can be diagnosed before the age of 18, though it is unlikely to be diagnosed in younger teenagers as the personality is still developing. It is more commonly diagnosed in females than males. When diagnosed in people younger than 18, it is sometimes described as emerging borderline personality disorder (EBPD).

How does Borderline Personality Disorder affect young people?

Young people with borderline personality disorder may describe many of the following:

  • feeling okay one moment and then feeling deeply despairing, angry, sad or anxious the next
  • emotions or moods that change very rapidly
  • feeling out of control of, or overwhelmed by, their emotions
  • self-harming in response to emotional pain, or when in crisis
  • feeling hopeless and burnt out, sometimes considering hurting themselves or others
  • being very sensitive to criticism and rejection and fearing people leaving them
  • feeling mistreated or misunderstood quite a lot of the time
  • periods of feeling numb or empty inside, or ‘cut off’ and disconnected from reality
  • problems with self-esteem, self-worth, or having little sense of who they are
  • feelings of guilt, shame and wanting to punish themselves at times
  • a tendency to act on impulse, putting themselves at risk of harm as a result
  • a tendency to get into very intense relationships, then experience problems in relationships such as control or abuse, or fear of rejection and abandonment
  • having very high standards and expectations of themselves and others
  • struggling to be assertive in a calm and effective manner, resulting in feelings exploding in outbursts or getting turned inwards in self-destructive behaviours
  • finding it difficult to ask for help or communicate distress effectively

Why do young people develop Borderline Personality Disorder?

It is not clear why some people develop Borderline Personality Disorder, but most research indicates it is likely to be a combination of genetic, psychological and social factors.

People who have Borderline Personality Disorder are more likely than most people to have had difficult or traumatic experiences in childhood and adolescence. These experiences might include:

  • Living with chronic fear or stress
  • Family instability, including parental mental health problems or substance misuse
  • Abuse
  • Neglect
  • Bereavement

How is Borderline Personality Disorder diagnosed?

There is no single test to tell if someone has Borderline Personality Disorder. It is likely the assessment process will involve different mental health professionals, such as a psychiatrist, a psychologist and a psychiatric nurse. The assessment should involve not just the young person, but their parents/ carers, and other people who know the young person well such as teachers, social workers and support workers.

The assessment should consider the life story of the young person as well as their current difficulties. The psychiatrist will do a thorough mental health assessment to ensure there is no other mental health disorder which can be diagnosed.

What helps people with Borderline Personality Disorder?

The main treatment for BPD is psychological therapy, rather than medication. You may be offered medication to treat another mental health problem, such as depression or anxiety.

Research studies have been done into the effectiveness of various psychological therapies for BPD, with some positive results. Few studies have been done specifically with under 18s.

  • Dialectical Behavioural Therapy (DBT) – uses individual and group therapy to help the young person learn skills to manage their own emotions.
  • Mentalisation Based Therapy (MBT) – longer term talking therapy which aims to improve the young person’s ability to recognise their own, and other’s emotions.

Working out what helps keep you well and what helps you cope when things are getting tough can help prepare you to ‘weather the storms’. This may be written down to form a personalised crisis plan.

There is evidence that admitting people with Borderline Personality Disorder to psychiatric hospital can increase the risk of self-harm, and is unlikely to have long-term benefit though it may temporarily relieve the crisis – for this reason, it is usually not helpful to consider hospital admission.

Recovery

It used to be thought that Borderline Personality Disorder was untreatable, but research has shown that 85% of people who receive treatment don’t experience enough of the symptoms of BPD after 10 years to be given that diagnosis any more.

  • Author
  • References
  • Further reading

Dr Lisa Egglestone

Consultant Child & Adolescent Psychiatrist

Review date: 28/1/19

NICE Pathway: Borderline Personality Disorder in Children, Young People and Adolescents

https://pathways.nice.org.uk/pathways/personality-disorders#path=view%3A/pathways/personality-disorders/borderline-personality-disorder.xml&content=view-index

NICE Guideline CG78: Borderline personality disorder: recognition and management

https://www.nice.org.uk/guidance/cg78