If you deal with emotions in a way that is harmful to yourself, and have difficulties with relationships, you may have a personality disorder. Here we explain what borderline is and how to get help.

What is borderline?

Borderline personality disorder (BPD) is also known as emotionally unstable personality disorder (EIPS). It is a mental illness and personality disorder characterised by significant emotional instability, intense relationships with others and a strong fear of abandonment. People with BPD may experience rapid and extreme mood swings, and their self-image may also be unstable.

This is a severe condition that often involves self-harm, suicidal thoughts, and substance abuse. If you have these problems, you should speak to your GP for a referral to specialist psychiatry, In case of severe suicidal thoughts, you should call 111 immediately.

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What is a personality disorder?

Personality disorders, or personality syndromes, are psychological conditions that affect an individual’s thoughts, feelings and behaviours in a way that differs significantly from societal norms.

Why do people get borderline?

The causes of borderline personality disorder are not entirely clear, but may be a combination of genetic, biological and environmental factors, including early trauma such as sexual abuse.

There doesn’t have to be trauma, but there are also theories that the way people are treated growing up, if parents have had a lack of empathy and mirroring the child emotionally so that they feel seen and heard, can contribute to the problem.

In adolescence, there may be symptoms similar to borderline as this period involves an exploration of identity, but these symptoms usually resolve themselves. With borderline, however, the symptoms are more persistent but they also tend to improve as you get older.

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How common is borderline?

Approximately 1% of the UK population suffers with with BPD.

Symptoms of borderline personality disorder

There are several symptoms of borderline. It is important to note that the severity and prevalence of symptoms can vary greatly between individuals. In addition, there may be co-morbidity with other mental health conditions, such as ADHD, autism, depression, eating disorders and PTSD, which can affect the expression of the profile. Diagnosis and treatment should be done by a licensed psychologist or psychiatrist. Here are some of the main symptoms and characteristics of borderline personality disorder:

  1. Fear of abandonment: An intense fear of real or imagined abandonment. This can lead to desperate attempts to avoid being abandoned, even through self-harming behaviour.
  2. Unstable relationships: Relationships can be intense and stormy, with periods of idealisation followed by devaluation. These swings are often due to black-and-white thinking, with the person with borderline either idealising others as ‘perfect’ or dismissing them as ‘terrible’.
  3. Unstable self-image: A deeply disturbed or changing perception of oneself. People with borderline may have problems with their identity and self-esteem.
  4. Impulsivity: This can include risky behaviours such as substance abuse, eating disorders, reckless driving, or excessive spending.
  5. Self-harm: Includes behaviours such as self-harm and suicidal thoughts or attempts.
  6. Emotional instability: Rapid and intense mood swings that can be difficult to control.
  7. Feelings of emptiness: A chronic sense of emptiness or meaninglessness.
  8. Intense anger: Difficulty managing anger, which can lead to temper tantrums or constant irritation.
  9. Stress-related paranoia or dissociation: During periods of extreme stress, people with borderline may experience paranoia or dissociation from reality.

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Assessment of personality disorders

Personality disorders are often diagnosed by specialist psychiatrists through a personality assessment. This involves taking an initial medical history to review the background to the symptoms and completing assessment forms. A structured diagnostic interview and an interview with family members are then carried out to see how the symptoms manifest themselves in different areas. You will often see both a doctor and a psychologist, and the assessment may include a blood test to rule out an underlying medical cause.

Treatment for borderline personality disorder

Treatment for BPD usually involves a combination of psychotherapy, medication (to manage co-occurring conditions such as depression or anxiety) and self-help strategies. Dialectical behavioural therapy (DBT) is a form of therapy specifically developed to treat borderline and has been shown to be particularly effective. MBT, which is short for mentalisation-based therapy, is also helpful for borderline.

An important part of the treatment is mindfulness to manage emotions, but other strategies and tools are also used to increase self-understanding and improve the ability to manage emotions.

Advice for those who know someone with personality disorder

Be careful with boundaries: It is important to set clear boundaries to protect yourself and your own psychological well-being.

Seek professional help: It is not your job to diagnose or treat someone. Let this be handled by qualified healthcare providers.

Try not to judge: A personality disorder is a medical diagnosis and not a character flaw. It does not always excuse a person’s behavior, but it can explain it. Try to have an empathetic attitude.

Be aware of your own needs: Take care of yourself and seek support, either from friends, family or a professional therapist or psychologist.

We make the hard things easier

Approaching the topic of personality disorder can feel overwhelming, but we are here to make the hard part easier. When you feel it’s time to talk to a psychologist or therapist, simply book an online session with us. Whenever you take that first step, our experienced team is always ready to help you or your loved ones.

12 frequently asked questions about borderline personality disorder

What is a personality disorder?

A personality disorder is an enduring pattern of behaviour, worldview, and inner experience that is markedly different from what is expected of those around you. This is because personality disorders can affect one’s ability to relate to others and function effectively in everyday life.

Is borderline a type of personality disorder?

Yes, borderline personality disorder is one of several types. It is a mental illness characterised by significant emotional instability, intense interpersonal relationships and a strong fear of abandonment.

How is borderline diagnosed?

A borderline diagnosis is usually carried out by a psychiatrist or psychologist and involves a detailed diagnostic interview and family interview.

What treatment options are available for borderline?

Treatment usually involves a combination of psychotherapy and medication. Recommended psychotherapy is Dialectical Behavioural Therapy (DBT) and Mentalisation-Based Therapy (MBT).

Does DBT help with trauma?

If you have experienced trauma and have symptoms of post-traumatic stress disorder (PTSD), it is important to get a thorough assessment and treatment for your PTSD symptoms. It is possible to get help with trauma as part of the treatment.

Is there any way to prevent personality disorders?

Personality disorders are largely caused by environmental influences during childhood, so there are things you can do to prevent unhealthy personality development if you have children. Personality disorders mainly manifest themselves in adulthood, so consult a child psychologist if necessary or adult psychiatry if you think you may have a personality disorder as a parent.

What is the difference between DBT and cognitive behavioural therapy (CBT)?

DBT is a later development of CBT but they are based on the same foundation of learning theory and thoughts, feelings and behaviors. DBT also includes more mindfulness-based elements that have been inspired by Zen Buddhism.

Are women more likely to attend DBT than men?

It is equally common for men and women to be diagnosed with borderline, with about 1% of the population having it. However, it is much more common for women to seek care and receive DBT, about 75% of patients are women.

Is it called EIPS instead of borderline?

Emotionally Unstable Personality Syndrome is also known as borderline, but EIPS is often used in healthcare due to the stigma of the term borderline. EIPS is used in the ICD diagnostic manual while borderline personality disorder is described in the DSM-5 diagnostic manual.

What can I do as a family member?

The most important step is to encourage the person to seek professional help. You can also offer emotional support, but remember that you are not a substitute for qualified care.

Can you force someone to go to therapy?

No, you can’t force someone to undergo therapeutic treatment. It is rarely a good idea to force someone into therapy. A person needs to understand that they need to work on themselves. However, in cases of severe self-harm and suicidality, compulsory treatment can be given, but this is decided by a doctor in inpatient care.

Where can I get help?

If you think you need treatment, contact your GP for a referral to psychiatry. Lavendla also has a team of licensed psychologists who can help you with an initial assessment and make further referrals. If you have acute suicidal thoughts, call 111 or visit 111.nhs.uk immediately.

Written by dominic

Dominic is a Cape Town-based copywriter and editor with a background in psychology.