Borderline personality disorder (BPD)

What is Borderline personality disorder (BPD)

Borderline Personality Disorder (BPD) is a complex and often misunderstood mental health condition. Characterised by intense emotional instability, difficulties in maintaining relationships, and a profound fear of abandonment, BPD can significantly impact an individual’s daily life. Despite its challenges, with the right support and treatment, those living with BPD can lead fulfilling lives.

Where does the term Borderline personality disorder come from?

The term borderline personality disorder (BPD) was used to describe patients whose symptoms did not clearly fit into either psychosis or neurosis- they seemed to be on the border between the two.

Later, psycho-analysts refined the concept, describing it as borderline personality organization, which they believed fell between neurotic and psychotic personality structures. By 1980, BPD was officially recognised as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Interestingly, the name has been debated over the years, with some experts arguing that it is misleading and contributes to stigma. Alternative names like Emotion dysregulation disorder, Relationship disorder or Emotional unstable personality disorder have been suggested.

Diagnostic criteria of Borderline personality disorder

BPD is characterised by a persistent pattern of unstable interpersonal relationships and self-esteem that begins in early adulthood, with at least 5 of the following criteria:

1. frantic efforts to avoid real or imagined abandonment
2. a pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
3. identity disturbance: markedly and persistently unstable self-image or sense of self
4. impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
5. recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour
6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. transient, stress-related paranoid ideation or severe dissociative symptoms.

A further explanation of the symptoms of someone with a Borderline personality disorder (BPD)

Borderline personality disorder (BPD) is a complex mental health condition characterised by instability in emotions, relationships, self-image, and behaviour. People with BPD often experience intense mood swings, difficulty maintaining relationships, and impulsive decision-making, which can make daily life challenging.

Common Symptoms of BPD

1. Emotional instability

Individuals with BPD frequently experience intense emotions that shift rapidly, such as deep sadness, anger, anxiety, or excitement. These mood changes can happen within hours or even minutes, making emotional regulation difficult.

2. Fear of abandonment

A strong fear of rejection or abandonment is a core symptom of BPD. This can result in frantic efforts to avoid perceived abandonment, such as clinging to relationships, becoming overly dependent on others, or pushing people away before they can leave.

3. Unstable relationships

People with BPD often experience extreme fluctuations in relationships, alternating between idealising loved ones and suddenly devaluing them. This instability can cause frequent conflicts and misunderstandings in personal and professional interactions.

4. Distorted self-image

A person with BPD may struggle with their identity, experiencing uncertainty about who they are, their values, or their goals. This instability can lead to frequent changes in careers, relationships, or interests.

5. Impulsive and risky behaviour

Impulsivity is a hallmark of BPD. This might include reckless spending, substance abuse, binge eating, unsafe sex, or other self-destructive behaviours that can have negative consequences.

6. Self-harm and suicidal thoughts

Many individuals with BPD engage in self-harming behaviours, such as cutting, burning, or other acts of self-injury. Suicidal thoughts or attempts are also common, often occurring in response to overwhelming emotions or relationship difficulties.

7. Chronic feelings of emptiness

A person with BPD might feel like they have an inner void, leading to boredom, loneliness, and emotional numbness. This sense of emptiness can drive impulsive behaviours or attempts to fill the void through external means.

8. Intense anger and difficulty controlling it

Sudden bursts of anger, irritation, or resentment can be common in individuals with BPD. This anger may be directed toward loved ones or oneself and can be difficult to manage.

9. Paranoia and dissociation

People with BPD may experience episodes of paranoia, feeling suspicious or distrusting others. They may also dissociate, feeling disconnected from reality, themselves, or their emotions during times of stress.

A story of someone with Borderline personality disorder

Bianca* and Liam* met after he started working on the same floor of a building for a different company.

They happened to run into each other frequently during social gatherings or at the coffee shop downstairs.

Within a very short time they became very good friends, best friends in fact. Bianca had sex appeal. She was always dressed in a short dress with a tight blouse. She was seductive and quickly charmed him.

Shortly in their friendship, she started to share very intimate details of her personal life, sometimes even inappropriately. She also told him that she thought he was the best ever in his profession and that he was the most wonderful person she had ever met. She herself was brilliant in her profession and had great success in what she did.

At the time, she was involved in a nasty divorce with a man she described as the worst person she had ever met.

Bianca was different from other people. She was a Pagan who lived close to nature, sometimes dancing on the roof of her house during full moon. She was just incredible, interesting and even mysterious.

Liam was married and managed to resist her. However, Bianca met someone and quickly became involved in a relationship with Gerald*. At first it was all moonlight and roses, but problems in the relationship arose over time. Bianca had meanwhile formed a best friendship with Talita*.

Talita one day sent Gerald a message and told him what a bad person he was and what he was doing wrong in their relationship. Strangely enough, Bianca and Talita’s friendship did not last and they never spoke to each other again.

Gerald is a good person and will do anything to make other people happy, but for Bianca he was never good enough. Yet she later restricted him and he was not allowed to see his family or friends. He was not allowed to do things he enjoyed. He was not allowed to live out his passions, such as his love for motorcycles.

Gerald’s sister meanwhile and Liam became involved in a relationship after his divorce.

During this time, she sent Liam a humiliating message one day about something he had done wrong in her eyes. Liam then blocked her and decided never to talk to her again.

In the building where they worked, Bianca and Liam were once in the elevator together where Liam did not greet her. Bianca just couldn’t understand it. Liam should just forget about it. It wasn’t that bad.

His feelings just didn’t matter to her.

• If you are wondering why I am telling you this story, you might want to look at the diagnostic criteria again and see how many of the criteria you can identify in the above story.

*Not their real names