Supporting and promoting the well-being of mental health carers and their families.
Mental Health Carers Austalia.
People living with borderline personality disorder (BPD) face challenges with managing emotions, their sense of identity and interpersonal relationships. While the symptoms of BPD can be distressing and difficult to manage, it is important to remember that there is effective treatment available.
What are the symptoms of BPD?
1. Challenging, strong emotions
People living with BPD often describe intense and changing emotions that feel out of control. These emotions can also be hard for a person to manage, meaning it is difficult to calm down. This can lead to people coping with emotions in any way they can. This might result in behaviours that are extreme or harmful to themselves or others.
2. Difficulties in relationships
For people living with BPD, there is often a fear of rejection and abandonment. This intense fear can cause the person to try to prevent real or perceived abandonment, causing stress in relationships. Some people may also experience paranoia, perceiving threats or judgment from others that isn’t real. This could cause them to respond with anger or withdraw from relationships.
3. Problems with identity
People with BPD may have challenges in feeling stable in their identity, having sudden changes in their sense of self or values. This can result in unexpected changes to relationships or goals.
4. Self-destructive or impulsive behaviours
To manage very challenging emotions, people with BPD may act impulsively or in a way that could be harmful to them or others. While these actions are often to manage painful emotions, they can have serious impacts on the person or those around them.
5. Feelings of emptiness or dissociation
Some other experiences often reported by people living with BPD are difficult feelings of emptiness or hollowness. Some people might also experience dissociation, where they feel removed or ‘checked out’ from the present, or where nothing feels real.
What causes BPD?
The exact causes of BPD are not known. Currently they are thought to be a combination of genetic and environmental factors. This is especially thought to be an interaction between a biological vulnerability and experiences of trauma in childhood.
BPD and trauma
There is a relationship between child abuse, neglect and adverse child experiences and a diagnosis of BPD. However, this does not fully explain why some develop BPD in adulthood and others do not. Abuse and neglect are not always present for people living with this diagnosis.
Because trauma can often be a part of a person’s experience, treatment that is sensitive to the impacts of trauma and supports a sense of safety is essential for many people.
Treatment and recovery
Psychological therapy is an important and effective part of treatment for BPD. This involves a supportive relationship with a trained professional. In this relationship people can talk about thoughts, feelings and experiences to better understand themselves. People also gain a range of skills for responding to the world and their own emotions.
There are many psychological therapies which are effective in treating BPD. Some of these therapies include:
- Dialectical Behaviour Therapy (evidence says Dialectical Behaviour Therapy is most effective delivered as a structured group program combined with individual therapy. However, it can also be provided in individual therapy).
- Cognitive Behaviour Therapy
- Emotion Regulation Training
- Interpersonal psychotherapy
- Manual-assisted cognitive therapy
- Mentalisation-based therapy
- Motive-oriented therapeutic relationship
- Schema-focused psychotherapy
- Systems training for emotional predictability and problem solving
- Transference-focused psychotherapy
All of these therapies have a few things in common:
- The therapist pays attention to the person’s emotions and experience.
- The quality of relationship between the person and the therapist is important.
- The therapy focuses on achieving change in the person’s life (common goals for people are around managing emotions, finding meaning in life and taking care of relationships).
- Therapy sessions are regular and often one session per week is recommended.
- The therapist receives support and supervision.
Medication is not the primary treatment for BPD. However, it may be used to treat symptoms such as anxiety, depression, or other mental health diagnoses.
As with many mental health issues, seeing a trusted or local GP to explain what you experience and ask about support options is a good start. You can also explore psychologists with expertise in BPD or trauma through Find a Psychologist. Programs that offer specialised support for people with BPD can be found in the Project Air Service Directory.
Many people find peer support helpful in their recovery. This is mental health support based on shared experiences of mental health challenges. This can be provided by a professional Peer Worker or in support groups and online settings. SANE’s online forums are one example of peer support. On the forums, people with experiences of mental health concerns share, listen and support each other.
Self-help for BPD
A common challenge for someone living with BPD is trying to manage very intense emotions. So anything that supports developing a wider range of skills for dealing with emotions is valuable. Here are some strategies people find helpful:
- Distraction: For short term relief, try talking to someone, watching TV, playing video games, listening to the radio, puzzles, cleaning or arts and crafts.
- Grounding: If you are feeling dissociated or physically anxious it can be helpful to get in touch with your senses. You can have a shower, smell flowers, taste food, walk barefoot, squeeze a stress ball or pet an animal.
- Emotional release: For anger and fear, you can go for a quick run, go to the gym, put on some music or a movie that makes you laugh or cry, dance or scream into a pillow.
- Self-kindness: When you’re feeling ashamed or empty try something you would treat a friend to, like a cup of tea, your favourite meal, having a bath or buying yourself a gift.
There’s no doubt BPD can involve very painful experiences, but there is effective treatment available to support people in their recovery. People can and do learn to manage symptoms so that they can achieve their goals in life, relationships and feeling less distress.
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