What is Borderline Personality Disorder?
Borderline personality disorder is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes self-image issues, difficulty managing emotions and behaviour, and a pattern of unstable relationships.
With borderline personality disorder, you have an intense fear of abandonment or instability, and you may have difficulty tolerating being alone. Yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though you want to have loving and lasting relationships.
Borderline personality disorder usually begins by early adulthood.
What causes BPD?
Childhood events as well as social and cultural surroundings play large roles in personality development and may also serve to facilitate the development of a personality disorder. Unstable family relationships, post-traumatic stress disorder (especially childhood neglect or abandonment), and exposure to intense and chronic stress and fear as a child seem to play a role in people developing BPD down the road. Early relationships help to form the person you become and what you believe to be normal. Since those suffering from BPT typically are prone to impulsivity, intense emotions, and a fear of abandonment, unresolved issues can exacerbate these symptoms.
Childhood trauma such as sexual, emotional, or physical abuse also may lead to the onset of borderline personality disorder. Unstable relationships are a main symptom of BPD, and children with traumatic backgrounds or unhealthy family relationships may be more prone to developing BPD later in life. They may have little to no indication that their relationships are not normal.
What are the symptoms of BPD?
The 9 symptoms of BPD
- Fear of abandonment. People with BPD are often terrified of being abandoned or left alone. Even something as innocuous as a loved one arriving home late from work or going away for the weekend may trigger intense fear. This can prompt frantic efforts to keep the other person close. You may beg, cling, start fights, track your loved one’s movements, or even physically block the person from leaving. Unfortunately, this behaviour tends to have the opposite effect—driving others away.
- Unstable relationships. People with BPD tend to have relationships that are intense and short-lived. You may fall in love quickly, believing that each new person is the one who will make you feel whole, only to be quickly disappointed. Your relationships either seem perfect or horrible, without any middle ground. Your lovers, friends, or family members may feel like they have emotional whiplash as a result of your rapid swings from idealization to devaluation, anger, and hate.
- Unclear or shifting self-image. When you have BPD, your sense of self is typically unstable. Sometimes you may feel good about yourself, but other times you hate yourself, or even view yourself as evil. You probably don’t have a clear idea of who you are or what you want in life. As a result, you may frequently change jobs, friends, lovers, religion, values, goals, or even sexual identity.
- Impulsive, self-destructive behaviours. If you have BPD, you may engage in harmful, sensation-seeking behaviours, especially when you’re upset. You may impulsively spend money you can’t afford, binge eat, drive recklessly, shoplift, engage in risky sex, or overdo it with drugs or alcohol. These risky behaviours may help you feel better in the moment, but they hurt you and those around you over the long-term.
- Self-harm. Suicidal behaviour and deliberate self-harm is common in people with BPD. Suicidal behaviour includes thinking about suicide, making suicidal gestures or threats, or actually carrying out a suicide attempt. Self-harm encompasses all other attempts to hurt yourself without suicidal intent. Common forms of self-harm include cutting and burning.
- Extreme emotional swings. Unstable emotions and moods are common with BPD. One moment, you may feel happy, and the next, despondent. Little things that other people brush off can send you into an emotional tailspin. These mood swings are intense, but they tend to pass fairly quickly (unlike the emotional swings of depression or bipolar disorder), usually lasting just a few minutes or hours.
- Chronic feelings of emptiness. People with BPD often talk about feeling empty, as if there’s a hole or a void inside them. At the extreme, you may feel as if you’re “nothing” or “nobody.” This feeling is uncomfortable, so you may try to fill the void with things like drugs, food, or sex. But nothing feels truly satisfying.
- Explosive anger. If you have BPD, you may struggle with intense anger and a short temper. You may also have trouble controlling yourself once the fuse is lit—yelling, throwing things, or becoming completely consumed by rage. It’s important to note that this anger isn’t always directed outwards. You may spend a lot of time feeling angry at yourself.
- Feeling suspicious or out of touch with reality. People with BPD often struggle with paranoia or suspicious thoughts about others’ motives. When under stress, you may even lose touch with reality—an experience known as dissociation. You may feel foggy, spaced out, or as if you’re outside your own body.
What is the treatment for BPD?
Borderline personality disorder is mainly treated using psychotherapy, but medication may be added. Your doctor also may recommend hospitalization if your safety is at risk.
Treatment can help you learn skills to manage and cope with your condition. It’s also necessary to get treated for any other mental health disorders that often occur along with borderline personality disorder, such as depression or substance misuse. With treatment, you can feel better about yourself and live a more stable, rewarding life.
Psychotherapy
Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline personality disorder. Your therapist may adapt the type of therapy to best meet your needs. The goals of psychotherapy are to help you:
- Focus on your current ability to function
- Learn to manage emotions that feel uncomfortable
- Reduce your impulsiveness by helping you observe feelings rather than acting on them
- Work on improving relationships by being aware of your feelings and those of others
Dialectical behaviour therapy (DBT).
DBT includes group and individual therapy designed specifically to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, tolerate distress and improve relationships.
What is the life expectancy of someone with BPD?
Although Borderline Personality Disorder is not a disease with a mortality rate, several studies indicate that people with BPD live shorter lives on average. Due to the multiple causes discussed in this article, they have a life expectancy of around 15-20 years shorter than people without BPD.
a lower life expectancy for someone with BPD
- Suicide
- Alcohol or drug addiction
- Partaking in higher-risk activities
- Not working and less exercise
- Not taking care of oneself
- Stress
- Medication
- Suicide – 1 in 10 people diagnosed with BPD will take their own life.
BPD is linked to extremely distressing negative emotional experiences. These experiences are so painful that many people with BPD describe that they want to find a way to escape. In a time of extreme emotional pain, someone with BPD may engage in suicide behaviour without fully considering the consequences. In this scenario, someone’s ability to cope with life events and emotional instability is crucial. To cope with a strong sense of mental emptiness, they frequently engage in self-harm or suicidal behaviour.
Suicidal behaviours and completed suicides are common in people with borderline personality disorder (BPD). According to studies, around 75% of persons with BPD will try suicide at least once in their lives, and many will attempt multiple times. Suicidal tendencies will remain a problem for someone with BPD, whether or not they receive treatment.
BPD and smoking
People with BPD are more likely to smoke a pack of cigarettes per day than people without the disorder.
People with mental illness may need extra help to succeed in quitting. This can include more counselling and longer use or a combination of stop-smoking medicines. With careful monitoring, quitting smoking does not interfere with treatments for mental illness and can be part of the treatment.
A case can be made for encouraging people with BPD to switch to a safer nicotine delivery and tobacco harm reduction. E-cigarettes are proven 95% safer without giving up the ritual of smoking with a safer nicotine alternative.
