What is BPD?

Borderline Personality Disorder (BPD) also known as Emotionally Unstable Personality Disorder (EUPD) is a complex mental health condition that is often misunderstood.

Symptoms include emotional distress, difficulty relating to others and the world around them and self harm. This can be very distressing for the person and for people close to them. The emotionally intense highs and lows can be difficult to manage leading to feelings of losing control, being trapped or isolation, making it difficult to connect with people.

If you’re in this situation, it’s crucial that you reach out for professional help, and open up to a loved one, as soon as possible. Signs of BPD usually appear in late adolescence or early adulthood. Experiences of BPD are different for different people. See our Symptoms page

Research estimates around 1-2% of the general adult community live with BPD, meaning over 1 million people in the UK suffer from the condition. 

Women are more likely to be diagnosed with BPD, but men experience BPD at a similar rate.

  • The nine criteria of Borderline Personality Disorder under DSM-5 include:

    • Chronic feelings of emptiness, worthlessness and shame.

    • Transient, stress related dissociation (losing touch with reality) or paranoia.

    • Frantic efforts to avoid real or imagined abandonment.

    • Rapidly changing and extreme opinions of others. Idealisation to devaluation (see ‘Splitting’).

    • Marked or persistently unstable self-image or sense of self and perfectionism.

    • Impulsive, risky behaviour.

    • Self-harm and suicidal thoughts.

    • Extreme anxiety, irritability or anger.

    • Intense emotions in reaction to day-to-day events e.g. (intense sadness to euphoria).

    BPD is a very diverse condition and to be diagnosed with BPD, you do not need to exhibit all nine of the symptoms.

    Read more on our Symptoms page

  • BPD can be a serious condition. Many people with BPD are at risk of attempting suicide at some point in their life – which is why it’s so important to get the right support. There are several specialist psychological therapies that can be effective for treating BPD. There are now several evidence-based psychological therapies that are effective in the treatment for people with Borderline Personality Disorder. These include:

    • Dialectical behavioural therapy (DBT)

    • Mentalisation based therapy (MBT)

    • Cognitive analytic therapy (CAT)

    Following your initial assessment, we will assess which approach we believe will be most effective for you. All our psychologists have specialist experience in the treatment of BPD and treatment will often also include medical reviews with our Consultant Psychiatrist, especially if your symptoms are severe.

  • Absolutely

    Contrary to popular belief, you can recover from BPD. After receiving evidence-based therapy, people very often no longer meet the diagnostic criteria for BPD. Even though your difficulties may feel pervasive, things can change and improve with the right therapeutic approach.

    If you’re struggling to understand what you’re going through, it’s important to find out more about your condition and reach out for help. For some a diagnosis is a light bulb moment that brings together their difficulties and sets them on the path for full and happy lives.

    Read stories of others here

The term “borderline” is meant to describe people who are on the borderline of neurosis and psychosis. It was coined in the late 1930s when very little was known about this disorder. Today, though, some doctors have taken to using the terms Emotionally Unstable Personality Disorder (EUPD) as it more accurately describes individuals with BPD, since fast-fluctuating moods are a principle characteristic of the disorder. We still use the term BPD as this is how its more commonly referred to.

BPD is normally diagnosed in young adulthood, but in rare cases it is diagnosed in individuals under the age of 18. The reason for this delayed diagnosis is that many symptoms indicative of BPD are inherently present in many adolescents. 

Why “Borderline”?

Girl on a pink bed thinking and looking sad

What does it feel like?

Each individuals experience of living with BPD will be unique, but this page describes some common experiences:

Difficult feelings and behaviour towards yourself

How you might think or feel

  • Lonely

  • Overwhelmed by the strength of your emotions and how quickly they change

  • Like there's something inherently wrong with you, and that it's your fault if bad things happen to you because you deserve them. A deep sense of shame.

  • Like you're a bad person, or not a real person at all

  • That you don't know what you want from life, or what you like or dislike

  • Empty, numb or like you have no purpose

  • A burden to others

  • Like your feelings are impossible to understand or describe

  • Like you're a child in an adult world

  • Believing you’re better of alone

How you might behave as a result

  • Perfectionism

  • Severe self criticism - Inwardly directed hostility, anger, or aggression

  • Using recreational drugs, alcohol or smoking to try to cope with your emotions

  • Quitting just before achieving something, or avoiding activities where you think you might fail or be disappointed

  • Withdrawing or isolating yourself

  • Often changing jobs, hobbies, goals or plans

  • Keeping very busy so you're never alone

  • Self-harming or attempting suicide

Difficult feelings and behaviour towards others

How you might think or feel

How you might behave as a result

  • Struggling to trust people

  • Withdrawing from people or cutting people off who have made you angry or upset - a pattern of idealizing, devaluing and discarding others

  • Wanting to be close to people but worrying they'll leave or reject you, and so avoiding or pushing them away

  • Spending a lot of time thinking and worrying about things that other people say or do. See Perfectionism

  • Distancing yourself from people or ending relationships with friends or partners because you think they might leave you

  • Asking for lots of reassurance or testing people’s commitment or opinion of you

  • Anxiously looking out for signs that people might reject you

  • Getting very angry or frustrated with people

  • Having unrealistic expectations of people or contacting them very frequently

The four types

  • This is also known as discouraged BPD. People with this type are afraid of being abandoned. They may take extreme actions to prevent real or imagined abandonment.

    Compared to people with other types of BPD, people with this type may keep their emotions inside. They also tend to blame themselves rather than others. 

    Discouraged types may:

    • Be perfectionists 

    • Be very successful

    • Be high functioning

    • Feel alienated and detached in groups

    • Feel like they don’t have real or strong bonds with others

    • Seek approval but also self-isolate

    • Engage in self-harm, suicidal or self-destructive behaviour

    • Feel lonely and empty a lot of the time

    Signs of discouraged BPD include:

    • A fear of being alone

    • Telling themselves they're independent and don’t need other people

    • Blaming or criticising themselves for things

    • Uncontrollable internalised emotions e.g Shame & Guilt

    • Believing that they deserve to be alone

    • Feeling like a burden

    Read more

  • Impulsive behaviour is a primary symptom of BPD. A person with BPD can act in impulsive and often dangerous ways. They may do this without regard for others or possible consequences.

    People with this type of BPD may appear:

    • Charismatic

    • Energetic

    • Elusive or detached

    • Flirtatious

    • Engaging or motivating

    Some example behaviours include:

    • Bingeing

    • Risky and self-destructive behaviours.

    • Aggression

  • People with a self-destructive type of BPD often experience self-hatred, feel a sense of bitterness, or have a case of being their own “worst enemy.”

    Other symptoms of self-destructive BPD may include:

    • Frequent bouts of low mood or depression

    • Constant feelings of self-doubt & shame

    • Negatives self-image

    • Engaging in risky and self-harmful behaviours such as cutting or substance use

    • Suicidal thoughts

  • People with this type of BPD may be angry one moment and sad or sulky the next. They may swing unpredictably between one emotion and another. They may also feel unworthy and unloved. This can lead to relationship challenges and an unhealthy desire for control.

    People with this type of BPD can be manipulative. They often feel very dissatisfied in their relationships. Substance abuse and other dangerous behaviours often follow.

    Example behaviours of people with this type of BPD include:

    • Irritability and impatience

    • Stubbornness and defiance

    • Passive-aggressiveness

    • Severe mood swings

How BPD affects people can vary. Studies have identified four primary types of BPD although other potential subtypes of BPD are still being studied. The four types include quiet, impulsive, self-destructive, and petulant. Each highlights a different aspect of BPD. Anyone with BPD may have one type or more than one, though some people don't squarely fit into any of these categories.

Causes

The development of this disorder is complex, and there are likely a variety of potential causes, so it's unlikely that one person or thing is at fault. Research suggests its caused by a mix of biological, genetic and environmental factors.

One common theme for those suffering BPD is that their emotional needs were not tended to as a child.

Sometimes this is obvious and plain to see – in the case of neglect, abandonment and abuse, for example. Other times it can be more subtle but just as impactful. Snide, invalidating comments, for instance, can come disguised as “compliments” or disempowering and demeaning dynamics can be hidden in the guise of parental discipline and “care”.

The following are theories that have some support in support but are by no means conclusive. More research is needed to determine how and why the factors discussed below are related to BPD.

Environmental Influences

There is strong evidence to support a link between distressing childhood experiences, particularly involving caregivers, and the development of BPD. The types of childhood experiences that may be associated with BPD include:

  • Emotional or physical neglect

  • Parental insensitivity

  • Early separation from caregivers

  • Physical and sexual abuse

It is thought that interaction between biological factors and an invalidating childhood environment may work together in predisposing a person to develop BPD. An emotionally invalidating environment is one in which a child's emotional needs are not met.

An invalidating environment is not always evident to those who have experienced it or to others around them. These painful experiences can be hidden and even disguised as praise. Recent studies suggest that socially prescribed perfectionism traits may cause or contribute to the development of BP

Not everyone who has BPD has had these types of childhood experiences—although a large number have. And not everyone who has these types of experiences will have BPD. It is likely that a combination of factors, rather than a single cause, is responsible for most cases of borderline personality disorder.

Genetics

While early studies showed that BPD does tend to run in families, for some time, it was not known whether this was because of environmental influences or because of genetics. There is now some evidence that in addition to the environment, genetic factors might play a role.

Biological Factors

Several studies have shown that people with BPD have differences in both the structure of their brain and brain function. BPD has been associated with excessive activity in parts of the brain that control the experience and expression of emotion.

For example, people with BPD have more activation of the limbic system, an area of the brain that controls fear, anger, and aggression, than people without BPD. This difference may be related to the emotional instability symptoms of BPD. Newer studies have also found associations between the hormone oxytocin and the development of BPD.

Recovery

BPD is a serious and distressing experience, but the right treatments are generally effective and a high proportion of people with the condition recover to the point where they no longer meet the diagnosis, or can live a meaningful life even with symptoms. Most people with BPD who receive good treatment and support get significantly better over time, though some effects can linger. 

Many people with BPD still don’t get the diagnosis, treatment and support they need. Understanding of BPD is insufficient (among health professionals as well as the general public) and access to appropriate services is limited. But the situation is improving, and with the right treatment and support, people with BPD can and do live full, meaningful lives.

Surround yourself with people who you can talk to easily, who can understand, listen and learn and always support you.