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People who experience borderline personality disorder (BPD) are

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1. Sensitive to their emotions and environment- (e.g., sensitive to comments and looks from others).

2. Experience emotions as intense- (e.g., could really struggle with disappointment if let down).

3. It takes longer to get back to feeling ok- (e.g., a seemingly mild incident could ruin one’s day).

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If you have bpd/traits/complex-trauma you may struggle to manage your emotions and you may often feel overwhelmed,  like you are on an emotional rollercoaster of mood swings and uncertainty about how you see yourself and your place in the world. You might be fearful and looking out for signs of rejection and abandonment.  You might have a bit of a pattern of having unstable or intense relationships, or of avoiding relationships,  and this may be partly due to difficulties you may have controlling upsetting emotions, moods and thoughts. This might have impacted on you acting impulsively at times. You may also tend to view things in extremes, such as all good or all bad, with changing opinions of other people. E.g., someone is considered a friend one day, but if they let you down, then you may feel like cutting them off. This makes sense because you are very sensitive and are fearful of rejection, so are hypervigilant towards this. 

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A significant number of people with bpd have co-morbid eating and anxiety disorders, you might have struggled with anxiety attacks, with bingeing/purging or other disordered eating. You may be self-harming, or have had a history of this in the past, and have possibly had suicide ideation and/or suicide attempts. These are all criteria for bpd, and some people will find they tick the boxes with most of these, while those of you with bpd traits will identify with just a few of these symptoms.

 

A diagnosis of personality disorder is made where the person's problems result in significant difficulty in their day to day activities and relationships, or cause significant distress. Diagnosis is made by a registered psychologist or psychiatrist.  People with bpd are not "making it up for attention", as stigma suggests. If you have bpd, you will be highly distressed at times and in need of specialist support, care and understanding.

 

People with BPD experience some or all of the following:

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• frantic efforts to avoid real or imagined abandonment/ rejection

• intense fear of being alone

• a pattern of unstable / or intense interpersonal relationships or isolation

• impulsiveness (potentially self-damaging)

• intense emotions, that do not fit with the situation

• recurrent suicidal behaviour (about 10% of people with BPD take their own lives)

• recurrent self-harm (up to 75% of people with BPD self-injure one or more times)

• Going between feeling overwhelmed to having feelings of  emptiness

• experiencing minor problems as major crises

• ‘black and white’ thinking which often means switching between love and hate in personal relationships

• the use of self-destructive coping mechanisms to express, anger, frustration, desperation and unhappiness

• difficulty trusting others

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It is vitally important for people with bpd/traits to learn ways of coping with stress and to seek help early. BPD traits can show up and then get worse over time, increasing risk of self-harm and suicide. With specialist evidence-based treatment, people with BPD can recover and live well.

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Who gets BPD?

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Borderline Personality Disorder (bpd) is diagnosed in around 2% of adults and in up to 20% of people using mental health services. It is more commonly diagnosed in women than men.  Just as we have physical features that make us who we are, we also have our own distinct personality features. Our personality is the way we see, think about, and relate to ourselves, other people, and the wider world – whether we see ourselves as good or bad, trust or mistrust others, or see the world as a good or bad place. 

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A personality disorder such as BPD will show up by late adolescence or early adulthood, though many people with bpd and their families/whanau can notice early symptoms in childhood. Some patients tell me that they had been trying to get help for years since childhood, and that often they were misdiagnosed with anxiety , low mood, stress. Talking about stress-  stress can exacerbate symptoms, including transient stress-related paranoid ideation or dissociative symptoms. 
 

As said, the risk of suicide in people who experience a personality disorder is significant. In particular, bpd is associated with self-harm and suicidal behaviours within its diagnostic criteria. Up to 10% of people with bpd will die by suicide. It is important that if you are feeling suicidal  you seek help immediately by calling the mental health crisis team (which every DHB has) or by calling 111. I have advised and written the BPD pamphlets for the NZ Mental Health Foundation.

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What causes BPD?

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Unfortunately the causes of bpd are not certain. There is good evidence that development of personality is a combination of our genetics and our environment. People with a personality disorder have often but not always experienced trauma including developmental trauma, and complex trauma and invalidation, abandonment, adoption, sexual, emotional or physical abuse. They may have been exposed to unstable, invalidating relationships, or hostile conflicts, emotional neglect or attachment difficulties in childhood, separation and loss. Invalidating environments where the person’s feelings are denied, ridiculed, ignored or judged as “wrong” could also be a factor .Others  cannot identify things that have gone wrong in their lives. They may feel their disorder is genetic and temperament based. Many believe it is a combination of these things.  People who have a close family member (such as a parent or grandparent) with a  personality disorder may be at a higher risk of developing bpd, this could also include intergenerational trauma. People who are emotionally sensitive and reactive may be more likely to be diagnosed with bpd. Being sensitive is not a bad thing, many creative artists/writers/actors are highly sensitive- however people with bpd find it difficult to learn to manage their sensitivity. People with bpd can have very sensitive and reactive nervous systems which can influence their psychology. Some studies show that people with borderline personality disorder can have structural and functional changes in the brain especially in the areas that control impulses and emotional regulation. It isn’t clear whether these changes are risk factors for the disorder or caused by the disorder.

 

Aims of therapy/treatment:

Important goals that people work on in our Lighthouse Coaching Academy are: 

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• to manage emotions and reduce overwhelm

• to reduce immediate self-harm and/or suicide risk

• to find more purpose in life 

• to develop healthy relationships

• to learn to trust other people

• to learn how to understand, be kind to, and live with yourself 

• To re-connect with your culture and/or faith

• to improve physical health.

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If you have bpd/traits/complex trauma it is really important to look after your wellbeing. Aside from joining the Lighthouse Online Coaching Academy and/or booking a psychologist appointment, here are some general coping strategies:

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• talk to your therapist about treatment options and stick with treatment

• try to maintain a stable schedule of meals and sleep times

• engage in mild activity or exercise to help reduce stress

• set realistic goals for yourself

• break up large tasks into small ones, set some priorities, and do what you can, as you can

• try to spend time with other people and confide in a trusted friend or family member

• tell others about events or situations that may trigger symptoms

• expect your symptoms to improve gradually, not immediately

• identify and seek out comforting situations, places, and people

• continue to educate yourself about bpd, realising that everyone is different.

 

Make a list of things that feel good and keep it on your phone, your diary or on the fridge. When you’re struggling, check your list and pick one thing you can do right now that might help. 

 

These may include:

• learning your particular early warning signs or triggers by keeping a mood diary (we do this in the coaching academy)

• identifying and reducing stressful activities

• ensuring you are eating healthy food

• using relaxation exercises, mindfulness, yoga, or massage

• getting enough sleep 

• spending time in nature 

• getting some exercise

• peer support (e.g. support groups)

• getting support from family/whānau, friends, therapist

• humour: comedies on TV, funny movies

• cut back on non-prescribed drugs and alcohol

• fun: Make sure you regularly do things that you enjoy and that give your life meaning

• engage in random acts of kindness

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Advice for Family/Whanau/Partners/Friends:
 

• Remember people with bpd/traits/complex trauma tend to easily take words and actions to heart. Meanings/ intentions can be lost in translation, or misinterpreted. Please don't give up, be patient and seek help on how to support them on their journey. 

• Learn what you can about the condition, its treatment, and what you can do to assist the person.

• Take the opportunity, if possible, to contact a family or whānau support, advocacy group or faith-based or culturally appropriate organisation. For many, this is one of the best ways to learn about how to support the person, deal with difficulties, and access services when needed.

• Encourage the person to continue treatment and to avoid alcohol and drug abuse.

• Find ways of getting time out for yourself and feeling okay about this. It’s important to maintain your own wellbeing.

• Get your own therapy for support if needed.

• I am currently creating a podcast series for family supporters, send us your email if you would like to be on this list.

One of the biggest barriers to recovery is discrimination. This stops many people from seeking professional help. Research shows that people with bpd have a high rate of discrimination.

 
 

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