Few people understand the common condition - educate yourself on the symptoms of BPD, plus what it can feel like to live with
You might be aware that Amber Heard got diagnosed with Borderline Personality Disorder (BPD) during the Depp-Heard defamation trial. You may also have seen Netflix’s Crazy Ex-Girlfriend, where the impulsive, obsessive, but loveable protagonist Rebecca Bunch (played by Rachel Bloom) is diagnosed with the condition.
Trigger warning: discusses themes of suicide
Despite those things, it's likely that you’ve only got a vague idea of what BPD is all about. One 2022 study found that 1.6% of the population is thought to have BPD, making it as common as bipolar disorder and schizophrenia combined, but the condition is still poorly understood.
There is also a long history of stigma towards people with borderline personality disorder (BPD), perpetuated by films like Adrian Lyne’s Fatal Attraction or James Mangold’s Girl, Interrupted.
“People can think that you’re dangerous, because that's the perception that's in the media,” says Tess Linton, Chief Executive at Borderline Support UK. “In reality, only 5% of violent crime in this country involves mental illness. The idea that we're dangerous to anyone is just absurd.”
So what is BPD, and what are the key symptoms?
4 main symptoms of borderline personality disorder
Dr. Marsha Linehan, who invented the leading treatment for BPD (called dialectical behavioural therapy — more on that later), famously used the following metaphor to describe the reality of living with the condition. “People with BPD are like people with third degree burns over 90% of their bodies,” she said. “Lacking emotional skin, they feel agony at the slightest touch or movement.”
The symptoms of BPD are complex and feed into one another, but, according to the NHS, they can be grouped into the following four main areas:
Emotional instability
A key symptom of BPD is experiencing intense, changeable, negative emotions (read out guide to reframing negative thoughts, here). This is sometimes referred to as emotional dysregulation and can include feelings like rage, despair, shame, or panic. “Their emotions can be full-on and very changeable — they might move between extreme emotions within a few hours,” says Dr Beena Rajkumar, co-Chair of the Women’s Mental Health Special Interest Group at the Royal College of Psychiatrists.
Intense feelings of sadness and depression are also common among people with BPD. “Typically, people who have this problem struggle with a chronic sense of emptiness,” explains Dr Rajkumar. “They find it difficult to identify a time when they were last happy.” Tragically, about 70% of people with BPD attempt suicide at least once in their life, and 10% of that group will lose their lives to suicide.
Intense but unstable relationships
“People who have this problem tend to have had traumatic life experiences, and so they often have difficulties with relationships,” explains Dr Rajkumar. “The difficulties are not so much with forming relationships, but with sustaining them. They have a fear of abandonment and trust issues”.
This fear can present as constantly texting or calling someone, physically clinging on to them, or even threatening suicide to prevent them from leaving.
Another symptom of BPD that can have a major impact on relationships is black-and-white thinking. This is because it can lead people to view others, or themselves, as wholly good or bad. Borderline Support UK’s Linton explains that black and white thinking is sometimes called "splitting," and can quickly spiral.
“You’ll think that someone must love you or they must hate you, and that's it,” says Linton, who was diagnosed with BPD when she was 40. “If somebody cancels a lunch date, you’ll think, "They must hate me, they don't want to be my friend anymore. They don't care." And because you can't control that emotion, it spirals out of control. You end up thinking, ‘They hate me, why am I even here? What's the point? Everyone hates me, everyone leaves me’.”
She continues: “It sounds absurd when I say it now, as a person in recovery, but at the time this thinking leads to self-harm and suicidal thoughts. You can't control the emotion that's happening.”
Impulsive behaviour
BPD is associated with two main impulses: the impulse to self-harm (read our guide to how to help someone who is suicidal, here), and the impulse to act recklessly, whether that’s through substance abuse, excessive spending or gambling, or having unprotected sex with strangers.
Disturbed patterns of thinking or perception
Otherwise known as cognitive distortions and perceptual distortions, disturbed patterns of thinking or perception can range from thoughts that you are a bad person, to delusions like hallucinations or hearing voices. Delusions could be a sign that you’re becoming more unwell, so it's important to tell someone and find help if this starts happening.
Overgeneralising (e.g. "I failed one thing, therefore am bad at all of these things"), personalisation (taking everything extremely personally), and catastrophising (thinking the absolute worst of any situation) are all examples of disturbed patterns of thinking, according to Linton.
Another is dissociation, where you disconnect from yourself and the world around you. “Dissociation is quite a frightening thing because you don't have control of what's happening,” says Linton. “It's a way for your brain to cope with the distress that you're feeling, by switching off. You go on autopilot, but sometimes you're not aware of what's happened. You might arrive somewhere and not know how you got there. It can be quite distressing.”
Meanwhile, there are four recognised types of perceptual distortions:
- Halo effect — judging someone based on one trait or action, rather than on their personality as a whole
- Stereotyping — applying attributes or situations involving one person to a category of people (for example, "that relationship with a man was bad, all relationships with men must be bad")
- Selective perception — interpreting information to suit our own preconceptions
- Projection — putting our own traits/behaviours/feelings onto others
Do I have borderline personality disorder?
Some of the symptoms of BPD might be relatable to lots of people. “Many of us are passionate people who experience strong emotions,” says Dr Rajkumar. It’s when things are very “extreme” and “changeable” that we might want to take notice, she explains. Or if we’re distressed a lot of the time, or finding it difficult to hold on to jobs or relationships.
If you think you might have BPD, the first thing to do is speak to your GP about it. They might run health checks to make sure there isn’t a physical issue causing your symptoms. They should then refer you to the community mental health team, who can arrange for you to speak to a psychiatric nurse or a psychiatrist.
As mental health specialists, they’ll be able to do more in-depth assessments of your symptoms, as well as your general health and lifestyle, in order to reach a diagnosis.
Borderline personality disorder treatments
Dialectical Behavioural Therapy (DBT)
If you do have BPD, it can be reassuring to know that treatment for the condition tends to be very effective. “The best treatments are psychological talking treatments,” says Dr Rajkumar (Not sure where to start? Read our guide on how to find a therapist). “The therapy that has the best-researched evidence is dialectical behavioural therapy (DBT), because it teaches people four key skills and how to apply those to their lives and problems.”
Those skills are called core mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. They will enable you to respond to situations, rather than simply react, as well as to tolerate and manage powerful emotions. DBT also focuses on key relationship skills, such as how to set boundaries.
The results of treatment can be life-changing. “If somebody has this diagnosis, it doesn't mean that it's static,” says Dr Rajkumar. “I work with women who have this diagnosis and over the years I see people change, because personality is very dynamic. It can change through the help we receive, by the support that we have around us, or through a sense of meaning and purpose. Some people find they don't meet that diagnosis any longer."
"They can go on to have fulfilling relationships and build a life that's meaningful for them.”
It’s also worth noting that the way personality disorders are classified has changed, ever since the 11th edition of the International Classification of Diseases (ICD 11) came out in January this year. The new system aims to diagnose personality disorders more broadly based on severity and types of symptoms. The symptoms are grouped into five domains:
- Negative affectivity
- Detachment
- Disinhibition
- Dissociality
- Anankastia (obsessive/compulsive habits).
Someone could have symptoms from multiple domains, e.g. they could exhibit detachment and disinhibition. For now, healthcare providers are still using the term BPD, but this will likely change over time.
Living with BPD: "I've cried myself to sleep before because a friend hasn't replied"
DBT has been transformational for Hana, 20 from Birmingham, who was diagnosed with BPD when she was 18. Before treatment, she’d suffer from suicidal breakdowns, dissociation, and turbulent relationships. She couldn’t say no to things — including sex that she didn’t want — because she was so afraid that if she did she’d be abandoned. “I've cried myself to sleep because a friend hasn’t replied,” says Hana. “I’d get so worried that he was hurt or that he was mad at me.”
Now Hana is able to communicate with those closest to her so that they understand her needs, which prevents things from escalating. But she's told very few people in her personal life about her diagnosis.
“People will judge you for what you're doing rather than help you out," says Hana. "They think it’s the same as multiple personality disorder, or that you’re just attention seeking, or just being clingy.”
She continues: “‘I’ve felt so, so alone with having my diagnosis, because no one talks about personality disorders unless they have something horrible to say. It was so difficult to find anyone who understood me.”
Hana found solace in Borderline Arts, a Derby-based charity that runs various art and writing workshops for people with BPD. “They just help you with finding who you are outside of the BPD label,” says Hana. “I am a whole human being, I just have BPD as well.”
“We need to move away from stigma and blaming these people,” says Dr Rajkumar. “We are all shaped by our life experiences. And if people have negative life experiences, they will have difficulties and vulnerabilities.”
And after all, she adds, there is no such thing as a “perfect” personality. We could all, in our own different ways, benefit from greater understanding and compassion. As Dr Rajkumar puts it: “It's about moving away from what is wrong with you, to asking, what is your experience? What happened to you?”
