How to tell if someone has a borderline personality disorder

Misunderstood, fearing abandonment, on an emotional rollercoaster, and often suicidal – this is life for many people with borderline personality disorder (BPD), but there is a treatment that offers hope and restored quality of life.

BORDERLINE PERSONALITY DISORDER IS LESS WELL-KNOWN

According to Linda Christensen borderline personality disorder is less well-known, than other mental health conditions such as depression and anxiety.

“But it comes with debilitating symptoms that cause significant distress and unstable relationships, for both those diagnosed and their families and loved ones.”

She said up to 10% of patients suffering from borderline personality disorder die by suicide and at least 40% will make multiple attempts to take their own lives while self-harming behaviour such as cutting is a common means to release their intense emotional pain.

THERAPY AND MEDICATION OFFER A LIFELINE

“However, psychiatrist and South African Society of Psychiatrists (SASOP) member, Dr. Aneshree Moodley said long-term therapy together with the right medication, offered a lifeline for people living with a borderline personality disorder.

“Appropriate treatment can assist BPD patients to regulate their moods, emotions, and behavior,” she said.

According to Moodley, there are coping strategies that can be learned, resources for information, and networks for support for those living closely with a BPD patient.

One of several types of personality disorders, border personality disorder, is characterised by rigid and unhealthy patterns of thinking and behaving.

Individuals with border personality disorder have difficulty interpreting emotions and relating to people and life experiences, leading to unstable interpersonal relationships and difficulty in functioning at work and in social situations, Dr. Moodley explained.

She said, as with many mental health disorders, the cause of BPD was “a combination of nature and nurture”.

THE CAUSE OF BPD IS A COMBINATION OF NATURE AND NURTURE

“There are strong hereditary factors in the causes of most personality disorders. In terms of nurture, the individual’s early childhood environment, the form of parenting they experienced, and their early childhood development all play a significant causative role.

“A lot of emphasis also falls on the person’s attachment style, based on the nature of their childhood bond or connection with their primary caregiver.”

She said they commonly see a real or perceived sense of abandonment or rejection triggered, for example, by the death of a parent or a divorce during the person’s early childhood, which leads to the pervasive feelings of rejection or abandonment experienced in borderline personality disorder.

For people with borderline personality disorder, the fear of abandonment is deep-seated and chronic, and they will respond with intense emotion and behaviour to real or perceived rejection, she furthermore said.

THE FEAR OF ABANDONMENT IS DEEP-SEATED AND CHRONIC

Dr Moodley said it was important to distinguish between the feelings of rejection that many people experience occasionally, and the BPD patient’s “constant stream of thoughts of being rejected and abandoned” in response to everyday events.

“The BPD patient’s response is not like a once-off reaction which could be explained or contextualised by a person being under more stress than usual, for example. This is a deep fear, a regular, frequent pattern of interpreting some small incident – such as a partner being a few minutes late for a date – as utter abandonment, resulting in accusations and angry outbursts that are disproportionate to the situation.

“The person with BPD may threaten to block the other person or end the relationship, and in extreme cases make threats to self-harm or commit suicide.

“Meanwhile, the other person is often left completely befuddled because the reaction is out of all proportion. This is one of the aspects that makes it difficult to live with someone who has BPD,” Dr. Moodley said.

She said feelings of rejection for individuals with BPD were a daily, if not hourly, occurrence.

“It’s constant and it’s disruptive emotionally, socially and in their work lives. They feel a constant, intense psychological sense of being emotionally tortured.”

Here are some core characteristics of border personality disorder:

• A person with a borderline personality disorder is unable to regulate their thoughts and feelings, and many describe a sense of emptiness, hollowness, or numbness.
• They also display impulsive and reckless behaviour such as impulsive eating or abuse of alcohol and/or drugs, reckless driving, impulse buying, out-of-control gambling or impulsive, disinhibited sexual behaviour.
• Unlike other personality disorders, such as narcissism, individuals with BPD do feel intense remorse, guilt and shame, deepening their fear that their behaviour will lead to further rejection or abandonment.

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Dr Moodley said it was important that a medical diagnosis of BPD – or any other personality disorder – be made by a professional such as a psychiatrist or clinical psychologist, as several different conditions could have similar outward symptoms but different causes, requiring different treatment strategies.

Dr Moodley said treatment for borderline personality disorder was “a long road to walk”.