Borderline Personality Disorder - A Misunderstood and Stigmatised Illness

Borderline Personality Disorder (BPD) is a type of mental illness. It is characterised by ongoing instability in the areas of interpersonal relationships, self-image and impulsivity (APA 2013).

The term ‘borderline’ was first used in the era of psychoanalysis when the condition was thought to exist on the border of psychosis and neurosis - BPD is now understood to be a disorder in its own right (Malcolm 2014).

It is estimated that 1-4% of the Australian population are living with BPD (Better Health Channel 2019). Approximately 10% of psychiatric outpatients are estimated to have BPD. The rate is close to 20% for people who are inpatients on mental health wards (Sane Australia 2016).

People living with BPD may experience difficulty in controlling impulses and emotions, relating to people and maintaining a stable self-image (Sane Australia 2016).

Generally, the symptoms of BPD first appear during teenage years or early adulthood (Sane Australia 2016).

Women are more likely than men to be diagnosed with BPD (Sane Australia 2016).

The intense, unstable nature of BPD can alienate those living with the condition, causing them to feel isolated and therefore increasing the risk of self-harm and suicide (Belmont Private Hospital n.d.).

BPD may be one of the most stigmatised mental illnesses, this stigma is likely a result of the following three factors:

• BPD has been poorly understood since the term was coined in the 1920s and the condition was initially considered ‘untreatable’.
• People with BPD have behaviours that are sometimes difficult for clinicians to handle, as people who have BPD may exhibit antisocial and/or aggressive behaviour.
• The high level of self-harm and suicidality of patients with BPD marks them as particularly at-risk.

(Beatson quoted by Malcolm 2014)

BPD can be extremely distressing for the person affected, as well as for their family and friends. Fortunately, there are treatments available for BPD, furthermore, people with BPD have a high recovery rate following diagnosis and treatment (Sane Australia 2016).

How Does BPD Present?

Common features of BPD are instability regarding:

• Self-image;
• Personal goals; and
• Interpersonal relationships.

This instability is accompanied by impulsivity, risk-taking and/or hostility. The person living with BPD will present with difficulties in regard to identity, self-direction, empathy, and/or intimacy.

(APA 2013)

DSM-5 Diagnostic Criteria for BPD

To form a diagnosis, the above-mentioned patterns of unstable interpersonal relationships, goals, self-image and marked impulsivity will be indicated by five or more of the following:

• Erratic attempts to avoid abandonment (real or irrational).
• Marked and ongoing unstable self-image or sense of self.
• Impulsivity in at least two areas that could cause self-harm (or example, reckless spending, reckless sex, substance abuse, reckless driving or binge eating).
• A series of interpersonal relationships that are unstable and intense.
• Recurrent suicidal behaviour, gestures, threats or self-mutilating behaviour.
• Instability as a result of a marked reactivity of mood (for example, intense episodic dysphoria, irritability or anxiety usually lasting a few hours).
• Persistent feelings of emptiness.
• Intense or uncontrollable anger (for example, frequent displays of temper, constant anger or recurrent physical fights).
• Impermanent, stress-related paranoid ideation or severe dissociative symptoms.

(APA 2013 quoted by Australian BPD Foundation Limited)

Causes of BPD

There isn’t a singular known cause of BPD (Sane Australia 2016).

While BPD was previously believed to be directly caused by abuse or neglect in childhood, more recent research indicates that it is instead a complex combination of factors, including genetic predisposition, developmental or psychological problems, neglect, abuse, or trauma during childhood, that make certain people more susceptible to developing BPD (Sane Australia 2016).

Treatment for BPD

The primary treatment for people living with BPD is psychological therapy. The aim of these therapies is to help people achieve a better understanding of their feelings, responses and behaviours (Sane Australia 2016).

Living with BPD can make a person feel that they have little control over their life. For this reason, establishing good routines, such as eating healthily, exercising and getting sufficient sleep can help a person regain a sense of control (Sane Australia 2016). Typically, the symptoms of BPD ease with age (Belmont Private Hospital n.d.).

Additional Resources

• If you’re in crisis and need support, call Lifeline on 13 11 14. Lifeline is open 24 hours a day, 7 days a week.
• Australian BPD Foundation Limited, https://bpdfoundation.org.au/
• Sane Australia, BPD Fact Sheet, https://www.sane.org/information-stories/facts-and-guides/borderline-personality-disorder?tmpl=component&print=1
• Sane Australia, Mental Health Guide for Families, Friends and Carers, https://www.sane.org/information-stories/facts-and-guides/families-friends-carers

References

• Australian BPD Foundation Limited, BPD Diagnostic Criteria, Australia BPD Foundation Limited, viewed 6 January 2020, https://bpdfoundation.org.au/diagnostic-criteria.php
• Belmont Private Hospital n.d., Borderline Personality Disorder, Belmont Private Hospital, viewed 6 January 2020, https://belmontprivate.com.au/specialties/borderline-personality-disorder/about-borderline-personality-disorder
• Better Health Channel 2019, Borderline Personality Disorder, Better Health Channel, viewed 6 January 2020, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/borderline-personality-disorder
• Malcolm, L 2014, ‘Borderline Personality Disorder’, ABC All in the Mind, viewed 6 January 2020, https://www.abc.net.au/radionational/programs/allinthemind/borderline-personality-disorder/5881922
• Sane Australia 2016, Borderline Personality Disorder, Sane Australia, viewed 6 January 2020, https://www.sane.org/information-stories/facts-and-guides/borderline-personality-disorder#factsheet