Borderline Personality Disorder

Borderline personality disorder (also known as emotionally unstable personality disorder) is a common diagnosis for people who self-harm. Broadly speaking, a person with BPD has personality traits which contribute to symptoms of unstable relationships, unstable self-image, mood swings and impulsive, self-destructive behaviour. People with BPD may experience very stong, overwhelming emotions and have difficulty in coping with these.

The DSM criteria for diagnosing BPD are:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

3. identity disturbance: markedly and persistently unstable self-image or sense of self

4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7. chronic feelings of emptiness

8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9. transient, stress-related paranoid ideation or severe dissociative symptoms

Source: http://www.borderlinepersonalitytoday.com/main/dsmiv.htm

BPD and Self-Harm

As you can see from the criteria above, self-harm is only one symptom of BPD, and a person must have at least four other symptoms to be diagnosed. Despite this, some doctors claim that if someone self-harms it’s almost certain they have BPD. This may be due to a lack of understanding about self-harm and the many different reasons why people do it. Some treatments for BPD (such as dialectical behaviour therapy) may be helpful for other self-harmers, but if you think you’ve been wrongly diagnosed with BPD and are not getting appropriate treatment, try to get a second opinion; if you’re in the UK, see our NHS page for details.

The following pages provide more information on the links between BPD and self-harm:

BPD and Self-Injury
A discussion of BPD and self-injury, which argues that people who self-injure are often wrongly diagnosed with BPD. See also Gunderson’s conception of BPD on the same site.

The Quiet Borderline
A look at how the “quiet” borderline is different from the “average” borderline. (Many self-injurers diagnosed with BPD will fit into this category.)

Is It Possible to Recover from BPD?

In a word, yes! In the past, it was thought that people could not recover from personality disorders such as BPD, but that view is outdated. In recent years many websites and books have appeared chronicling individuals’ recovery from BPD and sharing the treatments and strategies they used. Websites run by recovered borderlines include BPDRecovery.com and BPD From the Inside Out; books include Get Me Out of Here by Rachel Reiland.

Specialist treatments for BPD include dialectical behaviour therapy (DBT), STEPPS and mentalisation-based therapy, although not everyone who recovers goes by these routes.

However, recovery from BPD may only be possible if the person accepts they have a problem and is willing to put in a lot of hard work in therapy.

For more information, see the article The Controversy and the Reality about Recovery from BPD on AJ Mahari’s website.

Self-Help & Support

DBT Coping Skills
Sirius Project’s own page about learning coping skills from DBT therapy. Also check here for details of other DBT resources, including a free online programme.

BPDRecovery.com
A brilliant site with information, self-help “tools” and a message board for those trying to overcome BPD.

Borderline UK
A user-led network of people within the UK who meet the criteria for or have been diagnosed with BPD. Provides information and support.

National Personality Disorder Website
Information, resources and learning opportunities on all personality disorders. Includes details of specialist treatment programmes in the UK.

See also our book store for details of BPD self-help books.

Further Information

Understanding Borderline Personality Disorder
An online booklet from the UK charity Mind which explains the disorder and the help available.

Middle Path
Excellent visual information on BPD, treatments and recovery.

Helen’s World of BPD Resources
Vast collection of links and resources for BPD sufferers and their friends and families.

What’s the Difference Between Bipolar Disorder and BPD?
Discusses the overlap between these two conditions and the implications for treatment.