Diagnosing a borderline personality

Borderline personality disorder (BPD) is a type of personality or character disorder.

An individual might be diagnosed with a personality disorder if they have severe difficulties with how they think and feel about themselves and other people, and are having problems in their life as a result.

BPD is also known as emotionally unstable personality disorder (EUPD). People have different views on BPD/EUPD, and it can be a controversial diagnosis.

But however we understand these experiences, and whatever terms we prefer to use (if any), the important thing to remember is that the feelings and behaviours associated with BPD/EUPD are very difficult to live with, and deserve understanding and support.

When is it diagnosed?

A diagnosis of BPD is given if somebody experiences at least five of the following symptoms, and they’ve lasted for a long period and/or have a major impact on their daily life:

Constantly feeling very worried about being abandoned by others, and doing anything to stop that happening.

Having very intense emotions that last from a few hours to a few days and can change quickly (for example, from feeling very happy and confident to suddenly feeling low and sad).

Don’t have a strong sense of who they are, and this can change significantly depending on who they are with.

Finding it very hard to make and keep stable relationships.

Feeling empty a lot of the time.

Acting impulsively and doing things that could harm (such as binge eating, using recreational or other drugs or driving dangerously).

Often self-harming or having suicidal feelings.

Having very intense feelings of anger, which are really difficult to control.

When very stressed, the person may experience paranoia or dissociation.

Different views on diagnosis

Because only five of these difficulties are needed to be given a diagnosis of BPD or EUPD, it can be a very broad diagnosis which includes lots of different people with very different experiences.

Some people find it helpful to have a diagnosis because they feel it explains and helps people to understand their difficulties, or gives them a sense of relief and validation. Others feel a diagnosis isn’t helpful, finding it stigmatising.

What causes BPD?

There’s no clear reason why some people experience difficulties associated with BPD. More women are given this diagnosis than men, but it can affect people of all genders and backgrounds.

Researchers think that BPD is caused by a combination of factors, including:

Stressful or traumatic life events more specifically in early childhood.

Genetic factors – including a parent with severe mental health problems.

As a child often feeling very afraid, upset, unsupported or invalidated in their home especially.

Family difficulties or instability, such as living with a parent who has an addiction.

Sexual, physical or emotional abuse or neglect.

Early loss of a significant caregiver.

Many people might also experience BPD without having any history of traumatic or stressful life events, or they might have had other types of difficult experiences. Stress or trauma as an adult can exacerbate these feelings and thoughts.

Genetic factors

Some evidence suggests that BPD could have a genetic cause.

People are more likely to be given this diagnosis if someone in their close family has also received it. But it’s very hard to know if difficulties associated with BPD are inherited from parents or caused by other factors, such as the environment you grow up in or the ways of thinking, coping and behaving that you learn from caregivers.

A combination of factors could be involved. Genetics might make you more vulnerable to developing BPD, but often it’s due to stressful or traumatic life experiences that these vulnerabilities are triggered and become a problem.

Very often people with BPD think, act or feel:

Lonely and afraid.

Overwhelmed by the strength of their emotions and how quickly they change like there is something inherently wrong with them, and it’s their fault if bad things happen because they must deserve it.

That they don’t know what they want from life, or what they like or dislike.

Like they are intrinsically a bad person, or not a real person at all.

Like they are a child in an adult world.

Common behavioural responses are:

Self-harming or attempting suicide.

Overspending or binge eating.

Using recreational drugs, alcohol or smoking to try to cope with difficult emotions

Quitting just before achieving something, or avoiding activities where they think they might fail or be disappointed.

Often changing jobs, hobbies, goals or plans.

Keeping very busy so never being alone.

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Difficult feelings and behaviour towards others

Some people may think or feel:

That friends or partners will leave them forever if they are angry or upset with them.

Like no one understands them or they are not like other people and will never be able to understand others.

That people are either completely perfect and kind, or bad and hurtful, and there’s no middle ground (this is sometimes called splitting, or black-and-white thinking)

Like the world is a scary and dangerous place, and they want to run away and hide.

Some people with BPD might be more likely to misuse drugs and alcohol to cope. In the long run this is counterproductive.

It’s also common to experience other mental health problems alongside BPD.

Carin-Lee Masters is a clinical psychologist. Write to her at helpmecarin@inl.co.za or send a WhatsApp message or SMS to 082 264 7774.