Updated on 24. January 2022 from ÁYIO-Q Redaktion
Reading time: approx. 20 minutes
Get back a life without inner and outer conflicts.
When you have borderline personality disorder (BPD), everything feels unpredictable: Your relationships, moods, assumptions, actions – even your identification. But there is hope, and this guide to signs and symptoms, treatment and recovery can help too.
- Risk Factors
- Diagnosis & Treatment
- Help for family & friends
- 3 important tips for self-help
What is borderline personality disorder (BPD)?
Experts estimate that borderline personality disorder affects 3% of the population worldwide. Compared to other mental illnesses such as anxiety and generalised stress and anxiety disorder, these are relatively few. Nevertheless, BPD is one of the most common diagnoses for admission to psychiatric hospitals. Due to high levels of distress and concerns about self-harm, many sufferers seek psychiatric or psychotherapeutic treatment. Many people have had suicidal thoughts for years. More than half of them try to take their own lives at least once – but usually repeatedly. About 5 percent of those affected die by self-destruction.
The highest incidence of BPD, at least 6 percent, is found in young adults. Although the majority of those who seek help in therapy centres are female, experts assume that both sexes become ill with about the same regularity.
If you have borderline personality disorder (BPD), you probably feel like you’re on a rollercoaster – and not just because of your volatile feelings or relationships, but also because of the fluctuating sense of who you are. Your self-image, your goals and even your likes and dislikes can change regularly in ways that feel complicated and uncertain.
People with BPD tend to be extremely sensitive. Some describe it as a kind of hard-to-bear sensation. Small things can trigger intense reactions. And once you get upset, it’s hard to calm down. It is understandable that this emotional volatility and lack of ability to calm oneself leads to relationship turmoil and spontaneous – even negligent – actions.
When you are overwhelmed by overwhelming emotions, you are unable to think a clear thought or stay grounded. You may then say disturbing things or behave in dangerous or inappropriate ways, so that you later feel really guilty or embarrassed. It’s a painful cycle that’s hard to escape. However, this is not the case. There are BPD therapies and also skills that can help you really feel better and regain control over your ideas, feelings and actions.
BPS is treatable!
In the past, many mental health experts found borderline personality disorder (BPD) difficult to deal with and ultimately felt that little could be done. Today, however, we know that BPD is treatable. In fact, the long-term prognosis for BPD is far better than that for anxiety and bipolar affective disorder. Still, it requires a specific approach. The bottom line is that most people with BPD can and do get better – and quite quickly with the right therapies and support.
Recovery is about breaking the inefficient patterns of thinking, feeling and acting that cause you distress. It is a challenge to change lifelong habits. Deciding to pause for a moment, reflect and then act in a new way will certainly feel unnatural and also uncomfortable at first. Over time, however, you will develop brand new habits that will help you maintain your mental balance and stay in control.
Recognising borderline personality disorder.
Can you identify with the following statements?
- I often feel “empty”.
- My feelings change very quickly and I am often very unhappy, angry, stressed and anxious.
- I am constantly afraid that the people who are important to me will leave me or turn away from me.
- I would describe most of my close relationships as extreme but unstable.
- The way I feel about the people in my life can change significantly from one minute to the next – and I very rarely understand why.
- I usually do things that I recognise as threatening or harmful, such as driving carelessly, having risky sex, binge drinking, taking medication or investing.
- I have tried to self-harm myself, participated in self-harming activities, such as reduction, or been suicidal.
- When I feel really insecure in a relationship, I tend to cling or do spontaneous actions to keep the other person with me.
If several of these statements apply to you, you could be suffering from borderline personality disorder. Of course, you need a mental health professional to make an official diagnosis, as BPD can easily be confused with various other problems. But even without a diagnosis, you can helpfully apply the self-help suggestions in this post to calm your inner mental storm and figure out how to deal with self-harming impulses.
Signs and Symptoms of Borderline Personality Disorder.
Borderline personality disorder (BPD) manifests itself in different ways, but for diagnosis, mental health experts group the signs and symptoms into nine important categories. To be diagnosed with BPD, you must have at least 5 of these signs and symptoms. In addition, the symptoms should be long-lasting (usually starting in your teens) and affect many areas of your life.
The 9 signs of BPD:
Fear of abandonment
People with BPD are often very afraid of being abandoned or left alone. Even something as harmless as a loved one’s late return from work or absence over the weekend can cause intense anxiety. This can lead to agitated efforts to keep the other person close. They may ask, cling, pick fights, follow the loved one’s activities or even physically prevent them from leaving. Unfortunately, these actions usually have the opposite effect – they drive the other person away.
People with BPD often tend to have extreme and also short-lived relationships. They may fall in love quickly and think that any newcomer is the one who will make them feel whole, only to be quickly disappointed. Their relationships seem either ideal or terrible, with no middle ground. Your acquaintances, close friends or family members may feel like they have emotional whiplash as a result of your rapid swings from idealisation to devaluation, anger and hatred.
Unclear or changing self-image
If you suffer from BPD, your self-image is usually unstable. Occasionally you feel very good about yourself, but at other times you dislike yourself or may see yourself as evil. You may not have a clear idea of who you are or what you want in life. Therefore, you may regularly change your job, your good friends, your lovers, your religion, your value, your goals or perhaps your sexual identity.
Impulsive, self-destructive habits
With BPD, you may engage in insecure, sensation-seeking behaviours, especially when you are distressed. You may impulsively invest money you can’t manage, eat too much, drive recklessly, steal, have risky sex or overdo it with drugs or alcohol. These risky actions may make you feel better in the moment, but they harm you and those around you in the long run.
Self-destructive behaviour and deliberate self-harm are common in people with BPD. Self-destructive acts consist of suicidal thoughts, suicidal gestures or risks, or actually attempting suicide. Self-harm includes all other attempts to harm oneself without suicidal intent. Common forms of self-harm are cutting and burning.
Severe mental fluctuations
Unstable emotions and moods are prevalent in BPD. One minute you can feel happy, the next hopeless. Small things that are rejected by others can throw you into an emotional whirlpool. These emotional swings are extreme, but often pass relatively quickly (unlike the mental swings of clinical depression or bipolar disorder) and usually last only a few minutes or hours.
Chronic Feelings of Emptiness
People with BPD often report a feeling of emptiness, as if there is an opening or space inside them. In extreme cases, you can really feel like you are “nothing” or “nobody”. This feeling is unpleasant, so you might try to fill the emptiness with things like medication, food or sex. But nothing really feels pleasant.
If you suffer from BPD, you may struggle with intense anger and a temper. You may also have difficulty controlling yourself once the fuse is lit – shouting, throwing objects or being completely overcome by rage. It is important to note that this temperament is not constantly outward. You can spend a lot of time getting angry at yourself.
A sense of being in doubt or out of touch with the truth.
People with BPD typically struggle with paranoia or doubtful thoughts about the motives of others. If you suffer from anxiety, you may even lose touch with the truth – an experience called dissociation. You may then feel woozy, absent or as if you are outside yourself.
Typical concomitant disorders in BPD.
Borderline personality disorder is rarely diagnosed alone. Common concomitant disorders are:
When BPD is treated effectively, the other problems often improve. But the opposite is not always the case. For example, you can successfully deal with signs of clinical depression and still have problems with BPD.
What are the causes of borderline personality disorder?
Many mental health professionals believe that borderline personality disorder (BPD) is caused by a combination of acquired or internal biological factors and also external environmental factors, such as childhood.
Several complicated things take place in the brains of those affected, and researchers are still deciphering the connections. Basically, though, when you have BPD, your brain is put on high alert. Things feel much scarier and more challenging for you than they do for other people. Your fight-or-flight switch is easily triggered, and once it is on, it robs you of your rational mind and causes primitive survival impulses that are not always appropriate to the situation.
This can make it seem like you can do absolutely nothing. However, the truth is that you can change your mind. Every time you practise a new coping feedback or self-soothing method, you develop brand new neural connections. Some therapies, like mindfulness reflection, can even expand your brain matter. And the more you practice, the more powerful and automatic these connections become. So don’t give up! With time and commitment, you can change the way you believe, really feel and act.
Personality disorders and Stigmatisation
When psychotherapists talk about “character”, they are describing the patterns of thought, feeling and behaviour that make each person unique. No one behaves the same way all the time, but we often tend to connect and interact with the world in fairly consistent ways. This is why people are typically described as “shy”, “outgoing”, “careful”, “fun-loving” and so on. These are components of character.
Because individuality is so fundamentally linked to identification, the term “personality disorder” might give the impression that there is something fundamentally wrong with who one is. But a personality disorder is not a judgement about personality. In technical language, “personality disorder” means that your pattern of connecting with the world is dramatically different from the norm. (Simply put, you don’t behave the way most people expect). This leads to constant problems in various areas of your life, e.g. in your partnership, at work and in dealing with yourself and others. But the most important thing is that these patterns can be changed!
The cause of borderline personality disorder is not yet clear, but research suggests that genes, the structure and function of the psyche, as well as environmental, social and also societal variables may play a role or increase the risk of developing BPD.
- Familial factors: People who have a close family member with this disorder, such as a parent or sibling, may be at greater risk of also developing borderline personality disorder.
- Psychological factors: Research shows that individuals with borderline personality disorder may have both structural and cognitive changes in the brain, particularly in the areas that control impulses as well as emotional processes. However, it is unclear whether these changes are threat aspects of the condition or are caused by the disorder.
- Environmental, cultural and social factors: Many people with borderline personality disorder report stressful life events such as abuse, abandonment or unhappiness in childhood. Others may have been exposed to unpredictable relationship break-ups and aggressive conflict.
Although these aspects may increase a person’s risk, it does not mean that the person is certain to develop borderline personality disorder. Furthermore, there may be individuals who do not exhibit these aspects of danger and yet will develop borderline personality disorder in the course of their lives.
Medical diagnosis & treatment of borderline personality disorder
It is important to remember that you cannot recognise borderline personality disorder yourself. So if you suspect that you have borderline personality disorder, it is best to seek expert help. BPD is often overlaid or overlapped with other disorders, so you need a mental health professional to assess you and make an accurate diagnosis. Look for someone who has experience diagnosing and treating BPD.
The importance of finding the ideal specialist
The support and help of a qualified therapist can make a big difference in your treatment and recovery from BPD. Therapy can be a risk-free space where you can begin to overcome your attachment, and where you can also rely on your worries and ‘try out’ new coping methods.
An experienced professional knows about BPD treatments such as dialectical behaviour therapy and schema-focused treatment. However, although these treatments have been shown to be helpful, it is not always necessary to follow a particular therapy strategy. Many professionals believe that most cases of BPD can be treated with regular counselling about the problem, home support and social and emotional skills training.
It is very important to take the time to find someone who understands you and makes you feel accepted and appreciated. Take your time to find the ideal person. Once you have found them, commit to therapy. You may start out thinking that your specialist is your hero, only to become disillusioned and feel that they have nothing to offer. Remember that these swings between idealisation and demonisation are a sign and symptom of BPD. Try to ride it out with your therapist and let the partnership grow. Also remember that change is inherently uncomfortable. If you are not comfortable in therapy, you are unlikely to make progress.
Do not rely on drug treatment
Although many people with BPD take medication, the truth is that there are very few studies showing that it is helpful. What’s more, in the US, the Food and Drug Administration (FDA) has not approved any medications for the treatment of BPD. This does not mean that medication is never useful – especially if you are struggling with co-occurring problems such as anxiety or agitation – but it is not a cure for BPD itself.
When it comes to BPD, therapy is much more efficient. You just have to give it time. Nevertheless, your doctor may consider drug treatment if:
- You have been diagnosed with both BPD and anxiety or bipolar disorder.
- You are struggling with panic attacks or severe anxiety.
- You start imagining things or having strange, paranoid ideas.
- You feel self-destructive or are in danger of hurting yourself or others.
Therapy for friends and family members
Relatives and friends of people with borderline personality disorder can also benefit from treatment. Having a relative or loved one with the problem can be difficult, and family members or friends may inadvertently act in ways that can increase the signs and symptoms of the person with the disorder.
Some treatments for borderline personality disorder involve family members, friends or loved ones attending therapy sessions.
This type of therapy helps by:
- Enabling the loved one or friend to develop skills to better understand and also support a person with borderline personality disorder
- Focusing on the needs of family members to help them identify barriers as well as techniques for supporting a person with borderline personality disorder. Although further studies are needed to determine the effectiveness of family treatment for borderline personality disorder, research studies on other mental disorders suggest that involving family members in a person’s therapy can be helpful.
Tips for the family & also for friends
This is how you help a good friend or family member who is suffering from the disease:
- Offer emotional support, understanding, patience and inspiration – change can be difficult and also frightening for people with borderline personality disorder, but it is possible for them to gradually improve
- Educate yourself about mental illness, including borderline personality disorder, so that you can understand what the person with the disorder is experiencing
- Encourage your relative who is in therapy for borderline personality disorder to inquire about family therapy
- Seek therapy with a specialist yourself. It does not have to be the same as the therapist your loved one with borderline personality disorder sees
Tips for self-help: 3 ways to cope with BPD.
With many invaluable exercises
- Calm the emotional storm
- Find out how to manage your impulsivity and endure your distress
- Improve your interpersonal skills
Tip 1: Calm the emotional storm.
As someone with BPD, you have most likely spent a lot of time fighting your impulses and feelings, so it can be difficult to accept your feelings. But accepting your feelings does not mean allowing them or giving in to suffering. It simply means that you stop trying to eliminate, suppress or deny your feelings. If you give yourself permission to have these feelings, you can take away much of their power.
Try to simply experience your sensations without judging or criticising. Let go of the past and the future and focus specifically on the present moment. The following can be applied very reliably here:
- Start by observing your emotions, as if from the outside.
- Enjoy how they come and go (it can help to think of them as waves).
- Focus on the physical experiences that accompany your feelings.
- Tell yourself that you approve of what you are really feeling right now.
- Realise that the fact that you feel something does not mean that it is true.
Do something that stimulates several of your senses
Appealing to your senses is one of the quickest and easiest ways to instantly calm yourself. You will need to experiment to find out. You will also need different strategies for different states of mind. What helps you when you are angry or upset is very different from what helps you when you are numb or morbidly depressed. Here are some concepts to get you started:
- Touch: If you don’t feel enough, run cool or hot (but not scalding hot) water over your hands, hold a piece of ice in your hand or grip an object or the edge of a piece of furniture as hard as you can. If you really feel too much and need to relax, take a hot bath or shower, snuggle under the covers or cuddle a pet
- Taste: If you’re feeling really empty and numb, try sucking on strong-tasting mints or sweets, or slowly eating something with an extreme taste, such as salt and vinegar crisps. If you want to cool down, try something soothing like hot tea or soup
- Smell: Light a candle, smell flowers, try aromatherapy, spray your favourite scent or whip up something in the kitchen that smells good. You may find that you respond best to intense scents like citrus, spices and incense
- Sight: Focus on an image that catches your interest. This can be something in your immediate environment (a great view, a beautiful flower, a favourite colour or picture) or something in your creative imagination that you visualise
- Sound: Try listening to loud songs, humming or whistling when you want a boost. To calm yourself down, turn on relaxing music or listen to soothing nature sounds such as wind, birds or the sea. A sound machine works well when you can’t hear the actual thing.
Reduce your psychological vulnerability.
You are more likely to experience unfavourable emotions when you are weakened and under stress. This is why it is so important to take care of your physical and mental well-being.
Look after yourself by:
- Avoiding mood-altering drugs
- Eating a balanced, nutritious diet
- Getting plenty of good sleep
- Exercise regularly
- Minimise stress and anxiety
- Practice relaxation exercises
Tip 2: Learn to regulate your impulsivity and tolerate stress
The calming strategies discussed above can help you relax when you start to be thwarted by anxiety. But what do you do when you are confused by challenging sensations? This is where the impulsivity of borderline personality disorder (BPD) can come to the fore. In the heat of the moment, you’re so desperate for relief that you’ll do anything, even things you know you shouldn’t – like cutting, negligent sex, unsafe driving and binge drinking too. It can also feel like you have no choice.
You are no longer in control of your actions, but in control of yourself
It is important to recognise that these impulsive actions have a function. They are a means of coping with distress. They make you feel better, if only for a brief moment. But the price one pays for this is extremely high.
Regaining control over your actions starts with learning to tolerate distress. This is the key to overcoming the harmful patterns of BPD. The ability to endure distress will certainly help you to take a break when you feel the urge to snap. Instead of reacting to difficult emotions with self-destructive actions, you will figure out how to endure them while continuing to be in control of the experience.
For a step-by-step, self-directed programme that teaches you how to ride the “wild steed” of frustrating feelings, take a look at our free toolkit. The toolkit shows you exactly how to:
- Connect with your emotions
- Be able to deal with emotional intensity
- To take care of unwanted or harmful sensations
- Remain calm and focused even in stressful situations
The toolkit will show you how to endure distress, but it doesn’t end there. It will additionally show you how to move from mental compartmentalisation to fully experiencing your feelings. This will allow you to experience the full range of positive feelings such as joy, peace and satisfaction, which are also cut off when you try to avoid unfavourable feelings.
When the fight-or-flight response is triggered, there is no other option but to get calm. Do not focus on your thoughts, but on what you feel in your body. The following grounding training is a simple, quick way to curb impulsivity, calm down and regain control. It can make a big difference in just a few minutes.
- Find a quiet place and a comfortable position
- Focus on what you feel in your body. Really feel the surface you are sitting on. Feel your feet on the floor. Feel your hands in your lap
- Concentrate on your breathing, inhale slowly and deeply. Breathe in slowly. Count to four. Then breathe out gradually, counting to six. Continue like this for a few minutes
In an emergency, distract yourself.
If your attempts to calm down don’t work and you start to feel overwhelmed by destructive urges, it can help to distract yourself. All you need is something to hold your attention until the negative impulse is gone. Anything that grabs your attention can work, but the distraction is most reliable if the activity is also calming. In addition to the sensory techniques already mentioned, there are a few things you can try:
- Watch TV. Choose something that is the opposite of what you really feel: a comedy if you feel unhappy, or something relaxing if you are angry or worried.
- Do something that you enjoy and keeps you active. This can be anything: Gardening, painting, playing an instrument, knitting, reading a magazine, playing a video game or solving a Sudoku or word problem.
- Throw yourself straight into work. You can additionally distract yourself with chores and errands: cleaning the house, gardening, shopping at the supermarket, brushing the dog or doing laundry
- Get moving. A strenuous workout is a healthy way to get your adrenaline pumping and blow off steam. If you’re feeling anxious, you can also try relaxing activities like yoga or a walk around the neighbourhood.
- Call a close friend. Talking to someone you trust can be a quick and very effective way to distract yourself, really feel better and also gain a point of view.
Tip 3: Improve your social skills.
If you suffer from borderline personality disorder, you most likely have problems having stable, long-lasting partnerships with lovers, partners and also friends. This is because you have problems empathising with other people and understanding their point of view. You tend to misinterpret the thoughts and feelings of others, misunderstand how others see you and ignore how they are affected by your actions. It’s not that you don’t care, but when it comes to other people, you have a big blind spot. The first step is to admit this blind spot to yourself. When you stop blaming others, you can start taking action to improve your partnerships and also your social skills.
Check your assumptions
When you are hindered by stress and anxiety as well as negativity, as is often the case with people with BPD, it is very easy to misinterpret the intentions of others. If you recognise this tendency, you should check your assumptions. Remember that you cannot read minds! Instead of rushing to (generally unfavourable) judgements, consider different inspirations. Let’s say, for example, that your partner suddenly spoke to you on the phone and you now feel insecure and fear that he does not like you.
Before the action on these sensations:
- Think of the different possibilities. Maybe your partner is under pressure at work. He may be having a difficult day. Maybe he hasn’t had his coffee yet. There are many different descriptions for his behaviour.
- Ask the person to clarify their intentions. One of the easiest ways to check your assumptions is to ask the other person what they suspect or feel. Check what the person has implied by their words or actions. Don’t ask accusingly, but try a softer approach: “I could be wrong, but I have a feeling that …” or “Maybe I am very sensitive, but I have a feeling that …”.
Stop the Prediction
Do you tend to pass on your unfavourable feelings to other people? Do you lash out at others when you feel bad about yourself? Do comments or positive criticism feel like a personal attack? If so, you may have an assessment problem.
To fight projection, you have to learn to put the brakes on – similar to what you did to curb your spontaneous habits. Listen to your feelings and the physical experiences in your body. Look for signs of anxiety, such as rapid heartbeat, tightening of muscle tissue, sweating, nausea or lightheadedness. If you feel like this, there is a good chance you will go on the attack and say something you will regret later. Stop and take a few slow, deep breaths. Then ask yourself the following three questions:
- Am I dissatisfied with myself?
- Do I feel ashamed or scared?
- Am I desperate because I feel abandoned?
If the answer is “yes”, pause the conversation. Tell the other person that you are really uncomfortable and would like some time to think before discussing further.
Take responsibility for your role
Finally, it is very important that you take responsibility for the role you play in your partnership. Ask yourself how your actions can contribute to problems. How do your words and actions affect your loved ones? Do you fall into the trap of seeing the other person as either only excellent or only negative? If you take the initiative to put yourself in the other person’s shoes, allow them the benefit of the question and lower your defensiveness, you will notice a difference in the quality of your relationships.
In what way do people with BPD behave?
For sufferers with borderline personality disorder, life is like an unstoppable rollercoaster ride. They struggle with regular, severe mood swings, their habits are spontaneous, and in many cases they also hurt themselves.
What is the origin of borderline?
Often one or more terrible experiences (e.g. sexual abuse) are the trigger. Experiences of loss in adolescence, emotional forgetting, conflicts in adolescence and an overprotected childhood can also be causes of borderline problems.
What types of borderline are there?
The World Health Organisation (WHO) distinguishes between 2 borderline types: the impulsive borderline type, which is mainly characterised by impulsivity and changeability, and the borderline type, which is mainly defined by a disturbed self-image and attachment behaviour.
How exactly do borderliners react to rejection?
An endogenous hormone normally dampens the reaction to this. Patients with borderline personality disorder are very sensitive to real or perceived rejection by their environment.
Can borderline personality disorder be cured?
Therapy seemed to be able to do little beyond simple crisis observation. Now there are increasing signs that the strikingly altered thinking tasks can return to the typical ones. There is much to suggest that borderline personality disorder is treatable.
ICD codes for this condition: F60.31
ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctors’ letters or on certificates of incapacity for work.
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