image
Document Your CPD Online for Free

All of your CPD, all in one place.

Borderline Personality Disorder - A Misunderstood and Stigmatised Illness

CPD
4m

Published: 07 January 2020

Cover image for article: 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).

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

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).

The high level of self-harm and suicidality of patients with BPD marks them as particularly at-risk.

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)

Fortunately, there are treatments available for BPD, furthermore, people with BPD have a high recovery rate following diagnosis and treatment .

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

Multiple Choice Questions

Q1. True or False: BPD is more common in men than in women.

  1. True
  2. False

Q2. Which of the following is not accurate?

  1. BPD affects 1-4 percent of the population.
  2. BPD symptoms usually appear first during teenage years or early adulthood.
  3. It is not possible to treat BPD.
  4. The first line of treatment for people living with BPD is psychological therapies.

Q3. True or false: BPD is now considered to be a result of a combination of environmental and genetic factors.

  1. True
  2. False
References

(Answers: b, c, a)

Author

Portrait of Ausmed Editorial Team
Ausmed Editorial Team

Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile

Related Learning Hubs

Learner Reviews

4.1

75 Total Rating(s)

Generic portrait
Annette Auliciems
21 Jan 2020

Brief but well explained overview of BPD

Portrait of Elesha Eisermann
Elesha Eisermann
20 Jan 2020

This was insightful to read. It have me a better understanding of BPD and how serious it is for the individuals suffering from it.

Generic portrait
Philip Heap
20 Jan 2020

Short lectures on one aspect of mental health that was well constructed and was engaging

Generic portrait
Michael Woods
19 Jan 2020

Evidence based education on base line personality disorder.

Generic portrait
Pauline Chow
17 Jan 2020

Short but relevant

Generic portrait
Marlene Luck
16 Jan 2020

The subject gives me better understanding

Generic portrait
Natasha Franklin
13 Jan 2020

Easy to read and very informative.

Portrait of Jocelyn Gandy
Jocelyn Gandy
11 Jan 2020

I found this review easy to read, in point form, with a small test at the end. I was interested to be able to reinforce and also learn some new things about BPD.