Borderline personality disorder is a mental health diagnosis given when someone has a long-standing pattern of intense, rapidly changing emotions, an unsteady sense of who they are, impulsive behaviour, and relationships that swing between extremes. UK services also call it emotionally unstable personality disorder (EUPD).
Key points
- BPD is a diagnosis for a long-standing pattern of difficulty with emotions, self-image, impulses and relationships.
- UK services also call it emotionally unstable personality disorder (EUPD), and ICD-11 uses a severity rating with a borderline pattern qualifier.
- BPD is not untreatable. In a 16-year follow-up of 290 patients, 99% reached at least a two-year period of remission.
- NICE recommends structured psychological therapy, and says drug treatment should not be used specifically for BPD or its individual symptoms.
- It is often confused with bipolar disorder and complex PTSD, and most people diagnosed report childhood trauma or neglect.
Symptoms
- Intense feelings such as rage, sorrow, shame or panic that shift quickly; long stretches of feeling empty; an unclear sense of identity.
- Self-harm and thoughts of suicide; impulsive acts that carry risk, such as heavy drinking, drug use or spending.
- A strong fear of being abandoned; closeness and conflict alternating, sometimes within a single day.
Causes and risk factors
- Thought to result from a combination of genetic and environmental factors; the causes are not fully understood.
- Most people diagnosed have experienced trauma or neglect in childhood.
Treatment
- Structured psychological therapy, not brief interventions under three months: dialectical behaviour therapy (DBT) or mentalisation-based therapy (MBT).
- Drug treatment should not be used specifically for BPD or its symptoms; short-term sedative medication only cautiously in a crisis, for no longer than a week.
- People with BPD should not be excluded from any health or social care service because of their diagnosis or self-harm.
When to speak to a professional
- Intense emotions, impulsive behaviour or unstable relationships have lasted months and are affecting your work, study, family life or safety.
- You have self-harmed more than once, or your emotions shift intensely several times a day.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.