Borderline personality disorder: symptoms, causes and treatment

The NHS says BPD can cause a wide range of symptoms, broadly grouped into 4 main areas. NHS inform adds that borderline personality disorder can lead to disordered thinking, impulsive behaviour, problems controlling emotions, concerns that other people will abandon you, and intense but unstable relationships.

The NHS describes BPD as a disorder of mood and how a person interacts with others, and the most commonly recognised personality disorder. In general, someone with a personality disorder will differ significantly from an average person in how they think, perceive, feel or relate to others. NHS inform says someone with a personality disorder thinks, feels, behaves or relates to others in a way that is different to the average person, and that personality disorders are a common mental health problem.

Personality disorders have different types. NHS inform lists borderline, antisocial, narcissistic, avoidant and others. The NICE guideline on borderline personality disorder (CG78) says its aim is to help people with BPD manage feelings of distress, anxiety, worthlessness and anger and maintain stable and close relationships. NICE notes that the current ICD-11 classification defines personality disorder as a single condition classified by severity rather than separate types.

The NHS notes that many people with BPD also have another mental health condition or behavioural problem, such as alcohol-use disorder, generalised anxiety disorder, bipolar disorder, depression, drug misuse, an eating disorder or another personality disorder. It says BPD can be a serious condition and many people with it self-harm and attempt suicide.

The NHS says many people with BPD can benefit from psychological or medical treatment. Treatment may involve a range of individual and group psychological therapies delivered by trained professionals working with a community mental health team (CMHT), which can include social workers, mental health nurses, psychologists, psychiatrists, counsellors, psychotherapists and occupational therapists. Treatment may last a year or longer, depending on your needs.

If your symptoms are moderate to severe, the NHS says you will probably be entered into a care programme approach (CPA), a way of making sure you get the right treatment. It has 4 stages: an assessment of health and social needs, a care plan, the appointment of a care co-ordinator (keyworker), and regular reviews.

The NHS says to see your GP if you are concerned you have BPD. They may ask about your symptoms and how they are affecting your quality of life, and will want to rule out other more common mental health conditions such as depression and make sure there is no immediate risk. If your GP suspects BPD you will probably be referred to your local CMHT for a more in-depth assessment, usually by a specialist in personality disorders such as a psychologist or psychiatrist.

NHS inform says that diagnoses of personality disorders are made by specialist mental health services and need a referral from a GP. The NHS suggests asking whether the service you are referred to has experience of working with personality disorders. Once diagnosed, it is recommended that you tell close family, friends and people you trust, which may make your treatment more effective.

The NHS says there is no single cause and BPD is likely to be caused by a combination of factors. The first factor is genetics: genes you inherit may make you more vulnerable, as there is evidence that the condition can run in families. The second is brain chemistry: many people with BPD are thought to have a problem with neurotransmitters, particularly serotonin.

A third factor is brain development: MRI studies found that in many people with BPD three parts of the brain (the amygdala, hippocampus and orbitofrontal cortex) were smaller than expected or had unusual levels of activity. The fourth is environmental. The NHS lists being a victim of emotional, physical or sexual abuse, long-term fear or distress as a child, being neglected by one or both parents, and growing up with another family member who had a serious mental health condition or a drink or drug misuse problem.

The NHS says that if you have suicidal thoughts, call your GP or the out-of-hours GP service. If you have taken an overdose or self-harmed, dial 999. Samaritans provides emotional support 24 hours a day for people experiencing feelings of distress or despair; you can contact a friend, family member or someone you trust. If there is a risk of harm, use NHS 111 or 999.

If you have been diagnosed with BPD, the NHS suggests telling someone you trust about your condition and giving them the contact details of your care team, so that they can contact the team if they become concerned about your behaviour. You will probably be given several telephone numbers to use in a crisis, which may include your community mental health nurse, an out-of-hours number and a local crisis resolution team.

The NHS says the symptoms of a personality disorder usually emerge in adolescence and persist into adulthood. NHS inform says personality disorders usually emerge in adolescence and continue into adulthood. The NHS says additional treatment is recommended for people whose symptoms return.

The NHS says over time many people with BPD overcome their symptoms and recover, and that additional treatment is recommended for people whose symptoms return. It also says treatment may last a year or longer, and that the type of psychotherapy chosen may be based on a combination of personal preference and the availability of specific treatments in your local area.

On the NHS the first step is a GP, who can refer you to a community mental health team or a specialist personality disorder service. The NHS says that psychotherapy should only be delivered by a trained professional and that you should not be afraid to ask about their experience.

Private psychiatry and psychotherapy are also available and may reduce waiting times. Because effective therapy is long and structured, ask any private therapist which model they use, how many months it takes, and how they will coordinate with your GP and any NHS team.