Borderline Personality BPD Factsheet
Borderline Personality BPD Factsheet
Borderline Personality BPD Factsheet
disorder (BPD)
This factsheet has information on borderline personality disorder (BPD),
including symptoms, causes and treatments. You might find it helpful if
you live with a diagnosis of BPD, or if you know someone who does.
• BPD means that you feel strong emotions that you struggle to
cope with. You may feel upset or angry a lot of the time.
• Around 1 in 100 people live with BPD.
• There are different reasons why people get BPD. A lot of people
who live with a diagnosis of BPD have had traumatic experiences
in their childhood.
• If you are someone living with a diagnosis of BPD, it is more likely
that you will self-harm. And have challenges with relationships,
alcohol or drugs. There is help available.
• There are different ways to treat BPD. The NHS should normally
offer you therapy.
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1
1. What is borderline personality disorder (BPD)?
You can think of your traits as sitting along a scale. For example, everyone
may feel emotional, get jealous, or want to be liked at times. But it is when
these traits start to cause problems that you may be diagnosed as having
a personality disorder.
BPD can affect how you cope with life, manage relationships, and feel
emotionally. You may find that your beliefs and ways of dealing with day-
to-day life are different from others. You can find it difficult to change them.
You may find your emotions confusing, tiring, and hard to control. This can
be distressing for you and others. Because it is distressing, you may find
that you develop other mental health problems like depression or anxiety.
You may also do other things such as drink heavily, use drugs, or self-
harm to cope.
Research shows that around 1 in 100 people live with BPD.1 It seems to
affect men and women equally, but women are more likely to have this
diagnosis. This may be because men are less likely to ask for help.2
BPD is sometimes called emotionally unstable personality disorder
(EUPD). Some people feel that this describes the illness better.
Some people who live with BPD think that the name is insulting or makes
them feel labelled. Doctors don’t use this term to make you feel judged or
suggest that the illness is your fault. It is meant to describe the way the
illness develops. It’s important to remember this is a health condition. And
not a judgement of your character or you as a person.
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Everyone will experience BPD differently. If you live with BPD, you may
have difficulties with:3,4
• being impulsive. This means that you like to do things on the spur
of the moment,
• feeling bad about yourself,
• controlling your emotions,
• self-harming,
• suicidal thoughts and attempts to take your own life,
• feeling 'empty’,
2
• dissociation. This could be a feeling of being disconnected from
your own body. Or feeling disconnected from the world around you.
• identity confusion. You might not have a sense of who you are.
• feeling paranoid or depressed,
• hearing voices or noises when you are stressed, and
• intense but unstable relationships with others.
Sam’s story
On a bad day, my distress levels go through the roof. I feel unloved, empty
and helpless. I feel worse when my partner goes out to see friends, which
makes me feel like they don’t care about me. At times I hate everyone and
everything, which I deal with by cutting myself with a razor and by drinking
alcohol.
Many people who live with BPD will also experience other mental health
problems. Such as depression, anxiety, eating disorders, PTSD and
alcohol or drug misuse. People who live with BPD can also be diagnosed
with bipolar disorder. The symptoms of bipolar disorder can often be
confused with those of BPD. 5
• Personality disorders
• Dissociation and dissociative disorders
• Self-harm
• Anxiety disorders
• Depression
• PTSD
• Drugs, alcohol and mental health
• Bipolar disorder
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Your GP will look at different things when deciding how best to help you.
So, it can help to keep a record of your symptoms. This can help you and
your GP to understand what difficulties you are facing. It may help if you
keep a record of:7
When you have your first appointment with the CMHT they will ask you
questions to understand how your mental health is affecting you. They will
talk to you about:8
• how you manage your day to day life, relationships and work,
• coping strategies that you use,
4
• your strengths,
• areas in your life that you find difficult.
• any other mental health problems you may have,
• any other social problems that you may have,
• any social care and support needs you may have,
• any support you may need in staying in your job, or finding a job,
• any psychological treatment you may need. This is also known as
‘talking therapy’, and
• the needs of any dependent children that you have.
The guidelines tell your psychiatrist what to look for. They will diagnose
you with BPD if you have at least five of the symptoms below.9
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You can check what treatment and care is recommended for BPD on the
National Institute for Health and Care Excellence (NICE) website. NICE
produce guidelines for how health professionals should treat certain
5
conditions. You can download these from their website at
www.nice.org.uk.
The NHS does not have to follow these recommendations. But they should
have a good reason for not following them.
People who live with BPD have sometimes been excluded from NHS
services because of their diagnosis.10 But the NHS should not refuse to
give you specialist help because of your diagnosis. They should have
services to support people with BPD.11
If your local NHS doesn’t offer you appropriate treatment then there are
things that you can do. For information about your options please see
section 8 of this factsheet.
We have included details below of some of the therapies that your doctor
may use. But these are not available everywhere. And your doctor may
recommend other types of talking therapy.
The therapy you are offered should last at least 3 months.16 If your doctor
decides that talking therapies are not suitable, they should explain why.
6
DBT usually involves weekly individual and group sessions. And you
should be given an out-of-hours contact number to call if your symptoms
get worse.
Mentalisation means the ability to think about thinking. This means looking
at your own thoughts and beliefs. And working out if they are helpful and
realistic.
This type of therapy also helps you to recognise that other people have
their own thoughts, emotions and beliefs. And that you may not always
understand these. The therapy also helps you to think about how your
actions might affect what other people think or feel.
A course of MBT usually lasts around 18 months. You may first be offered
MBT in a hospital as an inpatient. The treatment usually consists of daily
individual sessions with a therapist and group sessions with other people
with BPD.
Some hospitals and specialist centres like you to remain in hospital whilst
you are having MBT. But others recommend that you leave the hospital
after a certain period of time but remain being treated as an outpatient.
This means that you will visit the hospital regularly.
Arts therapies20
• art therapy,
• drama therapy,
• music therapy, and
• dance movement therapy.
These therapies can be offered individually but they are often done in
groups. Sessions are usually weekly. These therapies can be helpful to
people who find it hard to talk about their thoughts and feelings.
Therapeutic communities21
Therapeutic communities are not a treatment themselves. They are places
you can go to have treatment. Most therapeutic communities are
residential. They help people with long-term emotional problems, and a
history of self-harming, by teaching them skills to help them have better
relationships.
Therapeutic communities vary a lot because they are often run by the
people who use them. And they shape them based on what they want to
achieve.
These services are not available in all NHS Trusts. And they can be
difficult to access. You can speak to your CMHT and if they can refer you
to a specialist service.
You can find more information about Tier 3 and Tier 4 services in our
factsheet ‘Second Opinions’ at www.rethink.org. Or call our General
Enquiries team on 0121 522 7007 and ask them to send you a copy of our
factsheet.
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A mental health crisis is when you need urgent help. You may be feeling
suicidal or wanting to self-harm. And you don’t think that you can use your
normal coping strategies to stop yourself from acting on your feelings
If you have a diagnosis of BPD but are not under the care of your local
community mental health team (CMHT), then you should speak to your
GP. Your GP should:23
If you are already under the CMHT, or a specialist service, then you
should have a care plan. The care plan should include a crisis plan that
you can follow. Your crisis plan is written by you and your mental health
team. It should include:24
8
• self-management skills which you have used before and find
helpful,
Your doctor may think about offering you sedative medication. Sedatives
can help you feel more relaxed. But your doctor should not give you
sedatives for more than a week.25
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Self-harm
It is common for people who live with BPD to self-harm.26 Some people
find self-harming can help them to deal with painful feelings. But it can
cause serious injury, scars, infections, or accidental death. A big focus of
BPD treatment is to find other ways to deal with painful emotions.
Suicide
People who live with BPD are more at risk of suicide or of attempting
suicide.27 Most people who live with BPD who feel suicidal will feel more
positive within a few hours.28So it is important to use techniques to try and
distract from the strong suicidal feelings.
• behave impulsively,
• drink too much alcohol,
• misuse prescription medication, or
• take illegal drugs.
9
You are more likely to die by suicide if you are also using alcohol.30 So If
you are feeling suicidal you can help keep yourself safer by making sure
that you don’t use alcohol.
If you drink a lot of alcohol or use drugs, you may find it difficult to get
treatment for BPD. But NICE guidelines state that you should be referred
to a service that can help with your substance use. And you should be
able to continue with BPD treatment where appropriate.32
You can find more about ‘Drugs, alcohol and mental health’ at
www.rethink.org. Or call our General Enquiries team on 0121 522 7007
and ask them to send you a copy of our factsheet.
Impulsive behaviours
When people make decisions quickly without thinking about the
consequences, doctors call this ‘impulsive’. This can include driving
erratically or having multiple sexual partners. Or spending money on
things you can't afford or don't need.
If impulsive behaviour leads you to have debt problems you can find more
support and information at: www.mentalhealthandmoneyadvice.org.
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Treatment options
You should first speak to your doctor about your treatment. Explain why
you are not happy with it. You could ask what other treatments you could
try.
Tell your doctor if there is a type of treatment that you would like to try.
Doctors should listen to your preference. If you are not given this
treatment, ask your doctor to explain why it is not suitable for you.
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Second opinion
A second opinion means that you would like a different doctor to give their
opinion about what treatment you should have. You can also ask for a
second opinion if you disagree with your diagnosis.
You don’t have a right to a second opinion. But your doctor should listen to
your reason for wanting a second opinion.33
Advocacy
An advocate is independent from the NHS. They are free to use. They can
be useful if you find it difficult to get your views heard. There are different
types of advocates available.
An NHS Complaints Advocate can help you if you want to complain about
the NHS. This service exists in all areas.
You can find your local PALS’ details through this website link:
www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-
(PALS)/LocationSearch/363.
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You can learn to manage your symptoms by looking after yourself. Self-
care is how you take care of your diet, sleep, exercise, daily routine,
relationships and how you are feeling.
Lifestyle
Making small lifestyle changes can improve your wellbeing and can help
your recovery.
Routine helps many people with their mental wellbeing. It will help to give
a structure to your day and may give you a sense of purpose. This could
be a simple routine such as eating at the same time each day, going to
bed at the same time each day and buying food once per week.
Breathing exercises
Breathing exercises can help to calm you when you are feeling anxious.
You will get the most benefit if you do them regularly, as part of your daily
routine.34
Support groups
You could join a support group. A support group is where people come
together to share information, experiences and give each other support.
Recovery College
Recovery colleges are part of the NHS. They offer free courses about
mental health to help you manage your symptoms. They can help you to
take control of your life and become an expert in your own wellbeing and
recovery. You can usually self-refer to a recovery college. But the college
may inform your care team.
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You might also find some of the following things helpful.35,36,37
• Make sure you speak to a doctor if you think that your relationships
with others are being affected.
• Think about how you will benefit from making changes to your
lifestyle.
• Don’t pay too much attention to the name of the condition. BPD is
a common condition and it is not meant to label you or to suggest
that your situation won’t change.
• If you’re offered group therapy or support, give it a chance. It may
seem intimidating to start with, but a lot of people find it helpful in
the long-run.
• If something annoys or upsets you, try to wait a while before
responding. Think carefully about what you’re going to say and
how you’re going to say it.
• Try to find ways of relaxing. Meditation, breathing techniques,
listening to music and exercising may be helpful.
• Look for patterns in the ways you respond to things that upset you.
This may help you to work through problems in relationships.
• If you self-harm to deal with distress, think of other ways to deal
with this. Try punching a pillow or writing about how you feel.
• Use an online mental health forum. Make sure that you check with
a mental health professional how trustworthy the website is for
helpful information on BPD.
• Recovery
• Self-harm
• Suicidal feelings – how to cope
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• Speak to your GP about medication and talking therapies for
yourself if your mental health is affecting your day-to-day life.
Craig’s story
Learning about BPD was the most important thing I did to help
understand the pain that my partner was going through. I learned how
to best help her in moments of extreme emotional pain. I am now able
to de-escalate situations quicker, leaving my partner comforted instead
of feeling distant. It has improved our relationship a great deal and
brought us closer.
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A care plan should always include a crisis plan. A crisis plan will have
information about who to contact if they become unwell. You can use this
information to support and encourage them to stay well and get help if
needed.
Your relative or friend needs to give permission for the NHS to share
information about them and their care.
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Website: www.nwbh.nhs.uk/healthandwellbeing/Pages/Breathing-
Techniques-.aspx
Website: www.cci.health.wa.gov.au/Resources/For-Clinicians/Distress-
Tolerance
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BPD World
Provides information and support to people affected by personality
disorders. It has an online support forum.
Website: www.bpdworld.org
Samaritans
Can be contacted by telephone, letter, e-mail and mini-com. There's also a
face-to-face service, available at their local branches. They are open 24
hours a day, every day of the year.
ASSISTline
National helpline offering supportive listening service to anyone throughout
the UK with thoughts of suicide or thoughts of self-harm. They are open
24/7.
Sane Line
Work with anyone affected by mental illness, including families, friends
and carers. Their helpline is open between 4:30pm and 10.30pm every
day of the year. They also provide a free text-based support service called
Textcare and an online supportive forum community where anyone can
share their experiences of mental health.
Telephone: 0800 58 58 58
Webchat: through the website
Website: www.thecalmzone.net
My Black Dog
Provides peer support webchat with volunteers who have experienced
mental illness. Available evenings and weekends. Check the website for
opening times.
Website: www.myblackdog.co
Papyrus UK
Work with people under 35 who are having suicidal feelings. And with
people who are worried about someone under 35. Their helpline is open
9am – 10pm in the week. And between 2pm and 10pm at weekends and
bank holidays.
Shout
If you’re experiencing a personal crisis, are unable to cope and need
support, text Shout to 85258. Shout can help with urgent issues such as
suicidal thoughts, abuse or assault, self-harm, bullying and relationship
challenges.
1 National Institute for Health and Clinical Excellence. Borderline Personality Disorder:
Recognition and Management. Clinical Guidance 78.. London: national Institute for
Health and Clinical Excellence; 2009. Para: introduction.
2 As note 1, at introduction.
3Royal College of Psychiatrists. Personality Disorder: different kinds of personality
disorder. www.rcpsych.ac.uk/mental-health/problems-disorders/personality-disorder
(accessed 21st January 2021).
4 Korzekwa MI, Dell PF, Links PS, Thabane L, Fougere P. Dissociation in borderline
18
36 Centre for Clinical Interventions. Facing your Feelings.
www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=54 (accessed 12th February
2021).
37 Elliot and Smith. Borderline Personality Disorder for Dummies. Indianapolis: Wiley
Publishing; 2009.
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© Rethink Mental Illness 2021
Last updated: Feb 2021
Next update: June 2023
Version: 5
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