Signs and Treatment of Borderline Personality Disorder (BPD): A Guide for Mental Health First Responders
Borderline Personality Disorder (BPD) is a complex mental health condition that affects how people think and feel about themselves and others. It is often characterised by intense emotions, unstable relationships, impulsivity and distorted self-image. Recognising the signs and understanding how to provide appropriate support as a Mental Health First Responder is useful in helping individuals manage BPD. In this blog, we’ll explore the signs of BPD, how those affected feel, and what you can do as a Mental Health First Responder to provide initial support.
Borderline personality disorder statistics
BPD is more common among women, although men are also affected.
Individuals with BPD are more likely to engage in self-harming behaviours, with 70–80% reporting some form of self-injury.
Around 75% of people with BPD will attempt suicide at least once, and 10% will die by suicide.
What Are the Signs of Borderline Personality Disorder?
The signs of BPD can vary from person to person, but there are common characteristics that most individuals with this condition experience. These include:
Intense Emotional Instability: People with BPD often experience mood swings and have intense emotional responses to everyday situations. Their emotions can change quickly from happiness to sadness, anger or frustration, making it difficult to predict their reactions.
Fear of Abandonment: One of the most prevalent features of BPD is a fear of abandonment. Individuals with BPD may go to extreme lengths to avoid real or imagined abandonment, which can include sabotaging relationships, begging others not to leave, or becoming overly attached.
Unstable Relationships: Relationships with those who have BPD are often unstable and tumultuous. They may view others in extremes, seeing someone as all-good or all-bad with no middle ground. This pattern of “splitting” often leads to cycles of idealising and then devaluing friends, family or partners.
Impulsivity: Risky or impulsive behaviours such as binge eating, reckless driving, substance abuse or unsafe sex are common in people with BPD. These behaviours are often coping mechanisms for dealing with emotional pain.
Distorted Self-Image: People with BPD tend to have a very unstable self-image or sense of identity. Their self-perception can shift dramatically, leading to feelings of worthlessness or a lack of purpose.
Chronic Feelings of Emptiness: Many people with BPD describe feeling empty or hollow inside. This chronic emptiness can lead to unhealthy attempts to fill the void, such as substance abuse or engaging in risky behaviours.
Self-Harm and Suicidal Behaviour: Self-harm, including cutting, burning, or hitting oneself, is common in people with BPD. They may also exhibit suicidal behaviour or threats, particularly when feeling overwhelmed by emotions or a perceived sense of rejection.
How Does a Person with BPD Feel and Why Do They Feel Like That?
Living with Borderline Personality Disorder can feel like a constant emotional rollercoaster. People with BPD often experience overwhelming emotions that are difficult to control or understand. They may feel trapped in a cycle of intense fear, anger or sadness that seems impossible to escape. The emotions can be so powerful that they lead to impulsive actions, such as self-harm or risky behaviour, as a way to cope.
One of the primary reasons people with BPD feel like this is due to the way their brain processes emotions. Research suggests that individuals with BPD may have a heightened sensitivity to emotional stimuli and difficulty regulating their emotions. The amygdala, the part of the brain responsible for processing emotions, is often overactive in people with BPD, while the prefrontal cortex, which helps regulate emotional responses, may be underactive. This imbalance can make it challenging for people with BPD to manage their emotions effectively.
The fear of abandonment, which is central to BPD, can lead to feelings of isolation, insecurity and anxiety. Even perceived slights or rejections can trigger intense emotional responses, causing individuals to feel as though they are constantly on edge. These emotions often stem from childhood trauma or adverse experiences, such as neglect, abuse or unstable relationships.
What Do You SEE as a Mental Health First Responder?
As a Mental Health First Responder, there are several key behaviours and emotions you may notice when supporting someone with BPD:
Rapid Mood Swings: You might observe the individual’s mood shifting quickly from one extreme to another. They may seem happy or calm one moment, and angry or upset the next. This emotional instability can make it challenging to provide consistent support.
Fear of Rejection: They may express a fear of being abandoned or rejected, even in situations where there is no immediate threat of abandonment. This fear may cause them to seek reassurance or validation constantly.
Risky or Impulsive Behaviour: Individuals with BPD might engage in impulsive or risky behaviours, such as substance use or self-harm. You may notice signs of physical injury, such as cuts or burns, or hear them talk about their struggles with impulse control.
Relationship Conflicts: They may talk about conflicts in their relationships, expressing feelings of anger or disappointment toward friends, family members or partners. They may idealise someone one day and then express deep anger toward that person the next.
Expressions of Emptiness: People with BPD often describe feeling empty or hollow, as though there is something missing from their lives. This chronic sense of emptiness can leave them feeling disconnected and unfulfilled.
What Do You DO as a Mental Health First Responder?
As a Mental Health First Responder, your primary role is to offer support, listen non-judgmentally, and help the individual access appropriate professional resources.
Here are some key steps you can take when supporting someone with BPD:
Provide Emotional Support: Acknowledge the intensity of their emotions and validate their feelings. It’s important not to dismiss or downplay their emotional experiences, even if they seem extreme to you. Let them know that it’s okay to feel the way they do and that you’re there to listen without judgment and help them.
Encourage Open Communication: Create a safe space where the person feels comfortable talking about their feelings and experiences. Ask open-ended questions, such as, “Can you tell me more about what’s going on?” This helps the individual feel heard and supported.
Reassure Them: Reassure them that you are there for them and that they are not alone. Reassurance is particularly important for people with BPD, as they may fear abandonment or rejection. Let them know that their feelings are valid and that help is available.
Address Immediate Concerns: If the person expresses suicidal thoughts or engages in self-harm, take immediate steps to ensure their safety. This may involve contacting emergency services or helping them access a crisis hotline. Your priority should be their well-being.
Help Them Find Professional Support: The NICE guideline on borderline personality disorder recommends psychological therapies for managing and treating the disorder. Because of the variety of symptoms and the variation in needs, flexible approaches that are responsive to the needs of each person with personality disorder are important. Involving people with borderline personality disorder in decisions regarding their own care is key for their engagement with treatment.
Follow Up: After the initial conversation, check in with the individual regularly to see how they’re doing. Following up shows that you care and that they can rely on you for continued support.
Treatment Options for Borderline Personality Disorder
Treating BPD typically involves a combination of therapy, medication and lifestyle changes.
Here are some common treatment approaches:
Dialectical Behaviour Therapy (DBT): DBT may be helpful although it is not always available and more studies are needed to evaluate it. It focuses on teaching individuals how to regulate their emotions, improve interpersonal relationships and develop mindfulness skills. DBT also helps people manage self-destructive behaviours and cope with distressing situations.
Cognitive Behavioural Therapy (CBT): CBT can help individuals with BPD identify and change negative thought patterns that contribute to their emotional instability and impulsive behaviour. It is often used in conjunction with DBT.
Medication: While there is no medication specifically for BPD although medications like antidepressants, mood stabilizers and antipsychotics may be prescribed to manage symptoms such as depression, anxiety, or mood swings.
Support Groups: Peer support groups can be a valuable resource for individuals with BPD. These groups provide a safe space for individuals to share their experiences, offer support to one another and learn new coping strategies.
Want to learn more about mental health first aid?
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