What is having BPD like?

“Living with Borderline Personality Disorder feels like a full-time job,” says 26-year-old Alex*. “From the mood swings to the fear of rejection, it can be really hard to live a stable life and to keep on top of my emotions.”

As Alex highlights, BPD involves rapidly changing thoughts and emotions and severe but short-lived mood swings - which is why it’s also known as Emotionally Unstable Personality Disorder (EUPD). One of the major areas which BPD might impact is relationships, as many individuals with BPD experience a profound fear of abandonment and may have a history of short-lived, intense and tumultuous relationships.

BPD and relationships

“When I fall in love with someone, I fall hard. It’s like they’re my everything,” Alex explains. “But because I navigate the world in such an emotionally charged way, partners struggle to support or understand me. They might do things - work more, or spend more time on their phone - which they don’t see as a big deal but which I take as signs that they are about to leave. This might make me ‘test’ them by threatening to break up or begin a process of pre-emptively pushing them away. This causes a lot of conflict.”

This is something that Debbie Longsdale, Therapy Services Director at private mental health care provider Priory Group also attests to. “People with BPD are likely to fall in love or develop friendships quickly and intensely, but then fall out of these relationships just as rapidly,” Longdale says. “There may also be some overwhelming trust issues and unwarranted fears of abandonment which can cause real negativity within a relationship.”

One of the major stigmas about those with BPD is that sufferers are manipulative towards friends and partners - as we saw in the Amber Heard and Johnny Depp defamation trial, where an unofficial BPD diagnosis by Dr Shannon Curry was used to discredit Heard’s testimony. Dr Curry characterised those with BPD as “concerned with image, attention seeking and prone to externalising blame” while also claiming that BPD sufferers are likely to make false claims of abuse.

It’s worth noting the very clear ulterior motives to Curry’s claims here and the damaging misrepresentation it creates. Rather than actively trying to cause harm, people with BPD just have a different way of perceiving and navigating relationships. A key part of this is a psychological process called “splitting” where someone might see people or situations as all bad or all good.

“Individuals with BPD can often view things in black and white, seeing everything and everyone as either entirely good or entirely bad. As a result, they can quickly shift from idolising to devaluing a person,” explains Longdale. “This typically happens when they experience a real or perceived slight which other people may be able to dismiss, work through or simply not feel too bothered about that causes them to feel disappointed, betrayed, unloved or abandoned.”

Other BPD symptoms

According to the NHS, BPD characteristics can be split into four categories:

• emotional instability – the psychological term for this is affective dysregulation
• disturbed patterns of thinking or perception – cognitive distortions or perceptual distortions
• impulsive behaviour
• intense but unstable relationships with others

However, this doesn’t tell the full story. Theodore Millon, the late psychologist and founder of the Journal of Personality Disorders, believed that there are actually four different subtypes of BPD. He first wrote about his theory in the book Disorders of Personality: DSM-IV and Beyond (1996).

Millon’s four BPD subtypes are:

Impulsive BPD: Sufferers may outwardly appear charismatic, elusive and energetic and their coping mechanisms may include binge-eating, overspending, sexual impulsivity and excessive drinking, drug use and gambling. When triggered, they may be prone to physical fights and outbursts of anger.

Discouraged or ‘Quiet’ BPD: This type of BPD is more strongly associated with a fear of abandonment and people in this sub-group might be highly professionally motivated but experience high levels of loneliness and a tendency towards self harm, suicidal ideation and threats or attempt of suicide. They are prone towards codependency and may experience anger and strong mood swings when in an abandonment crisis.

Self-Destructive BPD: People with Self-Destructive BPD will battle with strong self-hatred and may engage in particularly risky, adrenaline-fuelled activities and self-harm or threats of suicide. What marks it out from the other categories are feelings of euphoria, lack of desire to sleep and increased energy - though in some people these may be signs of a bipolar episode.

Petulant BPD: Individuals with Petulant BPD feel particularly unloved, which can lead to controlling behaviour in relationships. This category is most strongly linked to behaviour which may be read as manipulative, as well as irritability, severe mood swings and passive aggression.

That said, not everyone identifies with a BPD subtype and some individuals may identify with a combination of the different types. It’s also important to remember that no subtype is “better” or “worse” than the others - BPD is a mental health condition and should be approached with compassion across the various ways it may manifest.

It’s also important to note that there is disagreement among researchers around how many subtypes there are and how exactly they manifest. The NHS does not include mention of subtypes in official diagnostic criteria, preferring to focus on the severity rather than specificity of personality disorder symptoms.

How is BPD treated?

BPD is a serious condition and it is not recommended to self-diagnose - particularly as you may be suffering from another condition such as bipolar disorder (and, conversely, borderline is often misdiagnosed as bipolar II). If you are experiencing symptoms of BPD, book an appointment with your GP.

There, your GP will ask about symptoms and how they are impacting your daily life in order to rule out more common illnesses such as depression. If your GP believes you may have BPD, you will then be referred to your local community mental health team (CMHT) who will undertake a more in-depth mental health assessment.

If a BPD diagnosis is determined most appropriate, a treatment plan will be decided on. One of the common forms of treatment for BPD is Dialectical Behavioural Therapy (DBT) which is a form of therapy that combines group skills sessions with one-on-one sessions. The aim of DBT is to allow individuals to accept difficult emotions but change how they react to and deal with them.

“In DBT, acceptance techniques focus on understanding yourself as a person, and making sense of why you might do things such as self-harm,” says Stephen Buckley, Head of Information at mental health charity Mind. “For example, a DBT therapist might suggest that this has been your only way of coping with intense emotions.”

“Change techniques focus on replacing behaviours that harm you with behaviours that help you,” he says. “This may mean your therapist challenges your unhelpful thoughts or encourages you to find new ways of dealing with distress.”

Several studies confirm the efficacy of DBT as a treatment plan for BPD. However, there are added accessibility issues when it comes to this form of therapy. “Unfortunately, many people find that accessing DBT can be quite difficult,” Buckley explains. “DBT isn't available everywhere, and NHS waiting lists can be very long.”

Even if you have been able to afford traditional private talking therapy in the past, accessing DBT privately can be an extra challenge. “Many of us can't afford to go private and DBT can be more expensive than other types of therapy,” he continues. “This is because there tends to be both individual and group elements to it and it is usually provided over a longer period of time.”

Typically, private DBT programmes might involve a weekly group skills session costing £70 - £100 alongside a weekly one-on-one session (complete with telephone counselling between appointments) for anywhere between £70 - £250 a week. The combined costs of both these sessions, as well as the fact that many programmes require a minimum commitment of a year, makes it one of the more expensive treatment models.

Further resources and where to seek help

When it comes to BPD, relying on self-help materials in lieu of an official diagnosis or structured support is not recommended. If you believe that you have BPD, speak to your GP.

While you wait for a formal diagnosis, referral or treatment you can access DBT exercises online on the DBT Self Help website and can learn more about BPD via Mind.

*name changed