What is borderline personality disorder (BPD)?
Symptoms of BPD
Often when we are looking to assess someone for BPD, it is common to use criteria set out
in the Diagnostics and Statistical Manual of Mental Disorders, 5 th edition (DSM-5). Within the
DSM-5 there are nine criteria, one would need to meet 5 or more criteria to be diagnosed.
Symptoms are grouped into four types of dysregulation including: interpersonal, cognitive
(including difficulties with identity), behavioural and affective.
o People often experience unstable and intense relationships and find themselves
alternating between idealising (thinking a person is great and that they can do no
wrong) or devaluing others (finding it difficult to hold in mind the good someone
may have done in the past and instead focusing on the current grievance or
rupture in the relationship).
o People are very sensitive to rejection and make every effort to avoid real or
o People have difficulty in developing a sense of who they are as a person.
o People have difficulty setting and working consistently on goals.
o People can experience transient stress-related thoughts centred around feeling
o People can experience dissociation.
o People have ongoing, long term suicidal actions or self-harm behaviour.
o People engage in other impulsive behaviours in several areas such as spending,
gambling, sex, drinking or substance use, reckless driving, binge eating.
o People experience mood instability, marked reactivity of mood (feeling like they
are on an emotional roller-coaster) – lasting a few hours and only rarely more than
a few days.
o Often experiencing intense anger (with bigger anger responses to situations than
others would) that is difficult to control.
o Ongoing, long-term feelings of emptiness.
How common is BPD?
When looking at global statistics people living with BPD make up approximately 1% of the
general population. However, this increases to 11% when looking at outpatient mental
health settings, 20% of inpatient mental health settings and 5% across the primary health sector. Research has found that among people living with BPD there is an equal ratio of
males and females, although women are more likely to be seen in treatment.
How does it develop?
When considering the development of BPD, research supports the use of the Biosocial
Theory. This approach developed by Dr Marsha Linehan explains that BPD develops from a
transaction that occurs overtime, between someone’s biology (how they came they came
into the world) and their social environment (family, peers, teachers etc).
The “Bio” in Biosocial
This refers to the fact that some people are born into the world with vulnerabilities to how
their emotion and impulse systems function. There are four main factors to be considered.
The first, is that some people are born into the world being more sensitive to emotions, they
have “spidey senses” so to speak, when picking up on emotional input in their
environments. Second, some people have bigger emotional responses to situations and
events than others. Their emotion system kicks off quickly and goes from 0 to 100 in a flash.
Thirdly, for some it takes a long time for their emotions to return to “baseline” to the state
where their emotions are most settled. Lastly, some people have difficulty controlling their
impulse control systems. They find it very difficult to control their behaviour when
experiencing intense urges to do or say something. Now, people can have one, two, three or
all these vulnerabilities. The more vulnerabilities the more difficult it is to manage emotions,
behaviour and to navigate life effectively.
The “Social” in Biosocial
This refers to the fact that some people come from social environments that are
invalidating. Invalidation has many forms. It is the message which says, “you shouldn’t feel
that way,” “what you feel is wrong,” “And there’s something inherently wrong with you as
person because of it.” Invalidation often punishes emotional expression. Invalidation is also
when a person is expected to change without the coaching in how to change. It can also be
the message that what the person is dealing with can be simply fixed if you “just be
positive” or “just think differently.” Invalidation is also any form of abuse or neglect.
The important point to consider is that it is not enough for BPD to develop if you have
biological vulnerabilities in the absence of invalidation and vice versa. The development of
BPD happens in response to the transaction between someone’s biology and their
environment, over time. For e.g., You do something, the environment does something, you
do something, the environment does something – repeatedly.
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