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Understanding Borderline personality disorder (BPD)

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.

Interpersonal dysregulation:

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

imagined abandonment.

Cognitive dysregulation:

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.

Behavioural dysregulation:

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.

Emotion dysregulation:

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.

Would you like to discuss this further, contact me to book a consultation at

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