Borderline personality disorder: symptoms and help

What is borderline personality disorder?

Borderline personality disorder (BPD) is one of the most common personality disorders, It affects around 2% of adults in Switzerland. BPD is usually an emotional rollercoaster and can cause a wide range of symptoms.

10 symptoms of BDP

Although the symptoms of BDP vary widely, there are signs that may point to a borderline personality disorder. These include:

• Mood swings: Extreme highs and lows
• Unstable relationships: Many highs and lows with strong feelings, plus a tendency towards toxic relationships
• Identity crises: Distorted self-perception
• Extreme willingness to take risks: Includes an increased risk of addiction
• Fear of loss: Based on a negative self-image, often coupled with strong jealousy
• Impulsive and destructive behaviour: Particularly in stressful situations, patients react hastily and without thinking
• Self-harm and suicidal tendencies: A desperate attempt to change their current, unbearable situation
• Dissociation: When those affected feel alienated from their surroundings and their own self
• Emptiness: Feeling unfulfilled or bored
• Mental health problems as comorbidities

BPD symptoms in women

At first glance, the symptoms of borderline personality disorder are pretty similar for men and women. However, if you take a closer look, there are differences in how the symptoms present themselves: Women direct impulsive behaviour towards themselves and tend to self-harm, while men tend to direct aggressive behaviour towards others.

Borderline personality disorder types

Although the symptoms of borderline personality disorder vary widely, there are five widely accepted types:

1. Affective: Prone to a rollercoaster of emotions, whereby even the slightest disagreements in relationships can lead to depression or anxiety.
2. Impulsive: Difficulties with impulse control lead to risky behaviour, which often leads to strong feelings of shame afterwards.
3. Aggressive: Even little things cause quick-tempered behaviour, and anger often erupts uncontrollably.
4. Dependent: This type is characterised by a high fear of loss and has difficulty respecting their own and others’ boundaries.
5. Empty: When people lack confidence in themselves, in relationships and in the world, they often have a great sense of emptiness and a great need for support.

What causes a borderline personality disorder?

As with many other mental illnesses, BPD is often associated with difficult or traumatic experiences growing up. If basic emotional needs are not met, this can lead to a fear of loss and a disturbed attachment pattern in childhood and adulthood. If children experience physical, emotional, and psychological abuse, they often suffer from a distorted self-image later on and have difficulty regulating their emotions.

“It helps many patients to understand that, although we’re born with emotions, we actually have to learn how to manage them,” says Dr Roland Stehr (60), senior consultant and head of the psychotherapy ward for personality and trauma disorders at St. Gallen Psychiatric hospital. As children, we learn how to deal with emotions through experience and imitation. “In a loving and reliable environment that is suitable for children, this usually happens automatically,” explains Dr Stehr.

However, as things don’t always run smoothly, difficulties in regulating emotions can arise: “Coping strategies that initially worked well during childhood later become unconscious, obstructive automatisms.” Therapy can help process and understand these. “We also work on the patient’s self-image For example, many people with a borderline personality disorder think they don’t deserve to be loved.”

How is borderline personality disorder diagnosed?

BPD is an emotionally unstable personality disorder and is diagnosed in two stages as part of psychotherapy sessions. According to the Hamburg-Eppendorf university medical centre patients must display at least three of the following characteristics or behaviours:

• Clear tendency towards unexpected behaviour irrespective of the consequences
• Clear tendency towards arguments and conflict with others
• Propensity for fits of rage with an inability to control this behaviour
• Difficulty in maintaining actions that are not immediately rewarded
• Mood swings

To be diagnosed with BPD (ICD-Code F60.31), at least two of the following characteristics or behaviours must also be displayed:

• Disturbances and insecurity regarding self-image, aims and inner preferences (including sexual ones)
• Tendency toward intensive but unstable relationships
• Excessive efforts to avoid abandonment
• Repeated threats or acts involving self-harm
• A chronic feeling of emptiness

How is BPD treated?

Treating a borderline personality disorder is tough and requires patience. However, nowadays there are numerous tried-and-tested approaches that can significantly reduce the symptoms and improve interpersonal behaviour.

In recent years, various psychotherapy methods have been developed that can be used in an individual or group setting, such as dialectical behaviour therapy, schema therapy, mentalisation-based therapy and transference-focused therapy.

Tips for interacting with BPD patients

Very few people think in depth about mental illnesses, such as borderline personality disorder. So when they meet someone who suffers from this disorder, they are usually overwhelmed by their impulsive behaviour. This emotional stress can lead to chronic conflicts. So it’s all the more important to know what you’re dealing with. “We all see and judge the world based on the prejudice of our own experiences,” explains Stehr.

This categorisation is particularly important for borderline sufferers. “Due to their highly emotional nature, if a friend arrives late, this can already lead to a feeling of devaluation and be perceived as an existential threat. “If you realise that those affected are really struggling to survive, you can understand why the reaction may be so intense.”