Brief Overview: Borderline Personality Disorder (BPD)

BPD is more common than you think.

It is thought to manifest as a result of childhood maltreatment. Importantly, this can include emotional invalidation and abuse in childhood.

It seems to present itself more commonly than in previous generations - possibly due to greater family and social pressures in the contemporary era.

In psychiatry, BPD typically presents as an acute chronic emotional distress with suicidal ideation or ambivalence to life. It can also present as acute self-harm but is also just as difficult to treat as depression.

A disturbed relationship with oneself can lead to emotional instability, and hence relationship insecurity. Patients with BPD tend to have a chronic risk profile suitable for outpatient care, but expert assessment to gauge risk is needed.

Sometimes major depression, bipolar, and even psychosis can co-occur with the disorder. Substance abuse is also common amongst those with BPD.

The management of the disorder depends on stability in care relationships. Chaotic therapy interrupting behaviour often requires specific psychological counselling called dialectic behavioural therapy (DBT) so that BPD patients can cope with emotions less self-destructively.

Secure attachment and as tolerated insight over a number of years in psychotherapy is needed. Brief containing admissions to mitigate risk are sometimes needed.

While BPD is challenging, there are long term positive outcomes with continuity of care. In some cases, mood medications are also utilised for symptomatic relief where risk-benefit suggests merit.