Borderline Personality Disorder (BPD) is a pervasive disorder that affects up to 4% of the population (SANE, 2018). BPD can be very distressing for the person affected, and the impacts of this disorder are far reaching. BPD is more common in females than males. Typically, characteristics of this disorder emerge in late teenage years and early adulthood (SANE, 2018)

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Understanding BPD

Emotions

• Strong feelings of emptiness, depression, sadness, and anger.

• Sudden shifts in mood (unstable mood)
• Anxiety.
•Persistent fears of abandonment and/or rejection.

•Emotional detachment.

Behaviours

• Irritability
• Angry outbursts

• Impulsivity and risky behaviours

• Self-injury

• Self-destructive behaviour

• Suicide attempts

• Substance or alcohol misuse

• Sudden shifts in communication and reactivity ('hot and cold')

Cognitive/Psychological

• Low self-esteem

• Extreme thinking (black and white/all or nothing)

• Preoccupation with friendships and relationships.

• Intrusive and distressing thoughts

• Paranoia

Other Important Characteristics

• Difficulty maintaining healthy relationships with friends, family, and partners.

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What causes BPD?

Although BPD can be genetic, environmental factors are also a strong contributor. Childhood physical abuse, childhood emotional abuse, childhood neglect, and childhood sexual assault, are all factors that can contribute to the development of BPD (SANE, 2018). Similar experiences in adulthood can also lead to BPD, but this is less common. Signs of BPD will typically begin to present in late teenage years and early adulthood.

Treatment and help for BPD

Psychological treatment and support is strongly recommended for people with BPD. Given that this disorder can be chronic, counselling/therapy for people with BPD is often long-term and may involve multiple treatments (for example group therapy, and individual therapy). Although people with BPD may find it very hard to engage, connect, and open up to a Psychologist, research indicates that if this rapport is developed, therapy can assist in the management and recovery of BPD.​

Dialectical Behaviour Therapy (DBT) is an evidence-based treatment model that is widely used for people with BPD. The overarching objective of DBT is to help clients organise and manage their emotions in a healthy and helpful way. Schema Therapy is another model often applied. This model can help people with BPD understand how their beliefs about themselves, and others can influence their emotions and behavioural patterns. Psychodynamic therapy may also be utilised to correct past experiences and help the client feel engaged and connected in therapy.

Psychopharmacology (Medication) is often used in conjunction with therapy. Anti- depressants or Anti-psychotics may be prescribed to help reduce the intensity of unhelpful thoughts and uncomfortable emotions.

A strong and supportive network of friends and family is an important protective factor for many psychological disorders, including BPD. Often this is an aspect of recovery that is difficult to achieve for people with BPD because friendships and relationships are often the main trigger for their fears of abandonment and rejection. Unfortunately, for many people with BPD, friendships and relationships are very hard to maintain which can lead to isolation and become a factor that maintains this disorder. However with therapy and resources, it is more likely that a person with BPD Can learn to maintain healthier relationships.

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Case Study (Cheryl, 38)

For the purpose of This article to protect the client's identity names in this case study have been changed. The client is aware and has consented to the information used in this case study.

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Referral reason: Cheryl first contacted me when her Roy, her partner of 6 months ended

their relationship. She was very in love with Roy and was feeling confused and depressed.

Medical History: Cheryl believed she had Bipolar Disorder but this was never confirmed or diagnosed. After a psychiatric assessment Bipolar Disorder was ruled out. 

Family History: Cheryl’s parents separated when she was 5 and her dad moved interstate. She described her childhood as lonely, and remembers feeling misunderstood and scared as a child. Cheryl lived with her mother until she was 15 but remembers mum as an angry and “cold” parent. She described her current relationship with her mum as “distant”.

Emotions: Cheryl reported feeling lonely, empty and worthless most of the time.At times she also felt very angry, especially when other people around her were “nasty”.

Thoughts: Cheryl spoke a lot about “attracting the wrong people to her life”. She often thought the world was “out to get her” or that something or someone was “trying to teach her a lesson”. She believed that no one could be trusted. As much as she loved Roy, she never trusted him either.

Behaviours: Binge drinking alcohol was discussed as an unhelpful behaviour for Cheryl. She acknowledged it would help her “feel better” at the time, but she always felt worse afterwards. Cheryl also self-injured on and off for the last 5 years. Aggressive behaviour such as verbal abuse and and “outbursts” with her friends and family was also noted.

Interpersonal life: Cheryl had 3 friends she would catch up with from time to time, but nobody she could really rely on to help her on days that she was feeling down. She had close friends in the past, but reported that they all left her at some point.

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Therapy with Cheryl

After meeting Cheryl and discussing the therapeutic process, I asked Cheryl how it was for her to book the appointment and come to therapy. She expressed that she had been verynervous and anxious to come to the session, but it was difficult for her to pinpoint exactly what she was worried about. By the third session with Cheryl, she was able to identify that she had mixed feelings about me, and whether or not she could ever trust me,. She also had doubts about whether I could really help her. These fears were typical for Cheryl, as she felt this way about anyone who ever entered her life. We would continuously address these fears as they arose in therapy.

Throughout therapy Cheryl spoke extensively about her childhood, and at times she would become very tearful, angry, and distressed in the session. She felt abandoned by her dad, and this was very hard for her to talk about. At times she wondered if she was the reason he left. This would bother her on a daily basis. She also felt angry and sad that she had no one to talk to this about when she was a child. She discussed mum ‘telling her off’ when she cried or tried to ask mum questions about dad.

Soon it became evident that Cheryl believed that many other people had abandoned her in her life. Cheryl realised she had become hypersensitive to any signs of abandonment or rejection and this was a trigger for intense emotions of worthlessness and despair. Cheryl recognised that she often became very scared of being hurt and abandoned in her relationships, yet she so desperately longed to be loved and feel connected to people. This lead to unhelpful behaviours such as pushing people away when she felt scared, and desperately trying to reconnect when she was lonely. Recognising this cycle was very empowering but also very difficult to face.

It was imperative that I listened to Cheryl, and provided her a safe space to discuss these fears and her emotional pain. It was also important to facilitate her to come to these realisations.

Throughout the therapy we also discussed and practiced strategies to help Cheryl cope between sessions. We discussed and practiced mindfulness and relaxation. It took a few weeks for Cheryl to understand or see the purpose in these strategies, but eventually she reported them to be extremely helpful in times that she felt overwhelmed with emotions. Most of the time, Cheryl was able to replace the unhelpful coping strategies such as binge drinking and self-injury, with more healthy ways of coping.

Cheryl and I are now in the maintenance phase of therapy, where we touch base every month to discuss any concerns, and to maintain the progress she has made.

Cheryl has been able to reconnect with old friends and be more open with them about her emotions and her condition. She has also found a part time job that she really enjoys.

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Nicole is a Psychologist in Perth who is knowledgable and experienced working with people with BPD.  She is located in Padbury. To book an appointment with Nicole Please call 04 743 23 092 or email nicolehannpsychology@gmail.com