What’s it Like Living with Borderline Personality Disorder?

Do you often feel like you have really intense, overwhelming emotions that you can’t control? Or, do you experience a lot of chaos in your relationships and have a major fear of being abandoned? Maybe you even act impulsively or self-destructively and go to extreme measures to avoid being alone. If any of these traits sound like you, it’s possible that you could be living with borderline personality disorder, or BPD.

Signs of BPD (and other personality disorders) can first pop up in teenage years, and if you’re experiencing these symptoms for the first time, you may feel scared or confused, not understanding why you feel the way you do –– but you are not alone. 

Here’s what you need to know about BPD, its symptoms, and how to cope with it. 

What is borderline personality disorder?

First, it’s important to distinguish what exactly a personality disorder is. The American Psychiatric Association states that in order to be diagnosed with a personality disorder, a person must exhibit ongoing ways of thinking, feeling, and behavior that go against cultural expectations, ultimately causing them distress and difficulty functioning in their day-to-day life. In most cases, the worrisome behavior starts to emerge in adolescence or early adulthood.

A personality disorder can affect the way that you:

• Think about yourself and other people
• React emotionally to different situations
• Relate to other people
• Control your behavior 

There are three recognized types or clusters of personality disorders. BPD falls into what is known as Cluster B personality disorders. Aside from BPD, other disorders in Cluster B are:

• Antisocial personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

Essentially, the common thread throughout these disorders is that the person may be erratic, emotional, dramatic, and act unpredictably in certain situations. With BPD specifically, this includes mood swings, emotional instability, impulsive behavior, and troubled relationships.

While there’s limited research on BPD in teens, it’s estimated that borderline personality disorder may affect up to 3% of adolescents. Additionally, it may affect around 1.4% of US adults over 18. 

What are the symptoms of borderline personality disorder?

The symptoms of this condition can make living with borderline personality disorder tough.  There are many BPD symptoms that relate to how you feel, how you see yourself, and how you relate to other people.

Some borderline personality disorder symptoms include:

• Having intense emotions 
• Having an unstable mood or mood swings
• Having unstable relationships and overall difficulties with interpersonal relationships
• Having an intense fear of abandonment 
• Having an intense fear of rejection 
• Engaging in impulsive and/or dangerous behavior 
• Exhibiting suicidal behavior
• Exhibiting self-harming behaviors 
• Displaying intense anger 
• Having chronic feelings of emptiness
• Feeling paranoid, especially when stressed
• Dissociating when stressed
• Lacking a strong sense of self or self-image 
• Being overly self-critical
• Having quick shifting values and goals 

Due to these symptoms, you may have a lot of trouble regulating your own emotions and even your sense of self, which can make your day-to-day functioning and relationships hard. When you’re faced with your personal BPD triggers, whether that means feeling overwhelmed with stress at school or work, or feeling distressed if a loved one leaves you alone. You may go to great lengths to avoid being abandoned in a relationship because you fear being alone so much. You might have urges to harm yourself, or even consider suicide –– and you might threaten this to your loved ones. Ultimately, severe symptoms of BPD can affect your quality of life and make living with borderline personality disorder difficult –– especially if you don’t seek out help. 

What mental health conditions are related to borderline personality disorder?

If someone is living with borderline personality disorder, it is highly likely that they also have another mental health condition. According to the National Institute of Mental Health, 84.5% of people with BPD have a co-occurring condition. 

Common co-occurring mental health conditions include:

• An anxiety disorder
• A mood disorder (such as depression or bipolar disorder) 
• A substance use disorder
• Post-traumatic stress disorder (PTSD)
• An eating disorder
• Attention-deficit/hyperactivity disorder (ADHD)
• Another personality disorder

People with BPD who also have co-occurring disorders are often more likely to exhibit suicidal behavior.

What is the treatment for borderline personality disorder?

Pursuing treatment for borderline personality disorder is crucial, especially for people who experience severe symptoms and are at risk for self-harm or suicidal behavior. Early intervention in situations where symptoms are just starting to crop up can help to get a head start on the treatment of borderline personality disorder in teens. Many signs of personality disorders often start showing up during the teenage years. 

Most people with BPD don’t receive a diagnosis until they’re an adult, however, it is possible for adolescents to be diagnosed with BPD. As per The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), young people under the age of 18 can be diagnosed with BPD if their symptoms have been persisting for over a year. 

BPD treatment typically consists of two main courses of action: psychotherapy –– AKA talk therapy –– and medication. Combining the two allows for the most effective and long-lasting results. 

Therapy is key for helping someone who’s living with borderline personality disorder to learn how to cope with difficult emotions, improve self control, and have healthier relationships. Types of therapy commonly used for treating borderline personality disorder include: 

Dialectical behavior therapy (DBT)

DBT is a type of therapy very helpful for people who have trouble regulating their emotions and deal with suicidal thoughts or self-harm. In a DBT program, you will have individual therapy, skills training, and supported groups. The combination of these will make for a well-rounded treatment. Skills you learn in DBT include mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. All of this together helps you learn to manage your difficult emotions and improve your interpersonal relationships.

Mentalization-based therapy

The American Psychological Association defines mentalization as “the ability to understand one’s own and others’ mental states, thereby comprehending one’s own and others’ intentions and effects.” People with BPD often struggle with mentalization. This type of therapy helps you learn to understand and identify your emotions and the emotions of others. Ultimately, learning these skills should help you to be able to take a step back and think before you react to a situation. 

Schema-focused therapy

This type of therapy helps you look back on your life and unmet needs that occurred in childhood which may have affected your ways of thinking as you grew up. You will identify “schemas” which may be outlooks or assumptions that are hurting your well-being and/or relationships. By identifying these situations and schemas, you can learn healthier ways to cope and move forward. 

Systems training for emotional predictability and problem-solving (STEPPS)

STEPPS is specifically for people with BPD, and is meant to be used as an add-on to other types of therapy. Over 20 weekly sessions, you learn skills to help you regulate emotions and behaviors. Family members, significant others, or close friends can also be a part of this so they can become educated on BPD and help their loved ones.

Transference-focused psychotherapy (TFP)

This unique therapy modality focuses on the patient/therapist relationship. Oftentimes, the feelings someone with a personality disorder has towards their therapist or how they act with them is a reflection of their interpersonal relationships in the outside world, sometimes dating back to childhood. This can help you better understand your behaviors and relationships, improve your sense of self, and make positive changes from there. 

It’s ideal to seek out mental health professionals who have experience specifically working with patients with borderline personality disorder and using these unique therapy modalities. 

When it comes to medications, there is no one-size-fits-all approach for treating borderline personality disorder. Medications can’t cure BPD, but they can help you manage a variety of distressing BPD symptoms. The meds you’re prescribed will also depend on any other co-occurring mental health conditions you have. Some examples of medications that are prescribed to people with BPD include: 

• Antidepressants
• Mood stabilizers
• Antipsychotics

Your psychiatrist will work with you to determine the best medication (or combination of medications) for your treatment plan. Everyone is different and may respond differently to different meds. Since it can take several weeks for medications to kick in fully, you may have to be patient while you wait to feel the full effects of the meds.  

Tips for living with borderline personality disorder

If you’re living with BPD, there are many things you can do to improve your mental health, overall well-being, and your interpersonal relationships. Here are a few tips: 

Stick with your treatment plan: It’s so important to keep up with therapy and take your meds as directed. Even if you think you’re feeling much better and don’t need your medication anymore, be sure to continue with the treatment plan. Don’t make any changes to your medications without consulting with your doctor, and show up for your scheduled therapy appointments to continue to make progress. 

Help your loved ones understand: Since BPD can cause you to have troubled relationships, helping your loved ones understand BPD can be helpful. Share some educational content with them so they can learn exactly what BPD is and better understand why you feel and behave the way that you do. You can also communicate with them what would help you in times of high stress.

Try family therapy or couples therapy: If troubled relationships are very distressing to both you and your loved ones, it may be helpful to incorporate them into your treatment plan. For example, family therapy can be beneficial for borderline personality disorder in teens to help adolescents develop healthier ways of communicating with their parents, and also to help the parents better support their child. For adults with BPD who are in a troubled romantic relationship, couples therapy can help to build a healthier and more stable relationship with their partner.

Use your coping skills: In times of high stress or intense emotions, it can be hard to remember to use the coping skills that you’ve learned in therapy. Keeping a list handy in your room or on your phone can help you remember. You can also think of the acronym “TIPP” which is a mainstay in dialectical behavioral therapy for distress tolerance. This stands for:

• Temperature: For example, holding ice cubes or taking a cold shower when you’re feeling overcome by intense emotion. 
• Intense exercise: When you’re having overwhelming emotions, this can result in a lot of pent-up energy. By exercising and releasing this energy, you can find yourself feeling more emotionally balanced. 
• Paced breathing: This is a breathing technique that involves exhaling for longer than you inhale to promote relaxation if you’re feeling anxious or any other intense emotion. You can try inhaling through your nose for a count of four and exhaling through your mouth for a count of six. Repeat the cycle for a minute or so, until you feel more regulated. You can play around with the length of each breath to find what feels best for you so you aren’t straining. 
• Progressive muscle relaxation: PMR involves purposely tensing up different muscle groups in your body for a few seconds and then letting them go. You can start with your head and work your way down all the way to your toes, feeling tension melt away through your whole body, promoting relaxation. 

Practice self-care: On top of the work you put in with therapy, self-care can really make a positive impact on how you feel day-to-day. Here are some ideas: 

• Stay active, getting at least 15 minutes of physical activity daily
• Eat a balanced and healthy diet
• Get enough good quality sleep
• Abstain from drugs and alcohol
• Keep a strong social support system
• Find a creative outlet for your emotions, like music or art 
• Practice mindfulness or meditation
  

What to do in a mental health crisis

Since suicidal behavior and self-harm risk is high in people with BPD, it’s important to know that help is available in emergencies. It can be scary to have these thoughts, and you do not have to suffer alone if you are feeling suicidal or have the urge to hurt yourself. 

Here are some great confidential, free resources that are available 24/7 to help you in a mental health crisis:

• 988: 988 is the Suicide & Crisis Lifeline. Simply call or text 9-8-8 to get connected with a trained crisis counselor in your area. If you prefer, you can chat online. 
• Crisis Text Line: Crisis Text Line is a text message-based service. Text HOME to 741741 to connect with a crisis counselor. It’s available on WhatsApp, too.
• The Trevor Project: If you’re in the LGBTQIA+ community, The Trevor Project is a great resource. Call them at 1-866-488-7386, text ‘START’ to 678-678, or use their online chat.

While these services are great in emergency situations, they aren’t substitutes for formal mental health services or treatment for BPD. If you have BPD and struggle with suicidal or self-harm thoughts, it is crucial to get ongoing help from a trained mental health professional. 

How Charlie Health can help

Do you think you might have borderline personality disorder? If so, Charlie Health may be able to help you.

Our virtual intensive outpatient program provides personalized mental health treatment for teens, young adults, and families dealing with a variety of struggles, including BPD. 

With the help of experienced therapists and the social support of peers who face similar struggles, you can make strides toward feeling better by regulating your emotions, learning healthy ways to cope with your feelings, and gaining skills for healthy relationships.

Help is here now. We’re available 24/7 to get you started on your healing journey.