The symptoms of bipolar disorder can often be confused with those of BPD. Your GP will look at different things when deciding how best to help you. So, it can help to keep a record of your symptoms.
This can help you and your GP to understand what difficulties you are facing. It may help if you keep a record of:. Only a psychiatrist should make a formal diagnosis. A psychiatrist is part of the community mental health team CMHT. There may be a waiting list to see your CMHT. When you have your first appointment with the CMHT they will ask you questions to understand how your mental health is affecting you.
They will talk to you about:. Psychiatrists use the following guidelines to decide if you have a mental disorder. The guidelines tell your psychiatrist what to look for. They will diagnose you with BPD if you have at least five of the symptoms below. NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at: www.
The NHS does not have to follow these recommendations. But they should have a good reason for not following them. But the NHS should not refuse to give you specialist help because of your diagnosis. They should have services to support people with BPD. For information about your options please see further down this page.
There is no medication to treat BPD. But your doctor may offer you medication if you also have symptoms of another mental illness like anxiety or depression. There are lots of different types of talking therapies and your doctor should talk to you about what is available, how it may help you and what type of therapy you would like. We have included details below of some of the therapies that your doctor may use. But these are not available everywhere. And your doctor may recommend other types of talking therapy.
The therapy you are offered should last at least 3 months. If your doctor decides that talking therapies are not suitable, they should explain why. The goal of BPD is to help you accept that your emotions are real and acceptable. And to challenge how you respond to those emotions by being open to ideas and opinions which are different to your own. DBT usually involves weekly individual and group sessions.
And you should be given an out-of-hours contact number to call if your symptoms get worse. DBT is based on teamwork. You'll be expected to work with your therapist and the other people in your group sessions. In turn, the therapists work together as a team. Mentalisation-based therapy MBT Mentalisation means the ability to think about thinking.
This means looking at your own thoughts and beliefs. And working out if they are helpful and realistic. This type of therapy also helps you to recognise that other people have their own thoughts, emotions and beliefs. And that you may not always understand these.
The therapy also helps you to think about how your actions might affect what other people think or feel. A course of MBT usually lasts around 18 months. You may first be offered MBT in a hospital as an inpatient.
The treatment usually consists of daily individual sessions with a therapist and group sessions with other people with BPD. Some hospitals and specialist centres like you to remain in hospital whilst you are having MBT. But others recommend that you leave the hospital after a certain period of time but remain being treated as an outpatient.
This means that you will visit the hospital regularly. Arts therapies There are different types of arts of creative therapies. These include:. These therapies can be offered individually but they are often done in groups. Sessions are usually weekly. These therapies can be helpful to people who find it hard to talk about their thoughts and feelings.
Therapeutic communities Therapeutic communities are not a treatment themselves. They are places you can go to have treatment. Most therapeutic communities are residential.
They help people with long-term emotional problems, and a history of self-harming, by teaching them skills to help them have better relationships. These communities often set strict rules on behaviour. For example, no drinking alcohol, no violence and no attempts at self-harming. You may stay for a few weeks or months, or you may visit for just a few hours a week.
You may have group therapy and self-help sessions. You would be expected to take part in other activities to improve your self-confidence and social skills. These activities may include household chores, games and preparing meals. Therapeutic communities vary a lot because they are often run by the people who use them. And they shape them based on what they want to achieve. You may get support from a specialist service if your symptoms are getting worse. These services are not available in all NHS Trusts.
And they can be difficult to access. You can speak to your CMHT and if they can refer you to a specialist service. A mental health crisis is when you need urgent help. You may be feeling suicidal or wanting to self-harm. Your GP should:. If you are already under the CMHT, or a specialist service, then you should have a care plan.
The care plan should include a crisis plan that you can follow. Your crisis plan is written by you and your mental health team. It should include:. Your doctor may think about offering you sedative medication. Sedatives can help you feel more relaxed. But your doctor should not give you sedatives for more than a week.
Some people find it helpful to contact emotional support lines during a mental health crisis. There is a list of contact numbers at the bottom of this page. It is common for people who live with BPD to self-harm. Some people find self-harming can help them to deal with painful feelings. But it can cause serious injury, scars, infections, or accidental death. A big focus of BPD treatment is to find other ways to deal with painful emotions. People who live with BPD are more at risk of suicide or of attempting suicide.
Most people who live with BPD who feel suicidal will feel more positive within a few hours. So it is important to use techniques to try and distract from the strong suicidal feelings. You are more likely to die by suicide if you are also using alcohol. If you drink a lot of alcohol or use drugs, you may find it difficult to get treatment for BPD. But NICE guidelines state that you should be referred to a service that can help with your substance use.
And you should be able to continue with BPD treatment where appropriate. This can include driving erratically or having multiple sexual partners. Or spending money on things you can't afford or don't need.
If impulsive behaviour leads you to have debt problems you can find more support and information at: www. Learn about the four types of cluster B personality disorders. Many of the symptoms of bipolar disorder and borderline personality disorder overlap, particularly with type 1 bipolar disorder. Questionnaires and screeners can help mental health clinicians treat patients. But as…. Health Conditions Discover Plan Connect. Medically reviewed by Timothy J.
Legg, Ph. Borderline personality disorder is often misunderstood. Share on Pinterest. Read this next. When BPD is successfully treated, the other disorders often get improve, too. For example, you may successfully treat symptoms of depression and still struggle with BPD. Most mental health professionals believe that borderline personality disorder BPD is caused by a combination of inherited or internal biological factors and external environmental factors, such as traumatic experiences in childhood.
There are many complex things happening in the BPD brain, and researchers are still untangling what it all means. But in essence, if you have BPD, your brain is on high alert. Things feel more scary and stressful to you than they do to other people. After all, what can you do if your brain is different?
But the truth is that you can change your brain. Every time you practice a new coping response or self-soothing technique you are creating new neural pathways. Some treatments, such as mindfulness meditation, can even grow your brain matter. And the more you practice, the stronger and more automatic these pathways will become. With time and dedication, you can change the way you think, feel, and act. No one acts exactly the same all the time, but we do tend to interact and engage with the world in fairly consistent ways.
These are elements of personality. But a personality disorder is not a character judgment. This causes consistent problems for you in many areas of your life, such as your relationships, career, and your feelings about yourself and others. But most importantly, these patterns can be changed! Giving yourself permission to have these feelings can take away a lot of their power.
Try to simply experience your feelings without judgment or criticism. Let go of the past and the future and focus exclusively on the present moment. Mindfulness techniques can be very effective in this regard. Engaging your sense is one of the quickest and easiest ways to quickly self-soothe. You will need to experiment to find out which sensory-based stimulation works best for you. Here are some ideas to get started:.
If you want to calm down, try something soothing such as hot tea or soup. Light a candle, smell the flowers, try aromatherapy, spritz your favorite perfume, or whip up something in the kitchen that smells good.
You may find that you respond best to strong smells, such as citrus, spices, and incense. Focus on an image that captures your attention.
This can be something in your immediate environment a great view, a beautiful flower arrangement, a favorite painting or photo or something in your imagination that you visualize. Try listening to loud music, ringing a buzzer, or blowing a whistle when you need a jolt.
To calm down, turn on soothing music or listen to the soothing sounds of nature, such as wind, birds, or the ocean. This is where the impulsivity of borderline personality disorder BPD comes in. They make you feel better, even if just for a brief moment.
But the long-term costs are extremely high. Regaining control of your behavior starts with learning to tolerate distress. The ability to tolerate distress will help you press pause when you have the urge to act out. Instead of reacting to difficult emotions with self-destructive behaviors, you will learn to ride them out while remaining in control of the experience.
The toolkit teaches you how to:. One approach to identifying genetic factors involved in a trait or disorder is to select candidate genes: that is, genes that are likely, based on other evidence, to be associated with that disorder. For example, genes that modulate the breakdown or synthesis of serotonin might be logical candidate genes.
Another candidate is a variant of a gene that controls the serotonin transporter, which inactivates serotonin by taking it back from the cleft between the neurons the synapse , where it does its job, to the inside of the neuron, where it is broken down. Genes coding for other receptors that act like thermostats in modulating serotonin release have also been associated with suicide attempts in personality disorder patients.
There is evidence that trauma or abuse may modify serotonin system activity. People with borderline personality disorder often have histories of sexual or physical abuse.
While this experience is not unique to them, it may help shape their personalities and leave its imprint on the brain. Complex relationships have been found among responses to serotonergic agents, cortisol a major stress hormone , and a history of trauma. The relationship between serotonin activity and impulsive aggression raises the possibility that drugs enhancing the activity of the serotonin system could alleviate impulsive aggression.
These medications have helped in depression, and there is increasing evidence that they may help in impulsive aggression as well. Studies suggest that they reduce irritability and anger in patients with borderline personality disorder.
Indeed, the effects on anger are more pronounced than the effects on depression itself. Unfortunately, people with borderline personality disorder are often very sensitive to the side effects of these medications.
This sensitivity, or the likelihood of their not complying with the requirements, has meant that they often do not give the medication an adequate chance to work. This is particularly problematic because people who have reduced serotonergic capacity appear to require more SSRIs than others to achieve therapeutic affects. If used carefully, however, with incremental increases in dose, SSRIs can be brought to levels that reduce impulsive aggression.
In addition to vulnerability to impulsive aggression, people with borderline personality disorder are unusually emotionally reactive. They may be content for a while, then become intensely angry or hopelessly depressed or unbearably anxious—each state, although intense, lasting only a few hours or a day. Contrast this with classic mood disorders like depression, in which the emotion, although it may wax and wane during the day, endures for weeks or months.
To those who are close to them, borderline patients appear to have random and unpredictable emotions. On closer investigation, those emotions often seem to involve heightened emotional reactions to other people. Borderline patients may become distraught at ordinary criticism, which they experience as a blow to self-esteem; may react with rage to a disappointment or minor slight; or may feel terror at a separation that they experience as virtual abandonment.
Their emotional, or affective, instability may contribute to their turbulent, often unstable relationships and the inconstancy in their experience of themselves that leads to a confused sense of identity. A particular chemical system of the brain, the norepinephrine system, appears to be involved in regulating our level of arousal and vigilance in reaction to the environment. Substances that stimulate norepinephrine activity increase alertness and attention to the environment.
They found that those least emotionally stable were most sensitive to amphetamine-induced shifts in emotion. A second chemical system in the brain, the acetylcholine system, also appears to play a role in emotional reactivity. When substances that enhance acetylcholine are given to patients with depressive illness, they become more depressed; when these agents are given to patients in the euphoric phase of bipolar illness, they become depressed, as well.
Patients with borderline personality disorder who receive physostigmine, a substance that activates the acetylcholine system, swing to depression; those borderlines with a history of extreme affective instability show the strongest reaction.
Procaine, the local anesthetic dentists use to diminish pain, also stimulates the acetylcholine system. When borderline patients receive procaine intravenously, they show marked and variable emotional reactions, especially swings to depression and other unpleasant feelings.
Since the brain could not have evolved a receptor in anticipation of a drug product, this intriguing discovery suggests that the brain has its own natural Valium-like substance.
GABA receptors are found extensively in those parts of the brain most involved in processing emotion, particularly the amygdala— an almond-shaped structure located deep behind the temples on each side of the head. Because GABA may play a role in tranquilizing or damping down sudden surges of emotion, it seems possible that impairments in the GABA system may be involved in affective instability. We can use brain scanning to observe the activity of brain structures that may be involved in emotional instability.
When volunteers get shots of procaine, the substance that evokes intense emotional reactions in borderline patients, their brain activity increases in certain regions of the amygdala, suggesting that those regions may play a role in emotional instability. We have seen considerable evidence that improperly regulated brain systems may give rise to impulsive aggression and affective instability in borderline personality disorder.
Infants who are very emotionally sensitive may respond more intensely to the comings and goings of their mother or caretakers and show much greater distress at separating. This may lead to a more insecure attachment between infant and mother. If the infant is more impulsive and aggressive—that is, likely to express emotions forcefully— he may have crying spells and, later, temper tantrums when frustrated or left alone, which can wear down even the most supportive parents and overwhelm those who are depressed or who themselves have trouble with emotional reactivity and impulsiveness.
Parents may become frustrated at their inability to soothe such a child and decide not to respond to its distress; at other times they may try everything to indulge the child to appease its upset and rage.
These inconsistent and, to the infant, unpredictable responses may make it likely that the child will learn to deal with unpredictability by means of emotional storms or tantrums. As the child matures, he may draw on these interpersonal strategies in order to regain emotional equilibrium.
For example, when an upsurge of depression follows a blow to self-esteem, the borderline person may try to bolster her self-esteem by devaluing someone else. When feeling alone and abandoned, she may behave recklessly to stimulate the worry and involvement of others.
But because of their heightened sensitivity to the availability of others, people with borderline personality disorder often feel that they are not in charge of their own emotions—their emotions depend on the behavior of those around them.
Repeated again and again, these patterns of behavior become ingrained. The borderline person experiences these styles of relating as the only way to survive emotional ups and downs and the feeling that others cannot be trusted to support her.
Their sense of abandonment by the ending of a relationship may make them feel desperate and enraged.
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