Getting a diagnosis
As with any health issue, the best place to start is your local general practitioner (GP).
- Book a longer appointment so there is time to talk through your situation
- Make notes beforehand on what’s happening with your physical and mental health, relationships, work or study, and take them along
Your GP can refer you to a psychologist, psychiatrist or other mental health professional, who can then develop a treatment plan and work with you in the role of therapist. Some people with BPD also benefit from accessing a case manager.
The therapist may work in private practice (which can involve out of pocket expenses, though rebates are often available) or in the public mental health system, in your local mental health service or a specialist BPD service (which may be free or low cost, but can involve a longer waiting list). Your GP, a case manager or a helpline can help you determine what services are available in your area and the best options for you.
Your treatment team will need as much information as possible about you and the impact of BPD on your life, in order to make a good diagnosis and ensure effective therapy. You can help by being open and honest about the thoughts, feelings, and behaviour which concern you. The better the therapist understands, the better they’re able to help you.
Related: What use is a diagnosis? • Being at the centre of the conversation about your mental health
“It was a relief for me and my family to be able to put a name to what I was experiencing and to learn my triggers”
The term ‘borderline personality disorder’
When it was first identified in the 1930s, psychologists thought the symptoms of BPD were on the border between two other kinds of diagnosis, hence ‘borderline’. BPD is better understood now, but the title has stuck. The term ‘borderline’ doesn’t describe the symptoms of BPD or the people living with it, just the history of the diagnosis.
Some people dislike the term or believe other terms would describe the condition better. For example, some people believe that BPD should be relabelled as ‘Complex Post-Traumatic Stress Disorder’ (Complex PTSD).
Psychological therapy and medication
Psychological therapy is the most effective treatment for BPD (NMHRC, 2012). In therapy you’ll work with your therapist to reduce your symptoms and help you manage feelings, behaviour, and relationships better, so you feel more in control. With effective therapy, you’ll feel calmer, happier in yourself, and better able to cope with the ups and down of life.
Effective psychological therapies for BPD include:
- Dialectical Behavioural Therapy (DBT)
- Cognitive Analytic Therapy (CAT)
- Mentalisation-Based Therapy (MBT)
- Schema Therapy (ST)
Your GP or therapist can explain these and discuss which is the most helpful for you and what might be accessible to you. Therapy can take from several months to a year or more, depending on your needs and the services in your area.
Despite their differences in approach, therapies for BPD share common features (NHMRC, 2012):
- The therapist and you have a shared understanding of the therapy, and a commitment to work together
- The therapist is suitably trained, supported, and supervised
- The therapist pays attention to your emotions, thoughts, and current challenges
- Therapy is focused on achieving change in your current life
- You work in equal partnership with your therapist
- You agree to play an active role in therapy by working with the therapist, and working to make choices that will help you recover
- Therapy helps you learn skills to manage suicidal feelings and self-harm
- There is a focus on the relationship between you and the therapist
- Therapy sessions happen regularly (generally at least once a week, where possible)
Medication is not a primary treatment for BPD, though it may be helpful during periods of emotional crisis, and can be prescribed for other conditions (NHMRC, 2012). Taking multiple medications for long periods of time is not generally required. Discuss with your doctor the benefits and side-effects of any medication before making an informed decision.
Admission to hospital is only recommended in the short-term, to deal with a crisis where someone is at risk of serious self-harm or suicide. It is best if a hospital stay is brief, with a specific aim agreed between the person with BPD and their doctor or therapist.
Related: Psychotherapy • Treatments for mental illness • dialectial behavioural therapy • Changing thinking styles for better mental health
Learning about BPD
Education is important. Find out as much as you can about BPD: the symptoms, effective treatments, and ways to keep yourself well. Learning about BPD empowers you to manage your symptoms, making them more predictable and less scary.
There is a lot of inaccurate and misleading information on the internet about BPD, so be sure to access reliable sources, like those listed at the end of this guide.
After months or even years of distress caused by the effects of BPD, many people say that receiving a diagnosis can actually be a relief. Not only is there a medical explanation at last of why you have been feeling and behaving this way, there is also the good news that effective treatments are available.
Looking after yourself
What's true for people with BPD is true for all of us: make sure you eat healthily, get regular sleep, exercise and fresh air every day, don't drink alcohol excessively, and do things that make you feel calm — listen to music, do yoga, mindfulness exercises, or anything else that helps. It's the calming effect that matters, not the method, so choose whatever works for you.
Of course, we’ve all heard this advice many times, and it's often easier said than done. However, when you have BPD it's doubly important to look after yourself. This is because looking after your body, and developing healthy habits, can help people feel more in control and better able to manage their emotions and stress.
Set yourself small, easy-to-achieve goals and reward yourself when you reach them. Whatever the activity, you can strengthen your sense of self-worth, stability and control over your life just by regularly doing things that make you feel better.
Some people with BPD find it helpful to use mindfulness techniques when they feel distressed or overwhelmed by emotion. Mindfulness is a way of giving your mind a break from worries by focussing your attention on your breathing, body and surroundings.
Related: Healthy living • What mindfulness app is right for you? • Ten tips for sleep hygiene
Some people with BPD physically harm themselves. This is something that other people understandably find confronting and hard to understand. While self-harm can bring momentary relief and distraction from emotional distress, the effect is very short-term. It’s also damaging to your body and can lead to serious, even fatal, consequences.
Related: Self-harm • Self-care for self-harming behaviour
Managing suicidal thoughts
If you have suicidal thoughts sometimes, it’s a good idea to develop a safety plan so you can stay safe. When you're feeling calm, prepare a personal safety plan with your therapist or someone else you trust.
A safety plan includes strategies to delay, divert and distract yourself so when you feel the urge to self-harm, you can soothe yourself instead. Your plan will also include numbers of people and help services you can call in a crisis.
When you have a safety plan, make sure the people close to you know about it. Ask them to carry with them a simple summary of what to do and where to call for help if needed — in their phones, for example.
If you are at immediate risk, call 000 or visit your nearest hospital. For support with suicidal thoughts you can contact Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.
Related: Finding help if you're feeling suicidal • Guide to staying alive
Relating to other people
Dealing with other people can be the most challenging part of having BPD. Relationships with family, friends, colleagues and others can be fraught with misunderstanding and confusion.
You might sometimes feel so distressed that you lose your temper, say things you later regret, or even say contradictory things about the same topic. On the other hand, feeling you don't have a safe way to express your anger can lead to your emotions turning inwards, sometimes leading to unhealthy coping mechanisms.
The symptoms of BPD can affect your ability to communicate clearly and calmly. Practise strategies for better communication. For example:
- It can be helpful to prepare for difficult conversations, such as writing down what you want to communicate and how it makes you feel
- It can be less stressful to discuss something when you’re out walking or doing another activity together, rather than staring at each other across a table
- Recognise the warning signs that your emotions are becoming heightened when talking to other people. Say you need time out, give yourself permission to calm down and ask to meet again another time
- Make an effort to imagine how things look and sound to the other person. Arguments are rarely black-and-white, and it helps to imagine the other perspective
- When talking to someone about a distressing topic, consider having a third, independent person present
- Remember that family and friends can find these situations upsetting too, and that they need understanding and support themselves
Discuss with your therapist ways to manage your emotional responses and improve how you relate to other people. Doing this will reduce the distress caused by the surges of emotion you experience and the impact they have on your life.
Talk through one of these distressing episodes with your therapist or other suitable person. Treat it as a case study you can learn from. Discuss what was said and how it got out of control, and how next time you can manage it in a way that leads to a better outcome.
Related: Ten ways to get control of your anger
Thousands of people in Australia have BPD, so you’re not alone. Sharing experiences, helpful information and tips can make a huge difference to how you feel and cope.
The BPD Foundation can help you find information and support. Talk to a treating health professional, your local GP or SANE's free counselling service about what support is available locally for people affected by mental health issues.
Visit the SANE Forums to meet other people affected by mental health issues for peer support.