Common questions about BPD

There's far more to borderline personality disorder (BPD) than the stereotypes, myths and misunderstandings that often exist.

People who live with BPD are ordinary people. People who are overcoming challenging symptoms, as well as stigma and discrimination.

So, to raise awareness and reduce stigma we asked the community what they wanted to know about BPD. These questions have been answered by people who live with BPD and the SANE Help Centre.

How can I support someone with BPD?

Leah: It's so important to ask them what they're struggling with and what kind of support they'd benefit from. If they're unable to answer, then just being there and listening – letting go of stereotypes and assumptions – is a really great place to start!

Annie: Don't see someone as the label. It's part of us but doesn't define us. Don't see someone as 'back and white', see us as beautiful rainbows because we are actually colourful people! Do some reading. Don't limit this to clinical content, read about the actual experience of living with BPD. By doing research it shows that you care and are willing to go beyond the stigma.

Bronwyn: Give reassuring words. Write a letter that says all the nice things you feel towards that person. This is a token they can have on them when they feel distressed and alone.

Abbey: Be kind. If you're frustrated or angry, try to keep in mind that a person with BPD doesn't want to be behaving in ways that are difficult or aggressive. Most of the time, they're scared. Prepare for the very bad days by creating a plan together with strategies for support in times of crisis.

Sarah: Set clear barriers of what you will and won't stand for. You need to take care of yourself before you support your loved one.

How do you encourage someone with BPD to seek help?

Natasha: Listening is really important. You want the person to feel like you genuinely care. Frame it in a way that suggests it will give them an opportunity to talk to someone about their thoughts and feelings.

Sophia: You should approach them when they are in a calmer state and tell them that you don't like seeing them in pain and that there is an alternative. When you have a diagnosis a lot of things start to make a lot more sense.

Annie: Avoid the line 'just take some medication'. Because it will not sit well. Just create an emotional safe space, be nurturing, be reassuring and say 'I've noticed it's all a challenge for you at the moment, but I want you to know I'm here for you'.

Abbey: Seek out healthcare professionals who regularly treat people with personality disorders. I loved getting a proper diagnosis. I felt that once I knew exactly what I had, I could do something about it. I was just free-falling before my diagnosis.

Are people born with BPD?

SANE Help Centre: There are many theories about the development of BPD. These include difficulties with attachment, childhood trauma or neglect, temperament, neurobiological and sociocultural factors. 

While childhood trauma is a factor for many people who have BPD, it is important to recognise that not everyone diagnosed with the condition has experienced childhood trauma and it is not a requisite for the diagnosis.

Is there a way to explain BPD without people getting confused or scared?

Sophia: The best way to explain BPD is to use the phrase 'emotional regulation'. Someone may experience extreme reactions to an action or event that upsets or worries them. This can lead to impulsive behaviour. People with BPD often have 'black and white thinking' and might struggle to remember that their friend has not always hurt or disappointed them.

Leah: When explaining BPD, it can be helpful to give a personal explanation of your struggle rather than explaining the whole diagnosis.

What are the most effective treatments?

SANE Help Centre: A common psychological therapy used is dialectical behaviour therapy (DBT). This therapy aims to address skill building in areas of mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.

There are a range of other psychological therapies that are also effective in the treatment of BPD which includes schema therapy, cognitive analytic therapy and mentalisation-based therapy.

DBT often runs in groups and is offered at a range of different clinics and hospitals nation-wide. Victoria also has a specialist centre for borderline and other personality disorders called Spectrum.

Is there medication for BPD? If so, is it effective?

SANE Help Centre: BPD is often linked to other mental illnesses such as depression and anxiety. Medication is often prescribed to treat the symptoms of these conditions, making them manageable, however there is no medication to treat the symptoms associated with BPD itself.

If any medication is prescribed, it's effectiveness is a very individual thing. Every person reacts to medication differently and if you feel as though it's not working or there are side effects, it's best to talk with your prescribing doctor.

How can a person be doing so well and then, out of the blue, on a downward spiral?

Sarah: We are masters at hiding how we feel. But if someone is paying close enough attention there are always signs. Changes in personal hygiene, sleep, eating habits, caffeine intake, sexual habits and spending are all signs of a bad period.

Kelly: We fight our own minds every day. Some days we get complacent and we don't implement our strategies, or circumstances build up and a relapse happens. It may feel like it's out of the blue, but for the person with BPD it's probably been an internal fight to stay well for days, weeks or months.

Bronwyn: It is important to not immediately link someone's emotional behaviour to their disorder. It may seem like their downward spiral is 'out of the blue', but for someone with BPD it's a triggered reaction. It's like a wound that is mostly healed, but when scratched hard enough it reopens and all the previous pain remerges.

How do I help a loved one on a massive high who thinks they're fine?

Natasha: Patience is key. Be patient with their mood and experience. Try to keep them safe while they're up and let them know you are there for them. Remember that even though you want to help, it's not your sole responsibility. Sometimes you can't do much other than offering support, looking out for signs and suggesting professional intervention.

Leah: When people are acting outside of their 'usual self' it can be difficult to know how to react. It's never ideal to force treatment on a person against their will. But it's also not ideal to sit back and ignore your discomfort. Talk to the person, express how you feel and allow them express their feelings. Hopefully you can come up with a solution that meets everyone's needs.

Sophia: If they are harming you or anyone else, it is important to let them know how they are making you feel so they can be reminded of their responsibility to respect other people's boundaries. Remind them that you care and want to support them through their journey.

When is it appropriate to call the police if someone is unwell and stating that they want to kill someone else?

SANE Help Centre: If someone is stating that they want to kill someone else, it is always a good idea to notify the police. The police will make an assessment on the best course of action. 

If you are unsure or hesitant about contacting the police, you can talk it through with the SANE Help Centre on 1800 187 263 or contact Lifeline.

I'm a long-term sufferer. When am I going to get better?

Natasha: Sometimes I ask myself the same question! But then I remember to celebrate the little victories. I've been on my recovery journey for eight years and I still have bad days and bad moments. But there are good days and I make time to celebrate the unique qualities I have because of my BPD.

Kimberley: Give yourself what you need and practice self-care regularly. Make an agreement with yourself to relax at a certain time each day. Focus on anything that interests you, nurtures you and nourishes you.

Kelly: There's good news and slightly less good news. I wish I could tell you there's a magic pill or therapy. Maybe one day, but not now. The good news is you can get better.
The slightly less good news is that it is a lot of hard work. You have to fight yourself. Learn a whole new way of thinking and responding to emotions. It's hard work, but it's worth it.

Leah: I wish the answer could be, 'today'. Realistically, these things take time. If you don't have a support system around you, fight as hard as you can to find one. Having people that you can talk to about your experience can be so life changing. There may not be a definite end point to this journey, but it's a worthwhile road to travel!

For more information about BPD you can read SANE's Factsheet and Guide.

Jeremy Little is a Content Producer and Melissa Wilson is a Counsellor with the SANE Help Centre.