Symptoms - Borderline personality disorder

Borderline personality disorder (BPD) can cause a wide range of symptoms, which can be broadly grouped into 4 main areas.

The 4 areas are:

• emotional instability – the psychological term for this is "affective dysregulation"
• disturbed patterns of thinking or perception – "cognitive distortions" or "perceptual distortions"
• impulsive behaviour
• intense but unstable relationships with others

Each of these areas is described in more detail below.

Emotional instability

If you have BPD, you may experience a range of often intense negative emotions, such as:

• rage
• sorrow
• shame
• panic
• terror
• long-term feelings of emptiness and loneliness

You may have severe mood swings over a short space of time.

It's common for people with BPD to feel suicidal with despair, and then feel reasonably positive a few hours later. Some people feel better in the morning and some in the evening. The pattern varies, but the key sign is that your moods swing in unpredictable ways.

If you have suicidal thoughts:

• call your GP or the out-of-hours GP service. If you've taken an overdose or self-harmed, dial 999
• call the Samaritans on 116 123. This organisation provides emotional support 24 hours a day for people experiencing feelings of distress or despair
• contact a friend, family member or someone you trust

If you've been diagnosed with BPD, tell someone you trust about your condition. Give this person the contact details of your care team and ask him or her to contact the team if they become concerned about your behaviour.

Disturbed patterns of thinking

Different types of thoughts can affect people with BPD, including:

• upsetting thoughts – such as thinking you're a terrible person or feeling you do not exist. You may not be sure of these thoughts and may seek reassurance that they're not true
• brief episodes of strange experiences – such as hearing voices outside your head for minutes at a time. These may often feel like instructions to harm yourself or others. You may or may not be certain whether these are real
• prolonged episodes of abnormal experiences – where you might experience both hallucinations (voices outside your head) and distressing beliefs that no one can talk you out of (such as believing your family are secretly trying to kill you)

These types of beliefs may be psychotic and a sign you're becoming more unwell. It's important to get help if you're struggling with delusions.

Impulsive behaviour

If you have BPD, there are 2 main types of impulses you may find extremely difficult to control:

• an impulse to self-harm – such as cutting your arms with razors or burning your skin with cigarettes; in severe cases, especially if you also feel intensely sad and depressed, this impulse can lead to feeling suicidal and attempting suicide
• a strong impulse to engage in reckless and irresponsible activities – such as binge drinking, drug misuse, going on a spending or gambling spree, or having unprotected sex with strangers

Unstable relationships

If you have BPD, you may feel that other people abandon you when you most need them, or that they get too close and smother you.

When people fear abandonment, it can lead to feelings of intense anxiety and anger. You may make frantic efforts to prevent being left alone, such as:

• constantly texting or phoning a person
• suddenly calling that person in the middle of the night
• physically clinging on to that person and refusing to let go
• making threats to harm or kill yourself if that person ever leaves you

Alternatively, you may feel others are smothering, controlling or crowding you, which also provokes intense fear and anger. You may then respond by acting in ways to make people go away, such as emotionally withdrawing, rejecting them or using verbal abuse.

These 2 patterns may result in an unstable "love-hate" relationship with certain people.

Many people with BPD seem to be stuck with a very rigid "black-white" view of relationships. Either a relationship is perfect and that person is wonderful, or the relationship is doomed and that person is terrible. People with BPD seem unable or unwilling to accept any sort of "grey area" in their personal life and relationships.

For many people with BPD, emotional relationships (including relationships with professional carers) involve "go away/please don't go" states of mind, which is confusing for them and their partners. Sadly, this can often lead to break-ups.