Borderline Personality Disorder (BPD) is an often misunderstood, serious mental health condition that affects about 2.2% of the population. BPD is shrouded in stigma and misunderstanding and trails behind the societal conversation about mental health.

Often mistaken for Bipolar Disorder, BPD has distinctive characteristics that set it apart. BPD is a disorder of instability: in emotions, thought patterns, beliefs, behaviors, interpersonal relationships and sense of self.

In this article I provide a picture of what it’s like, and summarize the symptoms, how you can help someone with BPD, setting boundaries and supporting someone with BPD. 

A Look Into a BPD Person’s Daily Life

Best-selling books have been written which illustrate what it’s like to live with BPD. This article gives a good glimpse as well. Here’s a composite sketch of some aspects of BPD a person such as “Emma” might experience while at home on a Sunday reviewing her journal:

• Woke up tired because I had already woken up at 3am, alert and anxious as ever, then somehow fell asleep. Now I don’t know which way to turn. 
• What should I do next? Laundry, clean the house, cook, read a book, run errands or make a doctor’s appointment (no, that’s for tomorrow right?). It was exhausting just thinking about it all. 
• I just can’t focus for a long period of time. When anxious my mind goes blank and I can’t pay attention to anything.

• I’m worried about what people might think of me if they came to my house and saw this. I’m always thinking of catastrophic situations that might happen.
• And that’s not all. I constantly feel threatened, like something bad is going to happen.
• Suddenly I’m really upset because my partner left a cup in the sink, then because she interrupted me while I was on the phone talking with someone. 
• I really let her have it. Now I wish I hadn’t. I hope she doesn’t leave me.

• I’m worried about what people will say to me at work on Monday about my project. Maybe they’ll be annoyed with me because of the way I did it. 
• I feel irritated a lot, kind of on edge, and like everything is falling apart when something unexpected happens.
• I hope no one criticizes me because I got upset at the water cooler. I was feeling okay and then boom, I exploded at my co-worker. Now I feel so guilty.
• I always seem to have problems maintaining relationships because I get so easily upset or think people dislike me and then I withdraw or limit contact.

• In times of stress I get paranoid—I think people are looking at me, talking about me, or the boss wants to fire me.
• I can’t hold a job anyways. Maybe she’ll fire me. 
• I always thought she was the best boss. Now I think she may be the worst.
• Then another panic attack, and I burst into tears for hours when overwhelmed.

• The feeling of dissociating when I’m stressed—feeling like the world around me isn’t real.
• Suddenly I feel empty, like life has no meaning.
• Feeling worthless and like a parasite.
• My self-talk is out of control. Suicidal thoughts are running around my brain.
• But I’m not asking people for help because I’m afraid I will bother them.
• Even worse is when family or friends call. I avoid them when I feel upset, because I don’t want to make them feel bad.
• At least Mom is trying to understand me despite how many times I’ve torn a strip off her.
• But I always want company and having someone to talk to. Then I overshare.
• Anyways, I’m constantly changing opinions and feelings towards others.
• That’s why I’m afraid of close relationships.

• Suddenly I feel sick — stomach ache, nausea, pins and needles, sweating…
• So I grab a drink or smoke a little weed to relax, sleep and lower my anxiety.
• At least I’m not binging like I did at last Saturday’s party. That fling wasn’t worth it either. I barely know who it was. Sunday morning was awful.
• Why do I feel such intense anger and hate towards myself?
• If they fire me I’ll never get another decent job. I’m lucky to have the one I do but I don’t really deserve it.
• Even if they do like my work, I’m sure it’s not really good enough.
• Constantly sabotaging opportunities. That’s me alright.

• I wish I knew what I wanted to do in life. 
• I feel so empty.
• I feel ashamed of that.

How to Recognize Symptoms of BPD

Emotional dysregulation is a core feature of BPD. Some research suggests BPD patients grow up in homes in which neglected or overtly expressed aggression is more tolerated, or at least more openly experienced. 

People with BPD may have the following symptoms:

• Great emotional instability in reaction to day-to-day events
• Impulsive behavior
• Chronic feelings of emptiness
• Frantic efforts to avoid real or imagined abandonment
• Unstable self-image
• Rapidly switch between idealizing others and devaluing them (“splitting”).
• Intense emotions
• Unstable relationships
• Impulsive behavior that is self-damaging
• Inappropriate, intense anger or difficulty controlling anger
• Suicidal threats and self-harming behavior 
• Periodic paranoid thoughts and dissociative symptoms

Nature of Identity: Characterized by a single, unstable self-identity, leading to frequent changes in self-image and goals.

Emotional and Behavioral Patterns: Marked by intense emotional fluctuations, impulsivity, and an overwhelming fear of abandonment. Individuals may experience rapid mood swings and unstable relationships.

Origins and Triggers: Often associated with genetic predispositions, environmental factors such as childhood trauma and unstable relationships. developmental deficiencies, and neurobiological issues. Trauma specialists think that trauma is typically the underlying cause of borderline symptoms.

Diagnosis and Misconceptions: Common misconceptions by professionals include beliefs about manipulative behavior and unpredictability. BPD is often stigmatized for its emotional instability.

How Can You Help Someone Suffering From BPD

There is hope for those with BPD. Retrospective studies have shown that symptoms resolve over time, with 75% of patients at 15-year follow-up and 92% of patients at 27-year follow-up no longer having the disorder.

In the meantime, treatment approaches for BPD typically involve Dialectical Behavior Therapy (DBT), psychotherapy, and medication for symptom relief, usually antidepressants. DBT was developed primarily to treat BPD by developing healthy coping skills to replace unhealthy behavior. It teaches you how to be present and also provides skills using mindfulness for coping with stress, emotional regulation, and relationship improvement.

Practical tips are nicely explained by Melinda Smith and others, summarized here:

Learn About BPD: Understanding the nature of BPD and how people may react is very important to being able to deal with it. This is so because people with BPD can trigger strong emotional responses from their loved ones that may lead to unhelpful situations.

Offer Safety and Respect: People with BPD have an insecure identity, often due to early childhood trauma. Showing these values can enable them to feel safer and more connected.

Offer Trust: Do to the attachment issues of people with BPD, it’s important for you to be trustworthy and reliable. Do what you say you will do, within reason.

Manage Conflict: People with BPD may experience a conflict as a rejection or abandonment. Separate the person from the behavior when needed. Forgive the person and let go of the behavior. Attachment is about the good and the bad over the long run.

It’s Not About You: For family and friends, recognizing that someone with BPD is in emotional pain is a starting point. With the range of emotional volatility and intense symptoms that someone with BPD experiences, it’s not always easy to remember that it’s not about you. 

Focus on Strengths: Given the insecurity of people with BPD, it’s important to support their strengths whenever possible. 

Manage your Self-Care: So start with your own self-care and mental and physical health. Do things that promote tha and help you manage your own stress. This way you can minimize the tendency to be drawn into unproductive conflicts with your loved one.

Connect With Others: Join a support group either in-person or online to gain valuable perspective. Don’t go it alone! 

The 3 Cs: Out of the Fog is a helpful website for family members and loved ones of those suffering from personality disorders. The 3 Cs are a good guide to keep in mind: 1) I didn’t cause it  2) I can’t cure it  3) I can’t control it.

Communication: Given the distorted communication patterns of those with BPD, careful listening (with maximum patience) is the first step, especially if they are raging and abusive. Postpone intense conversations until the person is calm. When you do have a conversation, stay calm and listen attentively, especially to the feelings the person is expressing. Distract attention if tempers rise to something soothing. Divert the talk to something other than the disorder.

Recommend Professional Help:  There is therapy for BPD, specifically Dialectical Behavior Therapy which was developed for this purpose as an offshoot and evolution of Cognitive Behavioral Therapy. Individual psychotherapy and medication may also be helpful

How To Set Healthy Boundaries With Someone With BPD

Setting boundaries with someone with BPD is important because they will always test limits in any way possible due to their insecure attachment and fear of abandonment. 

• Begin slowly with one or two when they are calm. 
• Make sure all family members are in agreement. 
• Be frank with the person but calmly reassuring. 
• Don’t make threats and ultimatums. These will just provoke defensiveness by the person. 
• Don’t tolerate abusive behavior.
• Don’t enable the person by protecting them from consequences of their actions.

How to Become a Support During Treatment

The most important thing you can do is to be supportive of their participation in treatment. The second is to support their consistent attendance to sessions and to be on time, as that may be difficult for some less organized people. The third is to listen carefully if they choose to share. Be non-judgmental.

Corner Canyon Can Help

Treatment is available in Utah. If you or a loved one are looking for a compassionate space to heal from mental health issues such as borderline personality disorder with our licensed professional counselors, reach out to our Admissions team now at Corner Canyon Health Centers. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.

Sources

Kreisman j. And H. Strauss. 2006. Sometimes I Act Crazy: Living with Borderline Personality Disorder. 

Seven Z. 2022. A Day in the Life With Borderline Personality Disorder. verywellmind.com.

Borderline Personality Disorder. National Institute of Mental Health.
Smith M. et al. 2024. Helping Someone with Borderline Personality Disorder.