Borderline diagnosis
Question
I think I may have borderline personality disorder but I've not been diagnosed with it. Basically, I tried to commit suicide a while ago and was forced into family therapy afterwards so my therapist has been talking to my parents about it. Now they've got all these books about it and stuff, like they've already decided I have it.
I recently gave up going to therapy as I hated my therapist so I can't ask her about it. Can you tell me how BPD is diagnosed and how it's treated?
Answer
Even if you feel you are experiencing symptoms of borderline personality disorder (BPD), it's important to remember you have not received a formal diagnosis. People experience all kinds of difficulties with their mental health and this can be due to many different things. It's also important not to make a self-diagnosis. Instead, you might like to consider seeking professional medical advice. A first point of contact would be your doctor (GP). They will be able to go through the assessment and treatment options with you.
BPD is characterised by unstable moods that can affect relationships, perceptions of self-image, and behaviour. This instability often disrupts family and work life, long-term planning, and the person's sense of self-identity. Originally thought to be at the 'borderline' of psychosis, people with BPD experience a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2% of adults, mostly young women.
While a person with depression or bipolar disorder typically experiences the same mood for weeks, someone with BPD may feel intense bouts of anger, depression and anxiety that may last only hours, or at most a day. This constant change of emotions can be a very frightening experience, which can worsen feelings of insecurity or instability.
Diagnosis of BPD is difficult because it involves making assumptions about what is normal and, perhaps, abnormal about your personality. During your teenage years, life can be challenging at the best of times, which causes you to think and behave differently as you get older. Consequently, your personality can also change quite rapidly, as you gain your own ideas and independence. For this reason, often BPD is only ever diagnosed during adulthood.
In addition, there are no official diagnostic tests carried out for people who may have BPD. Instead, clinicians assess a client's behavioural patterns over the past year. If the client exhibits four or five certain behavioural traits, including paranoia, suicidal thoughts, impulsive behaviour (like extravagant shopping sprees, drug or alcohol abuse) or unstable relationships, then a diagnosis can be made.
Treatment for BPD comes in the form of medical treatments (such as anti-depressants and low doses of anti-psychotics) and talking treatments, including Cognitive Behavioural Therapy (and variants of this including Cognitive Analytic Theory, and Dialectical Behaviour Therapy), psychotherapy (group or one-to-one), and psychodynamic group therapy (perhaps in the setting of a therapeutic community).
You say you tried to commit suicide and, although feeling suicidal can be a common aspect of BPD, it is particularly important you understand you don't have to experience such thoughts alone.
Naturally, you may prefer to speak to close friends or family about how you are feeling, but sometimes it can seem easier to talk things through with someone you don't know. You can talk to someone in complete at SANELINE on 0845 767 8000. Or Samaritans is available 24 hours a day on 08457 90 90 90 or jo@samaritans.org.
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