High family member involvement predicts better outcomes amongst people with BPD.
– Hooley & Hoffman, 1999
BPD is one of the most serious of mental illnesses, with a prevalence in Australia exceeding that of Schizophrenia and Bipolar Disorder combined. It is an often-misunderstood condition that has many challenging aspects, to family members as well as clinicians. As a result, those affected by BPD are too often subject to high levels of stigma and discrimination within health services.
The primary hallmark of BPD is the inability to regulate one’s emotions – this is commonly called “emotional dysregulation” and appears as a major over-reaction to normal emotions such as anger, fear, dislike, love. The emotion is normal, the response to the emotion is abnormal.
The term ‘borderline personality’ was first proposed in the United States by Adolph Stern  to describe a group of patients who “fit frankly neither into the psychotic nor into the psychoneurotic group”. It was officially recognised by The American Psychiatric Association (APA) in 1980.
BPD is often misdiagnosed and seen on the border of other conditions, often co-existing [“co-morbid”] with depression, anxiety, eating disorders, post-traumatic stress disorder, substance abuse and/or bi-polar disorder.
BPD affects 2-4 percent of Australians.
It is more commonly diagnosed in women; this is probably because it is recognised less frequently in men, who may be less likely to seek treatment, or may be imprisoned for BPD-related behaviour.
Symptoms or Manifestations
Symptoms often arise in late adolescence or early adult life; these often occur in clusters and may fluctuate. They include:
- unstable self image
- rapid changes in mood, intense anger to intense emptiness
- fears of abandonment and rejection
- suicidal thinking and self-harm
- brief delusions and hallucinations
- unstable and/or intense personal relationships
- chronic feelings of shame, fear, emptiness and guilt, self-loathing
- paranoid ideation [a belief or suspicion that one is being harassed or persecuted or treated unfairly] OR severe dissociation [a detachment from reality]
- intense dysphoria [disquiet or restlessness]
- impulsivity in spending money, sexual behaviour, substance abuse, reckless behaviour e.g. driving, binge eating
Refer to official Diagnostic Criteria for further details:
How can Carers help?
- Listen – listen objectively to what the person we care for is trying to tell us
- Learn – learn about the illness, and learn about how it is affecting him/her right now
- Validate – learn and apply the skill of validating