Getting a diagnosis
As with any health issue, the best place to start is your local general practitioner (GP).
- Book a longer appointment so there is time to talk through your situation
- Make notes beforehand on what’s happening with your physical and mental health, relationships, work or study, and take them along
Your GP can refer you to a psychologist, psychiatrist or other mental health professional, who can make a diagnosis, discuss a treatment plan and work with you in the role of therapist.
The therapist may work in private practice (which can cost more) or in the public mental health system, in your local mental health service or a specialist BPD service (which can involve a longer waiting list). Your GP can tell you what services are available in your area and the best options for you.
Your doctor and therapist will need as much information as possible about you and the impact of BPD on your life, in order to make a good diagnosis and ensure effective therapy. You can help by being open and honest about the thoughts, feelings, and behaviour which concern you. The better the therapist understands, the better they’re able to help you.
“It was a relief for me and my family to be able to put a name to what I was experiencing and to learn my triggers”
— Stephanie
The term ‘borderline personality disorder’
When it was first identified in the 1930s, psychologists thought the symptoms of BPD were on the border between two other kinds of diagnosis, hence ‘borderline’. BPD is better understood now, but the title has stuck. The term ‘borderline’ doesn’t describe the symptoms of BPD or the people living with it, just the history of the diagnosis.
Psychological therapy and medication
Psychological therapy is the most effective treatment for BPD. In therapy you’ll work with your therapist to reduce your symptoms and help you manage feelings, behaviour, and relationships better, so you feel more in control. With effective therapy, you’ll feel calmer, happier in yourself, and better able to cope with the ups and down of life.
Effective psychological therapies for BPD include:
- Dialectical Behavioural Therapy (DBT)
- Cognitive Analytic Therapy (CAT)
- Mentalisation-Based Therapy (MBT)
- Schema-Focused Therapy (SFT)
Your therapist can explain these and discuss which is the most helpful for you. Therapy can take from several months to a year or more, depending on your needs.
Despite their differences in approach, therapies for BPD share common features:
- The therapist and you have a shared understanding of the therapy, and a commitment to work together
- The therapist is suitably trained, supported, and supervised
- The therapist pays attention to your emotions, thoughts, and current challenges
- Therapy is focused on achieving change in your current life
- You work in equal partnership with your therapist
- You agree to play an active role in therapy by working with the therapist, and working to make choices that will help you recover
- Therapy helps you learn skills to manage suicidal feelings and self-harm
- There is a focus on the relationship between you and the therapist
- Therapy sessions happen regularly (generally at least once a week, where possible)
Medication is not a primary treatment for BPD, though it may be helpful during periods of emotional crisis, and can be prescribed for other conditions. Taking multiple medications for long periods of time is not generally required. Discuss with your doctor the benefits and side-effects of any medication before making an informed decision.
Admission to hospital is only recommended in the short-term, to deal with a crisis where someone is at risk of serious self-harm or suicide. It is best if a hospital stay is brief, with a specific aim agreed between the person with BPD and their doctor or therapist.
Learning about BPD
Your willingness and determination to get better is essential. Find out as much as you can about BPD: the symptoms, effective treatments, and ways to keep yourself well. Learning about BPD empowers you to manage your symptoms, making them more predictable and less scary.
There is a lot of inaccurate and misleading information on the internet about BPD, so be sure to access reliable sources, like those listed at the end of this guide.
After months or even years of distress caused by the effects of BPD, many people say that receiving a diagnosis can actually be a relief. Not only is there a medical explanation at last of why you have been feeling and behaving this way, there is also the good news that effective treatments are available.
Looking after yourself
What’s true for people with BPD is true for all of us: make sure you eat healthily, get regular sleep, exercise and fresh air every day, don’t drink alcohol excessively, and do things that make you feel calm — listen to music, do yoga, mindfulness exercises, or anything else that helps. It’s the calming effect that matters, not the method, so choose whatever works for you.
Of course, we’ve all heard this advice many times, and it’s often easier said than done. However, when you have BPD it’s doubly important to look after yourself.
Set yourself small, easy-to-achieve goals and reward yourself when you reach them. Whatever the activity, you can strengthen your sense of self-worth, stability and control over your life just by regularly doing things that make you feel better.
Some people with BPD find it helpful to use mindfulness techniques when they feel distressed or overwhelmed by emotion. Mindfulness is a way of giving your mind a break from worries by focussing your attention on your breathing, body and surroundings.
Safety in a crisis
Some people with BPD physically harm themselves. This is something that other people understandably find confronting and hard to understand. While self-harm can bring momentary relief and distraction from emotional distress, the effect is very short-term. It’s also damaging to your body and can lead to serious, even fatal, consequences.
If you have suicidal thoughts sometimes, it’s a good idea to develop a safety plan so you can stay safe. When you’re feeling calm, prepare a personal safety plan with your therapist or someone else you trust.
A safety plan includes strategies to delay, divert and distract yourself so when you feel the urge to self-harm, you can soothe yourself instead. Your plan will also include numbers of people and help services you can call in a crisis.
When you have a safety plan, make sure the people close to you know about it. Ask them to carry with them a simple summary of what to do and where to call for help if needed — in their phones, for example.
Relating to other people
Dealing with other people can be the most challenging part of having BPD. Relationships with family, friends, colleagues and others can be fraught with misunderstanding and confusion.
You might sometimes feel so distressed that you lose your temper, say things you later regret, or even say contradictory things about the same topic. On the other hand, feeling you don’t have a safe way to express your anger can lead to your emotions turning inwards, sometimes leading to self-harm.
The symptoms of BPD can affect your ability to communicate clearly and calmly. Practise strategies for better communication. For example:
- It can be less stressful to discuss something when you’re out walking, rather than staring at each other across a table
- Recognise the warning signs that your emotions are becoming heightened when talking to other people. Say you need time out, give yourself permission to calm down and ask to meet again another time
- If you get upset when talking to someone, be open and calmly explain these feelings, without getting distressed again
- Make an effort to imagine how things look and sound to the other person. Arguments are rarely black-and-white, and it helps to imagine the other perspective
- When talking to someone about a distressing topic, consider having a third, independent person present
- Remember that family and friends can find these situations upsetting too, and that they need understanding and support themselves
Discuss with your therapist ways to manage your emotional responses and improve how you relate to other people. Doing this will reduce the distress caused by the surges of emotion you experience and the impact they have on your life.
Talk through one of these distressing episodes with your therapist or other suitable person. Treat it as a case study you can learn from. Discuss what was said and how it got out of control, and how next time you can manage it in a way that leads to a better outcome.
Finding support
Thousands of people in Australia have BPD, so you’re not alone. Sharing experiences, helpful information and tips can make a huge difference to how you feel and cope.
The BPD Foundation can help you find information and support. Talk to a treating health professional, your local GP or the SANE Help Centre about what support is available locally for people affected by mental illness.
Visit the SANE Forums to meet other people affected by mental illness for peer support.
Acknowledging the illness
People affected by BPD feel great emotional insecurity and an unstable sense of self and their place in the world — including their own family. This emotional instability can play havoc with relationships.
It can be understandable, even tempting, to think of this as just volatile feelings and behaviour. But it’s vital to recognise that the person with BPD is not choosing to behave like this. Their volatile behaviour is an expression of, and a response to, the overwhelming and changeable emotions they’re experiencing. It’s a symptom of a serious illness.
Recognising and accepting this is the first step to improving family relationships, and to a less stressful, mentally healthier life for everyone involved.
Find out about BPD and how other families manage it positively. Courses, support groups and online forums are all helpful ways to do this. Sometimes people use these to vent their very reasonable frustration, anger and despair. A good support group will acknowledge the turmoil BPD causes while focusing on positive strategies to help the family cope and thrive.
Listening with empathy
When someone is upset or angry, it’s easy to be angry and emotional back at them. It’s a natural, understandable reaction, but not very helpful. A slower, calmer approach works better in general, but especially with people with BPD.
- Even when you don’t agree with everything that’s being said, give the person time to speak, and listen without expressing personal judgement or blame
- Empathise with the person, and imagine how distressed they must be feeling in order to be talking in that way
- Avoid sarcasm or other tones that can be misunderstood, and talk calmly, reflecting back their own words, to demonstrate that you have been listening
Expressing yourself
Communicating calmly with someone doesn’t mean you can’t say how you feel. If you’re angry or frustrated by something, it doesn’t help to suppress it. Let the person know how you feel, but do so in a calm, matter-of-fact manner. Explain that this is how you are feeling and the reasons for it, so there is a better chance of resolving the issue.
Families affected by BPD explain how emotions can be contagious. While this often works in a negative way, you can turn it around to create an atmosphere of calm, setting the tone for everyone. ‘Contagious calm’ can be a surprisingly effective way of helping everyone feel they have had their turn and been heard, so you can move on to resolving disagreements.
It can be easier to talk about something while walking or doing something together outside, rather than staring at each other across a table. Suggest going for a walk together or doing something else outside that the person with BPD finds relaxing. Sometimes it can help to have a neutral third-party there too, as a kind of mediator.
As well as giving the person with BPD respect, you have a right to expect it too. If you need to set boundaries for what is acceptable behaviour, explain these clearly and calmly, giving your reasons.
Encouraging independence
It can be tempting to feel responsible for fixing the problems and difficulties of a loved one with BPD. This is a natural instinct, but it can be counter-productive, especially if they have BPD.
Offer support, but encourage self-care and independence. This will not only help them become more self-reliant, but also promote a better sense of self-respect and a stronger sense of existing as an independent being, less vulnerable to other people’s attitudes and actions.
“Caring is constant and hard. It’s very important to look after yourself and stay connected. I know this from personal experience”
— Jo
Looking after yourself
Caring can be hard and carers often put their needs last, but it doesn’t have to be that way. Carers deserve care. Also, if your mental or physical health suffers as a result of being a carer, you are less able to help.
You can’t make someone with BPD get better. It’s not your ‘fault’ they have the condition, and not your responsibility to ‘cure’ them. Recovery is something that people with BPD choose for themselves. Your contribution to this process is to be supportive while looking after your own health and wellbeing too.
So whenever you can, take time to prioritise your own needs: eat healthily, get regular sleep, exercise and fresh air, keep your alcohol consumption down and do things that calm you — listen to music, do yoga, mindfulness exercises or anything else that helps. It’s the calming effect that matters, not the method, so choose whatever works for you.
This might seem like obvious advice, and it’s easier said than done. But self-care has a powerful effect on people’s capacity to cope, and it’s doubly important to look after yourself when you look after someone else too.
When someone has a mental illness like BPD, it’s easy for the illness to become the focus of the family’s concern, with everyone else coming second or expected to look after themselves. So it’s important that everyone feels their needs are met.
Safety in a crisis
People with BPD have higher rates of self-harm and suicide than the general population. If this is a concern in your family, it’s a good idea to develop a safety plan that includes strategies to delay, divert and distract from self-harm, and also the numbers of people and help services to call in a crisis.
Discuss this with the person with BPD, who can develop a plan with support from their therapist.
When the person with BPD has their safety plan, ask for a simple summary of what to do and where to call for help if needed — in your phone, for example.
Finding support
Thousands of families in Australia are affected by BPD, so you’re not alone. Sharing experiences, helpful information and tips can make a huge difference to how you feel and cope.
The BPD Foundation can help you find information and support. Talk to a treating health professional, your local GP or the SANE Help Centre about what support is available locally for people affected by mental illness.
Visit the SANE Forums to meet other people in families affected by mental illness for peer support.
On BPD
BPD Foundation
The BPD Foundation is a partnership of people with BPD, families, and clinicians working together to improve the lives of all those affected by the condition. The Foundation provides referrals to courses and support groups around Australia.
National Education Alliance of Borderline Personality Disorder Australia
Provides news, information and support for people living with BPD, families and health professionals.
Project Air Strategy for Personality Disorders
A NSW personality disorder initiative that works with health services, agencies, clinicians, families and carers, and people with personality disorders to provide information, treatment guidelines and resources, training, conferences and events, consultation, complex care reviews, and research. Project Air publishes a national Australian service directory.
Spectrum
A Victorian service that supports and works with local Area Mental Health Services to provide treatment for people with personality disorder.
Safety Planning
Beyondnow, Beyond Blue’s safety planning app & website