Borderline personality disorder (BPD) is a difficult personality disorder to deal with. Coping with borderline personality disorder requires persistence, patience, rest, a healthy rhythm, and a good friend or therapist to reach out to. Without these key ingredients coping with borderline personality disorder can be extremely difficult and damaging (think of relationships and self-harm).
This page focuses on coping skills for those people with BPD who rather try things themselves before considering reaching out to a professional. Depending on the severity of BPD, these self help tips are effective if you follow the instructions. However, professional counseling is highly recommended, because treatment is effective and helps you deal with crisis situations as well.
NOTE: in case you have suicidal thoughts or want to self-harm, I strongly recommend you to reach out to a professional!!
At Barends Psychology Practice we offer (online) therapy for borderline personality disorder. Contact us to schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).
Reducing self-harm behaviour:
For most people with BPD coping with borderline personality disorder starts with reducing self-harm behaviour and suicide attempts.
- People with BPD use self-harm to help regulate their emotions, to express their pain or to punish themselves. Damaging your own body makes someone feel physical pain, which reduces the pain felt emotionally, such as sadness, guilt, rage, emptiness, and self-loathing. On the short run self-harm is effectively reducing the pain felt emotionally, but on the long run the emotional pain returns. This makes you want to self-harm again. Unfortunately, self-harm is by no means a solution: it leaves scars, makes someone feel pain anyway, can be very dangerous, and can make people feel guilty and bad afterwards. Most people who self-harm try to hide it from others close to them, because they feel guilty and ashamed. This further isolates people with BPD and that increases the severity of the BPD symptoms.
- 75% of the people with BPD attempt suicide, 10% commit suicide (usually before the age of 40) , . Suffering from substance abuse or major depressive disorder next to BPD increases both the seriousness and number of suicide attempts . A history of childhood sexual abuse increases the number of suicide attempts . People attempt suicide, because they really want to die. Some professionals also think that suicide attempts are used to get attention, but this has been disputed by other professionals.
What can someone do to reduce self-harm behaviour?
- 1. Confide in someone: opening up about your secret is both scary and a relief. Try to find someone you trust for a 100%, someone you respect. Think of a friend, a teacher or a relative. Talk to them (or email, call etc.) about the feelings and situations that lead you to self-harm (try to leave out the self-harm details). Let the other know whether or not you want a listening ear or advice. Realize that the other person may be shocked, angry, concerned about you and afraid. These are normal reactions, and you may not like them at all. However, give the person you trust some time to process everything you told them. Don’t be discouraged if that person responds in an unexpected way. In the end, an important step to take when coping with borderline personality disorder is to reach out to others. Isolation and BPD are a bad combination.
- 2. Identify your self-harm triggers: which feelings and situations cause you to self-harm? Write down specific examples, because that makes it easier to adapt healthier alternatives. Try to avoid these triggers in the beginning and see if you can find some effective alternative behaviour to reduce the impact the trigger has on you. For instance, if losing a discussion makes you feel worthless, then try to stay out of discussions, and at the same time read more about discussion techniques. If using drugs makes you more vulnerable to self harm then try to stay away from drugs.
Some people experience difficulty pinpointing what they are feeling. They are afraid that their feelings will be overwhelming or that they won’t go away. Fortunately, feelings last only for about 10 minutes and then fade away again. Try to expose yourself to your feelings and you’ll see that it gets easier.
- 3. Finding new coping mechanisms: stopping with self-harm without having an alternative will not help much. Try these steps in this fixed order:
(a) reduce the damage caused by self-harm (cut less deep, for instance),
(b) replace self-harm behaviours by healthier alternatives (for example: writing on your skin with a red felt tip or by flicking an elastic band on your wrist),
(c) direct your self-harm behaviour at objects (think of crushing ice cubes, pillows or cushions), and
(d) distract yourself (try to be with other people; play a video game, play some music, do sports). Distracting yourself makes it easier for you to stay away from those difficult feelings and that reduces self-harming behaviour,
- 4. Reach out to a professional: a professional counselor who is specialized in Dialectical behavioural therapy can significantly reduce amount of suicide attempts and self-harm behaviours . Also, a professional counselor can find out what is behind these triggers that cause you to self-harm. A lot of people with BPD have experienced a lot of traumatic things in the past and these could be causing self-harm. Unfortunately, the connections between traumatic experiences and self-harm are not easy to make by yourself.
PLEASE NOTE: Especially in case you have a feeling these steps may not work for you, reach out to a professional. If these steps work for you, then please consider reaching out to a professional nonetheless. These steps and tips may reduce the self-harm behaviours, but they won’t take away the underlying traumatic experiences that are still being activated in present day. Coping with borderline personality disorder is a long and bumpy road. Professional help can guide you through this process.
Coping with borderline personality disorder – coping skills.
Here are some coping with borderline personality disorder tips that may help you on your way to reducing the impact BPD symptoms have on you. Always consider contacting a professional who is trained in treating BPD, because they can help you cope with BPD.
- Adapt a healthy rhythm and diet. When your body doesn’t know when you will eat or sleep you can easily become cranky and that increases the chance of snapping at someone. Being tired the next day also increases the chance of lashing out or getting more emotional than you otherwise would be. Adapting a healthy rhythm and diet is important for people with BPD, because it positively affects your mood and emotion regulation. Sleeping and eating at set times enables your body to prepare for it mentally and subconsciously. This reduces the chance of responding out of proportion to the situation. It may also reduce the severity of an emotional response.
- Pay attention to how you feel. People with BPD usually have trouble recognizing their own emotions and figuring out where these emotions are coming from. A good way to practice this is by closing your eyes and asking yourself: “how have I been feeling these past two hours?”. If you notice some tension in your body, ask yourself where you got this from. It may be related to your emotions and feelings. Once you figured out how you’ve been feeling these past two hours you can ask yourself: “why have I been feeling this way?” to figure out where those feelings are coming from. Try to be as specific as possible. So not: “I am angry because of my stupid boyfriend”. But: “I am angry with my boyfriend, because he is forgot to pick me up again”. This way you understand better why you are angry, and in this case you even realize you are angry because of your boyfriend’s behaviour and not because of your boyfriend as a person. Try not to judge yourself for feeling the way you do.
- Recognize which emotions came first. People with BPD usually get overwhelmed by their emotions. All of a sudden they feel so many different emotions that it’s difficult to see which one belongs to which feeling or thought. Being overwhelmed makes it more difficult to calm down. Thus try to analyze your emotions: why did you get upset in the first place? Which emotions did you feel at that moment? Which other thoughts popped up after you got upset? And which emotions belong to those thoughts?
- An example: your boyfriend doesn’t pick up the phone. This makes you angry and annoyed. Thoughts pop up such as: He doesn’t want to talk to me (sadness). He doesn’t like me (sadness, depressed). Maybe he will leave me (anxiousness, sadness, depressed, panic-stricken). Maybe he is with someone else (anger, upset, scared, depressed).
By analyzing the situation it’s easier to identify which emotion belongs to which thought or feeling. Then focus on the trigger that caused all these emotions to pop-up and try to ignore all the thoughts, feelings and emotions that came after that. This will calm you down more easily.
- Increase tolerance of uncertainty levels. People who have difficulty to deal with uncertainty worry and panic more and sooner about topics that may not even be worth it. In the example above about the boyfriend who didn’t pick up his phone: he may have been busy at that moment. Perhaps he just got off the bus, paid a bill or wrote an email. People who have low tolerance of uncertainty levels will try to find explanations for the fact that the boyfriend didn’t pick up the phone. Unfortunately, intolerance of uncertainty in combination with the fear of (potential) abandonment is a deadly combination for panic, worry, and getting emotionally overwhelmed. Often, this combination makes people with borderline think of how the boyfriend is leaving or cheating on them. What can you do about it? Write down possible explanations for (in this case) your boyfriend not picking up the phone. Rate them according to likelihood. Another tip: figure out what your worst fear is (he will leave me) and test that if that fear is true. Let’s call this a hypothesis. In reality it’s very unlikely that your boyfriend will leave you, so it’s a safe hypothesis. Once you know the answer you also know whether or not your reactions were out of proportion to the situation. Coping with borderline personality disorder means you have to test certain hypothesis that cause you to panic, worry excessively or make you feel depressed. This way you’ll see that most of your fears are unrealistic and not true. Please note: don’t test these fears on your own, but always consult a professional. If such an experiment goes wrong you may feel worse rather than better.
- Use self-talk in a positive way. Tell yourself that your partner loves you, that your partner is with you because of who you are. Sometimes it helps to ask your partner to list 10 things about you that he or she appreciates and loves about you. Ask your partner to write down which characteristics make you unique in a positive way. Self-talk makes people in general feel more positive about themselves. The best athletes in the world use it to perform better, so why don’t you give it a try yourself.
- Don’t respond to others immediately. Responding immediately to someone’s comment, email or question significantly increases the likelihood that you’ll respond out of emotion rather than out of common sense or ratio. An emotional response often is driven by personal needs, desires, and fears. Its these needs, desires, and fears that can lead to a lot of false assumptions and miscommunication issues. Build in a delay: for some people it works really well to repeat the question before they answer to it (this gives people a few more seconds to answer), to ask the person if they understood them correctly (“so if I understood you correctly, you meant:….?”) before you answer, to ask themselves if the answer they want to give is emotionally charged (if so, then try to come up with an alternative response, one that is not emotionally charged). Always wait a week before you make life changing decisions. And talk about it with people you trust. Remember, people you trust want the best for you, so take their opinion seriously. And last but not least: analyze your own feelings (read below for more information).
- Analyze your own feelings. It’s difficult for people with BPD to identify their own feelings. Coping with borderline personality disorder becomes easier when you can identify your own feelings. Your feelings affect the way you want to respond or other behaviours. If you feel depressed or sad you’ll probably respond different compared to when you feel angry or happy. Try to figure out where these feelings are coming from (think of the previous step: recognize which emotions came first). If being in touch with certain people makes you feel sad or angry, then it may be a good idea to avoid these people right before you go into a meeting, before you meet with your partner and so on. By taking away certain triggers you make it easier on yourself. Don’t forget to mention these triggers in therapy if you are seeing a professional for BPD.
- Find some self-soothing activities or behaviours. Coping with borderline personality disorder requires effort, time and patience. When you are caught up in your emotions seconds feel like hours and it seems like it takes ages for you to calm down. Therefore it’s important to find some self-soothing activities or behaviours to calm down sooner, to kill time when you are anxious or nervous, and so on. Self-soothing activities or behaviours can literally be anything that doesn’t harm you or others around you.
- Exposure yourself to difficult experiences. This step may be a very difficult one. Thinking of difficult experiences brings up negative feelings and emotions. Usually people try to avoid these. However, by exposing yourself to these difficult experiences these negative feelings and emotions become less intense. Please note that you don’t act upon those feelings. Try to accept these feelings as they are. You’ll see that they will fade away after 15 minutes (sometimes a bit longer). If you have a feeling you can’t deal with them alone, then please reach out to a professional.
Coping with borderline personality disorder isn’t something that can be done every now and then. It’s a full time job and requires persistence, patience, and a lot of practice. If you experience difficulty during any of these steps, don’t hesitate to contact me for more help.
Literature used for this article
-  Black, D. W., Blum, N., Pfohl, B., & Hale, N., 2004. Suicidal behaviour in borderline personality disorder: prevalence, risk factors, prediction, and prevention. Journal of Personality Disorders, 18, 226-239.
-  Paris, J., and Zweig-Frank, H., 2001. A 27-year follow-up of patients with borderline personality disorder. Comprehensive Psychiatry, 42, 482-487.
-  Soloff, P. H., Lynch, K. G., & Kelly, T. M., 2002. Childhood abuse as a risk factor for suicidal behaviour in borderline personality disorder. Journal of Personality Disorders, 16, 201-214.
-  Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A., 2006. Outpatient psychotherapy for borderline personality disorder randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry, 63, 649-658.