Borderline personality disorder (BPD) is a diagnosis for those with intense and long-lasting emotions that are hard to regulate. Due to this, youth may have problems with risky or harmful behaviours, with how they see themselves and with relationships. Everyday life can be hard for youth with BPD. Their emotions can be very painful and feel out of control. They may feel misunderstood and have difficulty understanding themselves, what’s important to them, or what they want in life. This can make school, work, and friendships challenging. 

What causes borderline personality disorder?

There is no single cause for BPD, and often it is due to a mixture of factors. 

• Biology: Youth with BPD notice more things that cause emotions more quickly, have stronger emotion responses, and longer-lasting emotions than their peers.
• Social: Others may not know how to support a youth with BPD. What works for other youth may not work for a youth with BPD.
• Over time, these youth develop emotion “dysregulation” or painful emotions that become stronger and very difficult to manage. Emotion dysregulation can make it hard for the youth to have a positive self-image, healthy relationships, and to stop acting on impulse. 

BPD is usually diagnosed in early adulthood, but symptoms can start during adolescence when it is common for youth to feel strong emotions, change the way they behave and have relationship challenges. Those with BPD often have problems with relationships, self-image, and impulsive behaviour. If these problems last a long time and are intense, they may lead to a BPD diagnosis. If a youth has some of these behaviours at a young age or if they do not meet the full criteria, these may be called  called borderline personality ‘traits.’   

Those with BPD may have problems with:

• Emotion regulation:
  • They may have sudden, intense feelings, such as despair, panic, or rage.
  • They may worry often about being embarrassed, judged, left out, or abandoned.
  • When they are under stress, they might think differently, feel empty or like they are not really in their body, or have trouble seeing what’s really happening.
• Impulsive behaviour:
  • They may act on impulse in ways that can hurt themselves or others, like self-harm or harmful substance use.
• Self-image:
  • They may have a sense of self that changes based on who they are with or what is happening.
• Relationship difficulties:
  • They may change their mind about relationships suddenly.
  • They may have relationships that are chaotic and find it hard to end them, even if they are causing pain.

Not everyone with BPD has the same challenges or reacts to stress the same. To be diagnosed, the problems must have been happening for a long time and in different situations. A trained psychiatrist or psychologist can diagnose a personality disorder, and may need time to understand the person’s unique challenges.  

What can go along with borderline personality disorder?

Those with BPD often have other mental health challenges, such as:

• Mood disorders like depression and anxiety
• Disordered eating
• Harmful substance use disorders
• Post traumatic stress disorder

Those with BPD may need support for each mental health challenge they have. Sometimes, treatment needs to focus first on serious problems like self-harm or other safety issues. Treatment can also help with more than one problem at the same time. It is important to discuss a treatment plan that looks at all mental health concerns with a mental healthcare provider. 

Those with BPD can be treated unfairly and may not be understood by others. It is hard to know how to help. Most youth improve with effective treatments and in some cases, BPD symptoms can improve over time, even without treatment. However, treatment can help those with BPD learn to manage symptoms more quickly and improve the quality of their life in more areas.

Psychotherapy

The following psychotherapies are used to treat BPD:   

• Dialectical behaviour therapy (DBT): This is the most well-known and researched treatment for BPD in youth and adults. It is a type of therapy that focuses on behaviours and emotions. It teaches skills for mindfulness, managing and accepting emotions, coping with emotional crises, and improving relationships. It is an intensive treatment that involves both individual therapy sessions and group skills classes. Youth will often attend skills classes alongside their caregivers but, caregivers may also take part in individual therapy or group sessions as part of treatment.
• Family therapy:  Family therapy can involve all family members working to improve their relationships and support a family member with BPD. It can also focus on supporting caregivers while their youth is either in another treatment or if their youth is not in treatment.
• Mentalization-Based Treatment (MBT): This therapy focuses on thinking about and reflecting on your beliefs, thoughts, feelings, and intentions. You also learn to recognize these feelings in others. MBT helps a youth or young adult learn and strengthen their ability to ‘mentalize,’ which is often a weak skill in people with BPD.
• Psychodynamic therapy: This therapy focuses on exploring how the youth’s past may affect how they think, feel and act now. It often focuses on feelings and thoughts that might be hidden or not fully understood.
• Other psychotherapy: Other common therapies like cognitive behavioural therapy may not be enough or may not work for those with BPD. They can help treat anxiety, depression, or other common mental health challenges that can co-occur with BPD.

Medications

Medications are usually not enough on their own for treating BPD. They can be used to help treat specific symptoms or concerns that go along with BPD, including intense changes in emotions, anxiety, depression, and aggression. Medications tend to be most helpful when used in combination with psychotherapy to help treat BPD.

The role of inpatient hospitalization

When your child is in crisis (such as having a hard time staying safe) it is important to follow what the treatment team recommends. A short stay in hospital may take care of a safety concern, but outpatient treatment is most effective over time. Long stays in hospital can make BPD worse. Talk with your child's treatment team and develop a good safety plan to prepare for a crisis.

Family support

It can be hard to see your youth acting in harmful or risky ways such as self-harm, substance use, disordered eating, or suicide attempts. Parents and caregivers can talk to peer supports or professionals to learn how to offer support to their youth. Some family members may also benefit from psychotherapy for their own stress or mental health symptoms, like depression or anxiety. It is recommended to choose a different therapist from the person your youth is seeing. If you are feeling worried or distressed, you can call one of our Family Peer Support Workers for support.

• Talk to your doctor. They can decide if you need specialized medical services, like a psychiatrist or pediatrician, and help you with the referral.
• Get support and a mental health assessment from your local Child and Youth Mental Health team. Connect with your team at a walk-in intake clinic in your community.
• Contact a private psychologist for an assessment. You can start by visiting the BC Psychological Association website or call 1-800-730-0522.

Looking for more information on this topic? Connect with a Family Peer Support Worker at the Kelty Centre to discover additional resources, to learn more about support and treatment options, or just to find a listening ear.