The diagnosis of a personality disorder must be done carefully. The symptoms need to have lasted for long periods and be stable. Before you accept a diagnosis of BPD, make sure that any other mental illness is treated first (depression, an eating disorder, a substance use disorder, etc.).

It is hard for people with BPD to control their emotions and behaviour.

A youth or young adult with BPD may:

• have intense feelings such as sadness, worry or anger
• act on impulse or seem aggressive
• try to harm themselves, or act in ways that can hurt others (drive dangerously, binge-eat, self-injure, misuse drugs or alcohol)
• avoid social situations or getting involved
• worry about being embarrassed, criticized, rejected or abandoned
• have feelings of self-hatred, an unstable sense of self or no self-confidence
• feel misunderstood and not have a good sense of who they are

Day-to-day life can be very challenging for someone with borderline personality disorder. They can have trouble controlling their emotions, so it can be hard to have healthy relationships. The symptoms can make it difficult to deal with everyday life like school, work or at social events. It can be hard to know how someone with BPD will react to small problems and the pressures of everyday life.

BPD is difficult to diagnose because the symptoms of other mental illnesses are similar. BPD can also look like other personality disorders. That is why it’s important to be assessed by a trained person like a psychiatrist or psychologist over a period of time. If a youth or young adult has another mental illness such as depression, anxiety or an eating disorder, they shouldn’t receive a diagnosis of BPD until the other mental illness has been treated. 

BPD usually begins in early adulthood. Someone with BPD will have problems with relationships, self-image and impulsive behaviour. To be diagnosed with BPD, the person must show five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable, intense relationships and extreme swings of positive and negative feelings toward people.
3. A self-image or sense of self that seems to change with different situations or people.
4. Risky and impulsive behaviour that could be self-damaging in two or more areas (spending, sex, substance use, reckless driving, binge eating).
5. Self-injury or suicidal behaviour, threats, or signals.
6. Strong moods of feeling hopeless, uncomfortable, unhappy, irritable or anxious that last a few hours and only rarely more than a few days.
7. Feelings of emptiness.
8. Anger that is extreme and inappropriate, difficulty controlling anger (often loses temper, physical fights).
9. Seriously disturbed thinking or paranoid ideas that come and go when under stress.  

It is important to know that personality disorders need to be assessed over time.

Who does it affect?

The majority of people with BPD have a history of trauma.

It can be very scary to have a child take part in risky behaviours such as self-injury, an eating disorder or suicide attempts. There are effective treatments and most youth and young adults improve with treatment. If you are feeling worried, stressed or distressed call one of our Parents in Residence for support.

In the past, there has been a lot of stigma attached to BPD. But now we have treatments that are very effective. BPD usually improves over time, with or without treatment.

If the youth or young adult has experience trauma it may be beneficial to work on the trauma first.

Many patients are treated while staying in the hospital or as outpatients. The following therapies are used to treat BPD:   

• Dialectical behaviour therapy (DBT): The most well-known and accepted treatment for BPD. It focuses on learning mindfulness skills and how to manage feelings, cope with distress and improve relationships.  
• Group psychotherapy:  A group led by a professional can help people with BPD learn how to better interact with others and express themselves.  
• Family therapy:  May help family members learn how to understand and support a relative with borderline personality disorder.
• 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 weak in people with BPD.
• Psychotherapy: May include cognitive behavioural therapy and therapies for dealing with relationships.

Medications

Medications are usually not effective for BPD. But, sometimes they can be used to help treat specific symptoms of BPD, including anxiety, depression, and aggression. Medications can also be used along with psychotherapy to help treat BPD.

The role of inpatient hospitalization

When your youth or young adult is in crisis (such as having a harder 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, over time, is most effective. It is important to remember that long stays in hospital can make BDP worse. It is also important to talk with the treatment team, and to develop a good safety plan before a crisis so that you and your family have a good care plan.

• Talk to your doctor. They can decide if you need specialized services like a psychiatrist, 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, learn more about support and treatment options, or just to find a listening ear.