• ADHD books published by NorthEast Books & Publishing, by Association for Youth, Children and Natural Psychology
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IMPORTANT INFORMATION

By reading this site, the reader acknowledges their personal responsibility in choices for mental health for themselves and their children, and agrees that the AYCNP or anyone associated with this site, bears no responsibility for one's personal decisions in choices for mental health. Anyone coming off medication should do so gradually rather than abruptly, and under a doctor's supervision. Anyone experiencing thoughts of suicide should seek support.


Book covers in this column are Amazon-linked (off-site).

Unless otherwise stated, all text links are to on-site AYCNP pages.


The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells, by Randi Kreger

Randi Kreger is the co-author of Stop Walking on Eggshells and The Stop Walking on Eggshells Workbook. She operates www.bpdcentral.com, one of the top web-based resources for those living with Borderline Personality Disorder (BPD) and their families. Founder of the Personality Disorder Awareness Network, Kreger is frequently invited to lecture on BPD and related issues to clinicians and laypeople.


Self-Esteem: A Proven Program of Cognitive Techniques for Assessing, Improving, and Maintaining Your Self-Esteem by Matthew McKay, Patrick Fanning

Building self-esteem is vital for those with borderline personality disorder.


Finding Sunshine After the Storm: A Workbook for Children Healing from Sexual Abuse, by Sharon A. McGee, Curtis Holmes

When a child has experienced sexual abuse, he or she may struggle with low self-esteem and find it difficult to trust others. Though the mental damage from such abuse is significant, it can be substantially reversed if a caring adult is willing to dedicate a few minutes each day to helping the child heal. Finding Sunshine After the Storm contains forty compassionate activities kids who have suffered abuse can do to raise their self-esteem, establish boundaries, and identify people they can trust.


Adult Children of Abusive Parents: A Healing Program for Those Who Have Been Physically, Sexually, or Emotionally Abused, by Steven Farmer

A history of a childhood abuse is not a life sentence. Here is hope, healing, and a chance to recover the self lost in childhood. Drawing on his extensive work with Adult Children, and on his own experience as a survivor of emotional neglect, therapist Steven Farmer demonstrates that through exercises and journal work, his program can help lead you through grieving your lost childhood, to become your own parent, and integrate the healing aspects of spiritual, physical, and emotional recovery into your adult life.


Page updated: April 11, 2015



Borderline Personality Disorder (BPD)


Facts, symptoms, causes, treatment


This page has been reviewed and edited by Eualalee Thompson, MSc, PGDip, a trained and practicing psychotherapist and counselor in private practice since 2005. She commonly assists her clients with anxiety, depression, post-traumatic stress disorder (PTSD), and surviving sexual abuse.


Girl Interupted. Recent film about young woman with borderline personality disorder. A bit oversimplified idea of BDP, but makes the point.

Definition - Borderline Personality Disorder (BPD) is a serious mental illness characterized in the DSM 5 as pervasive instability in moods, interpersonal relationships, self-image, and behavior.

The pervasive instability in a person with BPD often disrupts relationships in family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation.

While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting about 2% of adults (mostly young women), according to the National Institute of Mental Health (NIMH), or by another estimate, 1-3% of the general population in terms of lifetime occurrence.

Some suggest that the name itself, Borderline Personality Disorder, is an inappropriate term for this disorder, or "a misleading label." The disorder has nothing to do with neurosis or psychosis, but rather involves emotional volatility; what one reporter described as "a [very] thin emotional skin." Self-loathing, poor self-esteem, and suicidality are also part of the profile of BPD.


High Rate of Self-Injury in Borderline Personality Disorder


1. There is a high rate of self-injury without suicidal intent, as well as a significant rate of suicide attempts and completed suicide in severe cases of BPD. Between 69 and 80% of persons with BPD engage in suicidal behavior.

2. Patients with BPD often need extensive mental health services, and account for 20% of psychiatric hospitalizations (NIMH, 2009). Forty percent of the highest users of inpatient psychiatric services receive a diagnosis of BPD. Many are helped through psychiatric services. However, about 50% or 46% have repeat hospitalization despite long-term or extended-term care (Tucker, 1987).


Inner Conflicts Involved with Borderline Personality Disorder


While a person with depression or bipolar disorder typically experiences the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety within a short period of time, perhaps within a few hours or at most, a day.

These variations in emotional expressions may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse.

Self-hate, self-loathing: Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad or unworthy.

With borderline personality disorder, one's self-image is distorted, making one feel worthless and fundamentally flawed. The anger, impulsivity, and frequent mood swings associated with BPD may push others away, even though the person with BPD yearns for loving relationships [Mayo Clinic].

People with BPD may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, which may result in frantic efforts to avoid being alone.

People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). For instance, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they quickly switch to the other extreme and angrily accuse the other of not caring for them at all.

Mayo Clinic: “Your relationships are usually in turmoil. You often experience a love-hate relationship with others. Difficulty accepting grey areas. Often a result of childhood sexual or other abuse.”

Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless.

Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments. People with BPD exhibit other impulsive behaviors, such as excessive spending, binge-eating, and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorderdepressionanxiety disorderssubstance abuse, and other personality disorders.


Some of the emotions and behaviors which contribute to the label
of borderline personality disorder

  • Impulsive and risky behavior, such as risky driving, unsafe sex, or gambling sprees

  • Drug or alcohol abuse

  • Self-destructive behavior
  • Self-hate, self-loathing

  • Feelings of social isolation

  • Unstable relationships

  • Frequent changes in life plans, careers, jobs

  • Poor self-image

  • Feelings of emptiness, being mistreated, bored
  • Strong emotions that wax and wane frequently

  • Intense but short episodes of anxiety or depression

  • Inappropriate anger, sometimes escalating into physical confrontations

  • Difficulty controlling emotions or impulses

  • Wide mood swings

  • Suicidal behavior
  • Fear of being alone

  • Fear of abandonment

  • Periods of paranoia, loss of touch with reality

  • Current Treatment Approaches

    The first treatment for borderline personality disorder is the non-pharmaceutical approach that incorporates some elements of Eastern religious practice, Dialectical Behavior Therapy or DBT.

    As with all psychiatric treatment, pharmaceutical drugs are prescribed whether they are proved effective or not for that particular disorder. In the case of BPD, antidepressants are often utilized for the disorder itself or for concurrent depression. The same could be said for mood stabilizers and antipsychotics in addressing other symptoms.


    Note: There is no evidence that inpatient hospitalization is an effective treatment for suicidality in borderline personality disorder patients. Therefore, it may be that inpatient admissions for suicide ideation were actually iatrogenic* rather than therapeutic.

    While those in DBT therapy were less likely to take medication while on therapy, those in expert community care were both more likely to be on medication or much more likely to be hospitalized. This raises the thought that community therapy resorts to hospitalization and depend more on drugs for treatment, and therefore may be less effective than more intensified therapy through specific well-trained therapists.

    Also of note is that many of the symptoms of borderline personality disorder can basically be described as the intense side of the residual effects of child abuse. That is, child abuse, especially sexual child abuse, produces most of the symptoms in later life for some people, as described for borderline personality disorder. If a client is treated for child abuse — if there has been this experience in his or her life — then it might be the best way of dealing with the issues, rather than focusing on labeling and medicating.

    *iatrongenic - (of a medical disorder) caused by the diagnosis, manner, or treatment of a physician.

    Please Note: This site informs and educates the reader on specific treatments, but does not necessarily recommend or endorse DBT. Please see note at bottom of page (dialectical behavior therapy).


    References for Symptoms of Borderline Personality Disorder and Treatment page


    1. Borderline Personality Disorder. (May 13, 2009). National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml

    2. Borderline Personality Disorder. (May 14, 2008). Mayo Clinic. http://www.mayoclinic.com/health/borderline-personality-disorder/ds00442

    3. Brody, J. (June 15, 2009). An Emotional Hair Trigger, Often Misread. New York Times. http://www.nytimes.com/2009/06/16/health/16brod.html?_r=1&scp=6&sq=borderline%20%20personality%20disorder&st=cse

    Korzekwa, M.I., Dell, P.F., Links, P.S., Thabane, L. & Webb, S.P. (2008). Estimating the prevalence of borderline personality disorder in psychiatric outpatients using a two-phase procedure. Comprehensive Psychiatry, 49(4), 380-386.

    4. Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z. Gallop, R.J., Heard, H.L. Korslund, K.E., Tutek, D.A., Reynolds, S.K., Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and Borderline Personality Disorder. Archives of General Psychiatry,63. 757-766. http://archpsyc.ama-assn.org/cgi/content/full/63/7/757

    5. Tucker, L., et al., (1987). Long term treatment of borderline patients: A descriptive outcome study. American Journal of Psychiatry, 144, 1443-1448. http://ajp.psychiatryonline.org/cgi/reprint/144/11/1443?ijkey=7b3811f2d7dd690d7517c475e263ed11ea22e967