What’s it like living with BPD?
When you have BPD, it’s often difficult to cope with feelings of abandonment, anxiety or anger. Various forms of self-harm, whether physical or psychological, are common. You can have a reasonable amount of self-confidence one moment, and then feel extreme self-hatred a short time later. Many people with BPD also experience uncertainty around their self-image as well as issues with their identity.
You may have difficulty with trust and a sense of security in intimate relationships. People with BPD often tend to switch between admiring and despising those closest to them. Having such feelings can make you feel very lonely. It’s important to remember that there are many other people who understand and can offer support.
How do I know if I have BPD?
BPD manifests itself in different ways depending on the situation and the context. According to the DSM-5*, you should have at least five of the following symptoms:
Abandonment avoidance. You go to great lengths to avoid being abandoned, whether the threat is real or imagined.
Unstable and intense relationships. You have a pattern of deeply variable interpersonal relationships where you can idealize someone one moment to then suddenly devalue that same person.
Identity disturbance. You experience persistent uncertainty about your self-image or identity, and your sense of self often changes.
Impulsivity. You act impulsively in ways that can be harmful to yourself in at least two different areas (such as money, sex or drugs).
Suicidal behaviour. You’ve expressed or shown a desire to take your own life, deliberately harmed yourself or previously attempted suicide.
Emotional instability. You have a noticeable tendency towards mood swings. For example, you may feel intense anxiety, irritability or sadness that usually lasts for a few hours but seldom more than a few days.
Chronic feelings of emptiness. You often feel empty with no purpose.
Anger management problems. You have difficulty controlling your anger. This can manifest itself as frequent outbursts of anger or prolonged irritation.
Paranoid or dissociative symptoms. You suffer transient, stress-related paranoid thoughts or severe dissociative symptoms, such as a feeling of being separated from yourself.
Even if you recognize these symptoms, it’s not certain that you have BPD. To find out whether you have BPD, you need to be assessed by a medical professional. It’s important to establish that your symptoms aren’t due to other causes.
What causes BPD?
Many people with BPD have had a very traumatic or chaotic childhood. Some have been subjected to abuse. However, you can have BPD even if you had a stable childhood without any obvious trauma. BPD can be caused by a combination of genetic, psychological and environmental factors.
What help can I get?
If you have BPD, you can receive treatment in the form of psychotherapy, either in a group or individually. Several different therapies have been shown to be helpful in BPD, such as dialectical behaviour therapy (DBT) and mentalization-based therapy (MBT). Voluntary admission as a crisis intervention has proven to be a valued form of support for coping with overwhelming situations. You may also be prescribed medication to relieve some symptoms.
You have the right to be informed about the available treatment options and to be involved in your treatment plan. It’s important that you are motivated and trust your therapist.
Things often get better
It’s not uncommon for people with BPD to have other diagnoses, such as ADHD or bipolar disorder. As with these diagnoses, life often improves over time as you learn to better understand yourself and can communicate your needs to those around you to ensure your wellbeing.
Reviewed by: Joachim Eckerström, researcher within psychiatry at Karolinska Institutet.
Last edited 2023-12-12
* DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.