What is borderline personality disorder, and how can you help friends and family cope?

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the handbook on mental disorders used by professionals in the United States, BPD is defined as a pervasive pattern of showing at least five of the following conditions:

• efforts to avoid real or imagined abandonment
• intense mood swings
• stress-related paranoia
• intense or uncontrollable anger
• impulsive behaviour like excessive spending and substance abuse
• chronic feelings of emptiness
• distorted and unstable self-image
• problems in romantic relationships, for example, either idolising or devaluing their partners
• self-harm and suicidal behaviour

These symptoms should be experienced for at least a year, Lau says, before BPD will be diagnosed. What’s more, most people are typically not diagnosed until after they turn 18, adds Chiu, because an individual’s way of thinking, feeling and behaving is still developing until you reach adulthood.

People with BPD tend to suffer from emotional dysregulation (the impaired ability to control unwanted emotional states) and a strong sense of insecurity, so everyday life can be “an emotional roller-coaster ride”, says Lau.

“Their moods often careen wildly from normal to sad or hostile at the slightest provocation,” she adds.

And with a severe lack of self-image and an inconsistent perception of others, Lau says sufferers have “difficulty relating to others and the world around them”.

“This can be very distressing for the person [with BPD] and people close to them,” she adds.

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Professionals still don’t fully understand the causes of BPD, but they can be a combination of biological, cultural, social and environmental factors. One example is being abandoned or abused at a young age. Children with parents, siblings or caretakers with BPD traits are also more likely to develop the disorder.

“[Those] who experience BPD in childhood may internalise [the behaviours of] these adult figures, causing them to unconsciously behave in similar ways,” explains Chiu.

Mental health professionals use two common types of psychotherapy to treat BPD: cognitive behavioural therapy and dialectical behaviour therapy. The former focuses on changing people’s thinking patterns, and the latter – shown to produce the most promising results – focuses on helping people manage their emotions.

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“Sometimes medication may help to stabilise mood swings or depressive moods,” Chiu says, but it is the long-term therapy sessions which help the patients understand how the disorder is affecting their mood and behaviour, “stabilise [their] sense of self”, as well as “learn ways to manage ambivalent emotions and challenging situations better in the long run”.

While you should encourage a family member or a friend showing multiple signs of the disorder to seek professional help, there are plenty of other ways you can support people with BPD, who often struggle with being alone.

Chiu says you need two essential qualities if you want to help people with BPD: patience and understanding.

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Since the disorder causes volatile thoughts and behaviour, it is important to not take their aggression personally. “Understand that their behaviour or verbal attacks are ... geared by the desire to cease the pain they’re experiencing at that moment,” she explains.

Clear communication is also crucial to prevent them from misinterpreting your words or actions as negative, Chiu adds, which can feed their fear of rejection and abandonment.

You can also suggest doing a relaxing activity that you both enjoy, such as taking a walk in nature, going to a concert or watching a comedy show.

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“These self-soothing activities benefit both the person with BPD and the support person,” Lau says.

Supporting someone with BPD can be distressing, though. Make sure you’re aware of your own limits, and take a break when you feel you need to.

“Frame this as your own self-care and part of a healthy relationship – not a rejection or criticism,” Lau adds. “Your own self-acceptance and self-care is a powerful model for the person you are supporting.”