Borderline personality disorder (BPD) is a mental health condition characterised by instability in terms of emotional experience, identity, interpersonal relationships, and impulse control. BPD can look very different in different people; some individuals may display more overt manifestations of instability, whereas for others the instability is more internal and less visible to others. Nonetheless, there are nine symptoms of BPD, with at least five of the following required to meet the diagnostic criteria:

• Rapid, intense mood swings in response to interpersonal stress

• Intense and difficult-to-control anger in response to interpersonal stress

• An unstable sense of self/self-image to such a degree that, at times, one may feel that one does not know who one really is or if one exists at all

• Chronic feelings of emptiness—often with difficulty tolerating being alone

• Frantic efforts to avoid real or imagined abandonment

• Intense and unstable interpersonal relationships characterised by shifting between extremes of idealisation and devaluation

• Stress-related paranoid ideation or severe dissociation

• Recurrent self-harm (e.g., cutting) and/or suicidal behaviour

• Impulsivity in two areas that are potentially self-damaging (e.g., substance use, sex, spending)

Despite the suffering that these symptoms can cause, there are a number of evidence-based treatments that are effective for treating BPD. Some of these approaches are more skill-based, such as dialectical behaviour therapy, whereas others are more insight-oriented and relational, such as transference-focused therapy and schema therapy.

Whilst I have experience treating BPD using both skill-based and insight-oriented/relational approaches, I tend to work from an insight-oriented/relational approach called psychodynamic therapy. Psychodynamic therapy views BPD as the result of attachment trauma in early relationships in combination with a biological vulnerability to emotional dysregulation. Over time, this can lead to the development of powerful but conflicting relational templates—ways of experiencing oneself and others—that remain emotionally intense and psychologically split off from one another. Psychodynamic therapy focuses on gradually understanding and emotionally processing these relational patterns as they emerge in the therapeutic relationship. Over time, this process can help reduce symptoms and support the development of a more stable sense of self and more secure relationships.

For many, the hardest part is the act of starting therapy, as well as continuing to engage in the long term, even when the process feels painful or confronting. If you have been diagnosed with BPD or suspect you may have BPD, please do not hesitate to contact me for an initial phone call to discuss your concerns and ask any questions you may have about engaging in therapy.