What is emerging borderline personality disorder (EBPD)?
Borderline personality disorder is a condition that affects a person’s thoughts, emotions and behaviour.
In some circumstances it can be diagnosed before the age of 18.
Young people with emerging borderline personality disorder may describe many of the following:
- feeling okay one moment and then feeling deeply despairing, angry, sad or anxious the next
- emotions or moods that change very rapidly
- feeling out of control of, or overwhelmed by, their emotions
- self-harming in response to emotional pain, or when in crisis
- feeling hopeless and burnt out, sometimes considering hurting themselves or others
- being very sensitive to criticism and rejection and fearing people leaving them
- feeling mistreated or misunderstood quite a lot of the time
- periods of feeling numb or empty inside, or ‘cut off’ and disconnected from reality
- problems with self-esteem, self-worth, or having little sense of who they are
- feelings of guilt, shame and wanting to punish themselves at times
- a tendency to act on impulse, putting themselves at risk of harm as a result
- a tendency to get into very intense relationships, then experience problems in relationships such as control or abuse, or fear of rejection and abandonment
- having very high standards and expectations of themselves and others
- struggling to be assertive in a calm and effective manner, resulting in feelings exploding in outbursts or getting turned inwards in self-destructive behaviours
- finding it difficult to ask for help or communicate distress effectively
Why do young people develop EBPD?
Young people with emerging borderline personality disorder (EBPD) come from many different backgrounds, but most will have suffered some difficulties in early life.
EBPD is often a difficult thing to live with, but there are approaches that can help people cope better with the condition, so that their lives become more manageable and less of a ‘rollercoaster’.
Developing a shared understanding between young people, their families and services
Receiving the diagnosis need not be a negative thing;
- it may help you feel less alone, realising that other people experience the same sorts of difficulties
- understanding ourselves can be a first step towards positive change
- it may help identify treatment options
- it may be a relief to have an explanation for the problems you’ve been experiencing
Diagnosis
The diagnosis may be made simply by talking to you, and others who know you well, about the sorts of problems you experience. In some cases you may have a psychological assessment.
The diagnosis is not always clear from a one-off assessment, but becomes clearer over time.
People with EBPD may also experience other conditions, such as:
- low mood
- anxiety
- post-traumatic stress
- eating difficulties
- a tendency to become dependent and rely on others to make decisions and solve problems
What helps people with EBPD?
The main treatment for EBPD is psychological intervention, rather than medication (although medication may play some part). You may be offered medication to treat another mental health problem, such as persistent low mood or anxiety.
Commitment and motivation
We know psychological work or therapy takes effort and courage. Psychological work may challenge people to place less reliance on longstanding coping strategies such as self-harm and to become more compassionate towards themselves, instead of being self-destructive and self-sabotaging. Setting some personal goals may help keep you on track, for example attending appointments regularly.
Given that change is hard, why is it worth the risk of trying to change? – Think about what will make it worth it for you? What do you want your life to look like in the future? What needs to change to make life more bearable?
Therapy
Research studies have been done into the effectiveness of various psychological therapies for EBPD, with some positive results.
Your care coordinator may want to refer you for further therapy such as Dialectical Behaviour Therapy (DBT); some therapies are delivered one-to-one, some via groups or as family and some a mixture of the two.
Many people have understandable anxieties about group work but benefit greatly from the group setting when they try it.
Crisis plans
Working out what helps keep you well and what helps you cope when things are getting tough can help prepare you to ‘weather the storms’. This may be written down to form a personalised crisis plan.
For example:
- What tends to trigger you into a more agitated or upset state of mind?
- Track back, before the self-harm (or other harmful behaviour), what had happened and what were you feeling?
- What were the consequences to yourself and others of your behaviour?
- What can you and others do to prevent the emotion escalating when it starts?
- What does and does not help?
- What steps can you and others take to help keep you safe?
You can talk to your care coordinator about developing a personalised crisis plan. Generally speaking, people make most progress in EBPD when they start to take some responsibility for their own recovery.
Self-help techniques
Often a switch is needed – from the person feeling out of control of their emotions and attempting to get other people, or other things, to help them manage that emotional turmoil, to a state in which the person takes some responsibility for their own emotions and learns the skills to cope with them.
Listed below are some focus areas and suggestions for things that might help you:
General wellbeing
- Develop and maintain a healthy daily routine including regular sleep and regular meals (you’ll be more vulnerable to stress if tired or hungry)
- Give physical activity a try (eg, walking, swimming) to help lift mood and reduce stress
- Start to relate to yourself in a more compassionate and understanding way – notice your achievements, however small; recognise and praise your own hard work; understand that you may behave as you do for valid reasons that aren’t your fault; start to develop an ‘inner cheerleader’ as well as an ‘inner critic’
- Do some regular planning, prepare for any changes, problem solve – break down problems into smaller chunks and plan how you’re going to address the situation (rather than avoiding problems and then getting overwhelmed)
- Talk to someone, don’t bottle-up or suppress your emotions
- Test out your expectations of yourself with others – can they help you recognise when you’re setting yourself too big a task, or when you’re losing perspective?
- Remember your strengths as well as your weaknesses – connect with a sense of resilience – what have you managed to overcome or survive? Do you keep going even when it’s hard? Have you shown you’re strong at times?
Calming and soothing activities
- Try a guided meditation or relaxation CD or app
- Prioritise and set aside some regular time for yourself, to rest and relax – do something nice for yourself in that time
- Be around nature or animals
- Keep in mind, ‘this will pass’ – remember things can often feel a bit better in a short space of time
Grounding activities
- If you’re starting to feel overwhelmed or disconnected from your surroundings, focus your attention on something very specific, such as counting the number of objects in the room, or use something with a strong smell to ground you back in the room
Distracting activities
- Try Lego, jigsaws, crafts
- Watch a DVD/film/TV
- Listen to music
- Keep up any work or education (but don’t over-work and burn out – set a pace you can sustain)
- Go for a walk
Tension releasing activities
- Read up about alternatives to self-harm and experiment to see which work for you
- Punch pillows, smash fruit or ice
- Use an elastic band
- Write things down
- Draw or paint
- Do something physical – go for a run, throw a ball around outside
- Use a stress ball
L969, V2, 23/01/2020 (Archive: 23/01/2023)
