Borderline personality disorder (BPD)

Diagnosis

BPD is usually noticed when you reach your late teens or early adulthood. As a young person, your personality is still developing and changing, which can make it more difficult for a professional to diagnose BPD. For this reason young people are often diagnosed with 'emerging BPD'.

Many people with BPD have experienced relationship problems in childhood, such as problems in their relationship with their parents or carers, or experiences such as maltreatment or neglect.

It is also common to have other mental health conditions, which can make it more difficult for professionals to diagnose BPD. Other mental health conditions could include:

• anxiety
• depression
• conduct problems
• eating disorders including anorexia nervosa, binge-eating disorder, and bulimia nervosa
• post-traumatic stress disorder (PTSD)
• alcohol misuse & substance misuse
• attention deficit hyperactivity disorder (ADHD)

 

Accessing services

It is really important that you ask for help when you need it. Getting support from professionals early can help to stop BPD symptoms getting worse, and help with long-term positive changes. 

Your GP and mental health professional should understand how hard asking for help can be, and listen to you with sensitivity and respect. 

You might already have contact with mental health professionals because of concerns about self-harm, depression or other mental health conditions, and often your professionals within these services may suspect or diagnose BPD. 

If your professional thinks that you have BPD, they should work with you to put together a treatment plan. It is important that you are involved in making decisions about your care, and that your professional listens to your preferences and concerns. Specialist child and adolescent mental health services (CAMHS) usually provide treatments for BPD, and you might be offered extra support by education, healthcare or social services. 

If it’s available where you live, you should be able to access an out-of-hours crisis service. 

Planning treatment

Your professional should give you information about BPD and explain the support that’s available for you. They should give you extra help to understand this information if you need it, and give you time to ask questions. 

Your professional will think about a range of factors which might be important for your BPD treatment and suggest options which address these factors. These could include: 

Biological factors 

• Diet: although it’s not a specific treatment for BPD, having a healthy diet can improve your physical and mental health. If your BPD affects your eating, your treatment plan should include ways to manage your diet. Read how Eating a balanced diet can help manage your mental health and wellbeing.
• Exercise: you might find that exercise can help with managing your emotions, and this might be something to discuss with your professional. However, if over-exercising could be a risk for you, you should discuss this with your professional too. Read how physical exercise can help manage your mental health and wellbeing.
• Sleep: sleep problems can be common in BPD, particularly if you are depressed. If you have problems with sleep you should ask your professional for help. In many cases having a good routine and healthy sleep habits can be enough. Read how Sleep can help manage your mental health and wellbeing. 
• Drugs and alcohol: try to limit these and discuss with your professional whether they might be affecting your BPD symptoms. There is strong evidence that alcohol and drugs such as cannabis can have a negative effect on your mood. Alcohol and some drugs can also make you more impulsive. Read how Reducing consumption of stimulants and other drugs can help manage your mental health and wellbeing.

Social factors 

• Your assessment should identify any important social factors which might be adding to your difficulties, and your treatment plan should include ways of helping with them. 
• These social factors will be individual to you, but might include things such as bullying, abuse, neglect, housing problems, or problems with education or employment. 

Psychological factors 

• The main treatments for BPD are psychological therapies. These aim to help you with some of the difficulties caused by BPD, including how you think and feel about yourself and other people, and difficulties in managing your emotions. 

• BPD increases your risk of other mental health conditions, and of other problems such as poor sleep and poor self-care. If you need support with these things, it is important that your treatment plan includes help for them too. 

You will usually be offered a psychological therapy first, which will last for at least three months. Your professional should explain your treatment options and what each one involves, which will help with putting together your treatment plan. 

Your care plan should include: 

• the support and services you need
• your goals to do with treatment, education, employment and relationships with other people 
• how you can achieve these goals
• ways to keep you safe from risks linked to BPD (e.g., depression, self-harm or substance misuse)
• a crisis plan (including who to contact and techniques to help you cope).

Your treatment plan should be shared with you, your GP, your mental health professional and your parents or carers (if appropriate). 

Making decisions

You should be involved in making decisions about your care. If you are able to make your own decisions about your care, then your professional should talk with you about how you would like your parents or carers to be involved. 

You can find more information about how treatment decisions are made here.   

What about my parents or carers?

Your parents or carers could play an important role in your treatment, so your professional should talk with you about how you would like them to be involved. For example, your parents or carers would usually be involved in making decisions about your care. This doesn’t mean that your parents or carers will know everything that happens in your individual sessions, you can find more information about confidentiality and privacy here. 

The wellbeing of your parents or carers is important, and your professional should help them to access support and advice. This could include support with: 

• the challenges they might face when supporting you
• understanding how their behaviours and actions could affect you.

Transitions between services

It’s important that you’re supported during your transition from CAMHS to adult services, to help you keep up with progress you’ve made with your CAMHS professional. 

Transitions and endings can be difficult, and can cause strong emotions like feeling abandoned or rejected. Your professional should talk with you about your transition to adult services well ahead of time, so that you feel prepared for the change and your transition goes smoothly. 

It’s important for professionals in adult services to get to know you before your transition, to help it feel more comfortable and familiar. If it’s appropriate, your parents or carers should also be involved in planning your transition to adult services. 

You may also transition to another CAMHS service (e.g., if you move house). If this happens, your professional should work with you to make sure that your care can continue smoothly, and that your new service has all the information they need. 

For more information about transitioning between services, please see Moving on.

Ending treatment

Some young people who are supported by CAMHS won’t be able to receive support from adult mental health services. This could be because personality disorder services aren’t available, or because of the criteria set by adult services. Ending treatment can be difficult, and if this happens your professional should talk with you and make sure you feel prepared for when your treatment ends. 

In some places, young people with BPD can continue treatment in CAMHS after they are 18 years old, to keep seeing the same professionals. If you need this and it’s possible in your area, continued treatment in CAMHS should be arranged for you. 

You can find more information on ending treatment here. 

Additional support

The below organisations offer BPD specific support for children, young people and their families:

• AFC Crisis Messenger: a free, confidential, 24/7 text message support service for anyone who is feeling overwhelmed or is struggling to cope. If you need support, you text AFC to 85258
• Borderline Arts: charity that uses arts and creativity to raise awareness of BPD and tackle the stigma around it
• Childline: Childline is there to help anyone under 19 in the UK with any issue they’re going through. Whether it’s something big or small, their trained counsellors are there to support you.
• Supportline: charity offering helpline for people of all ages on a wide range of issues including anger, eating disorders, self-harm, depression, anxiety, panic attacks, and addictions
• PD and Me: website created for those who have been newly diagnosed with a personality disorder to help them understand their diagnosis
• The Mix: support and advice for children and young people under 25

Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.