Unstable emotions, volatile relationships, and a desperate fear of being abandoned are what characterise someone with a borderline personality – a condition that is also known as emotionally unstable personality disorder. Seven in every 1000 people in the UK have borderline personality disorder – and three-quarters of people diagnosed are women.

Borderline personality disorder is often misunderstood, and has been characterised in movies as being a manipulative ‘bunny boiler’. Living with the condition can leave people feeling confused, panicked, bitter and despondent. Life can be challenging for you, too, if you have a friend, partner or family member who has borderline personality disorder. You may not understand why your loved one adores you one minute and blames you for everything the next. It can be hard to cope with. Understanding the condition may be one step closer to helping you, however.

Here’s how to recognise the signs and symptoms of borderline personality – which is only a disorder if there is significant impairment to personality and functioning, and if the person possesses at least five of the following traits:

Borderline personality traits

• They have a poor self-image, feel empty inside, and have a relentless, punishing inner critic. They don’t know who they really are, and fear deep down that they are a bad person.

• They have extreme mood swings, and their emotions are often intense and out of proportion to events or circumstances.

• Their close relationships are intense and unstable. When meeting someone new (friend or lover) they may idolise initially, sharing all their secrets and wanting to spend all their time with the new person. The next minute they are devaluing the new friend or lover because they are not giving enough love, care and attention.

• They are anxious and needy and terrified of being abandoned, and will take desperate steps not to be left alone – even when they are doing the rejecting. The phrase “I hate you, don’t leave me” encapsulates the push-pull dynamic of relationships with someone who has borderline personality disorder.

• They are hypersensitive and easily feel hurt or slighted, even if someone has to change an appointment or arrives late, or doesn’t look at them in the ‘right’ way. This can make them angry, hostile or antagonistic to the person they believe has let them down. They want to make the other person hurt as much as they are hurting.

• They can be impulsive and take extreme risks on the spur of the moment, with little regard for their safety – perhaps through substance abuse, gambling, unsafe sex, binge eating. Under extreme emotional stress they may self-harm and they make have thoughts about suicide and threaten to kill themselves if someone wants to leave them.

• Their anxiety makes them churn things over and over, worrying about how they could have behaved differently – and feeling shame and blame after verbally attacking someone. They are terrified of the unknown, and of falling apart and being out of control.

What causes a borderline personality structure?

Borderline personality traits generally start to manifest in teenage years, when the person may be dismissed as a moody teenager with dramatic outbursts. However, the roots of the disorder go much deeper and earlier than that.

No one can pinpoint exactly how borderline traits develop. However, an inability to regulate emotions is at the heart of a borderline personality. In childhood we learn behaviours from our caregivers and other people around us. If parents act acted in emotionally volatile ways then the child won’t learn how to contain emotions or work them through. This may happen if one or both parents is mentally unwell, absent emotionally, is a heavy user of drink or drugs, if they are emotionally cruel or critical to their children, if they abuse them physically or sexually, or simply don’t care.

Borderline personality traits generally start when a baby is between 9 and 18 months. If the breast/bottle or significant parent is absent then the child can become stuck emotionally at that stage of development: everything goes into their mouths, and they suffer attachment anxiety, fearful of being abandoned.

As a child we internalise the thoughts and behaviours of others and make them our own. Someone with borderline personality traits grows up thinking the world is fearful, unsafe and uncertain. They may have been blamed by their parents for perceived faults. They may have internalised that they are a bad person, and feel traumatised by being neglected or abused. They find it difficult to distinguish between self and other. They develop distortions in feeling and thinking that lead to the traits outlined above.

How to support someone with a borderline personality

• If you believe a loved one may have a borderline personality, then support is available through their GP and community mental health teams.

• Encourage them to access individual or group psychotherapy with someone trained and specialising in borderline personality disorder. Over time, psychotherapy can help them to identify their emotions, know what triggers them, and how to have an emotion without acting it out or feeling guilty about having felt it. Psychotherapy can also help them to become more reflective and less impulsive, and to identify healthier ways of thinking. Most importantly, psychotherapy can help them feel heard and understood in ways that they could not internalise as a child.

• Creative therapies, such as art and movement therapy, can also help them to express difficult emotions in more constructive, creative ways. Encourage your loved one to draw, paint, write, dance, be creative when they feel emotional distress. A creative outlet can make the feelings more bearable.

• Good self-care – such as exercising, eating and sleeping well, reducing exposure to stressful situations – can reduce symptoms of irritability and mood swings. Where you can, make sure your loved one is looking after him or herself properly.

• Don’t get dragged into the drama. Yes, it may feel like being on an emotional rollercoaster when you have someone with a borderline personality in your life. One minute they love you. They next they hate you. If you can see them as a small child having a tantrum – rather than an adult having a go at you – you may be able to find the patience to hold the space rather than becoming distressed alongside them.

• Don’t leave your loved one in a place of not knowing. That can be triggering for them. They need constant reassurance that they are loved and that everything is OK. While you can’t be on hand to deliver that reassurance every minute of the day, you can take steps to show that you are there for them and won’t abandon them.

• Set your boundaries and stick to them – for your sake as well as theirs. Your loved one may have grown up in a household that was chaotic or neglectful. Having firm boundaries is therefore an act of love because it creates something more solid and reliable.

• Truly listen and attempt to understand. Try not to take things personally. Be empathic where possible.

• Find some support for yourself. It can be hard not to react when your loved one is blaming you for everything under the sun, threatening to self-harm, and somehow making you responsible for their distress. We’re all human. If you feel fit to burst sometimes, think about finding a supportive therapist with whom you can talk things through and find calmness in your life.

• Identify ways to handle your stress. A mindfulness practice can help you and your loved one bring your attention to the present, and can help you focus on having an emotion rather than becoming it.

For confidential advice and support, and to discuss booking an appointment with one of our therapists, please call 020 8673 4545 or email appointments@theawarenesscentre.com