A professional medical diagnosis usually, though not exclusively, refers to the 9 symptoms of BPD. If the majority, or all of these, have been experienced over a long period with detrimental effects on daily life. • Feeling very worried about people abandoning you and would do anything to stop that happening. • Experiencing very intense emotions that last from a few hours to a few days and can change quickly (for example, from feeling very happy and confident to suddenly feeling low and sad). • Not having a strong sense of who you are, and it can change significantly depending on who you're with. • Finding it very hard to make and keep stable relationships. • Feeling empty a lot of the time. • Acting impulsively and doing things that could harm you (such as binge eating, using drugs or driving dangerously). • Harming yourself or thinking about harming yourself (for example cutting yourself, overdosing or making attempts to end your life). • Experiencing very intense feelings of anger, which are difficult to control. • When very stressed, you may also experience paranoia or dissociation.

• There are 10 classified personality disorders and of those, Borderline Personality Disorder (BPD) is the most common, most complex, most studied, and certainly one of the most devastating, with up to 10% of those diagnosed taking their own life. • BPD exists in approximately 1% of the UK population. • There are some gender discrepancies in BPD, with 75% of people diagnosed with BPD being female. • Up to 20% of all psychiatric inpatients and between 10-30% of all psychiatric outpatients have BPD. • Between 50-80% of people with BPD engage in deliberate self-harming behaviour, such as cutting, which is done without suicidal intent. For some people, this is a coping strategy to cope with mood difficulties and reduce distress. Sometimes it can be a way to feel 'real' when dissociating. • Many people with BPD also have other mental health difficulties, with almost 85% also meeting the criteria for another mental health diagnosis, such as depression, anxiety or eating disorders.

Living with BPD can vary drastically from person to person so no two people's experiences will be the same. It is important to remember that people with BPD are people first and foremost, and are NOT defined by the diagnosis/label Below you can read Borderline Arts' Founder Sarah's story, to get a glimpse into one individual's experience. This article is an adapted combination of two stories , written by journalist Wendy Roberts and published in the Derby Telegraph 2013. For 16 years, Sarah has been fighting anorexia and a condition called borderline personality disorder (BPD). It is a daily battle. "Most friends and family only see me when I'm having a fairly good day," she says. "When it's bad, I shut myself away from the world. People who don't know me see me as an able, intelligent articulate girl. They don't understand or even believe that I have such a debilitating condition”. What is important is that the brave and brutally honest young woman is sharing her story. She wants people to read what she is going through and how she copes. Anorexia, suicidal thoughts, self-harm and [unstable] moods are what Sarah has to cope with in her life. Sarah was just a teenager when she tried to take her own life. And between suicide attempts, she was severely self-harming and restricting her food intake as a form of self-punishment. Sarah was a teenager when her mum first noticed the wounds on her arms. She took her to the doctor and was referred to the Child and Adolescent Mental Health Services. Sarah left school with a bunch of GCSEs but when her health took a serious dip, she was forced to drop out of education. Struggling to maintain her weight, she spent time some time at home with her parents. "I had chronic feelings of emptiness and a complete lack of self-worth," she says. "I had distortion of reality and had started to self-harm. I'd been restricting my eating and would only allow myself a cold shower as punishment. I must have had BPD then, but as the personality is not yet fully developed, it isn't diagnosed until adulthood. It was well over a year later when I started to eat better. My parents were distraught to see how poorly I had become. These days, on bad days, I just go to bed, I take my pills which knock me out and I try and sleep it off. I can be in bed for days but I think that's the safest place for me when I'm feeling bad.” Today is a good day for Sarah. She has got out of bed and is dressed. She is bright, bubbly and chatty. But tomorrow, things could be very different. She may not be able to get up. She could feel low and depressed and be too frightened to leave her little bungalow. A slight change in mood or a tiny (real or imagined) incident can trigger her off. Her day can quickly get worse. Mood swings, from suicidal to [euphoric], can pose real dangers for Sarah – and paranoia simply consumes her. "I have severe mood swings, can have no rational thinking and experience dangerous psychotic episodes. I self-harm, hear voices in my head and feel very insecure. When you're faced with these problems, simple things can prove hugely difficult. My head is always full of stuff. I nap all the time because I'm so tired." Her mood changes and lack of stability make it impossible for her to get a job. She would like to join a choir or an orchestra but she lacks the drive to do it. Her paranoia and psychosis have caused rifts with friends and problems with her family. And maintaining a romantic relationship would be impossible right now. Sarah's deep fear of abandonment and her erratic moods would certainly push someone away. Sarah admits she struggles to cope on a daily basis. Doing simple tasks like cooking a meal can be impossible. And if she is feeling low, upset or paranoid, she simply stays under the duvet. "Imagine waiting for the bus and when it doesn't come, thinking that someone is out to ruin your day and it's all part of the 'conspiracy' against you," says Sarah. "Everything is personal. I can be walking down the street and the voices in my head start telling me that I'm being followed. I 'zone out' and forget what I'm doing." The psychotic and dissociative episodes are scary and Sarah never knows what she has done until she has come out of one. Once she woke up to found she had cut all her hair off. Another time, in the middle of the night, she was convinced there were dangerous men in her house forcing her to harm herself. She says, “I ran into town and didn't even have my shoes or coat on." She left her house unlocked and ran off, ending up in a very vulnerable situation. When times get really bad and she can recognise her mental health is deteriorating, she calls for help. She has friends who come over and stay at her place. Her parents and one of her sisters also live locally and do all they can to help. "I try to contact friends when I'm in a panic. They call for the paramedics if they think I've taken an overdose or harmed myself," she says. "But I find it hard to reach out for help, as I hate being such a burden to people." When Sarah was rushed to hospital following another suicide attempt in her 20s, the true extent of her problems was revealed. She was in Australia working on community projects when she took an overdose. "Since then, I've been in and out of hospital for my anorexia but I've not had treatment for Borderline Personality Disorder," she says. "I spent 11 months in hospital in 2010/11. I am definitely better than I was then. I was admitted to an eating disorder unit in Oxford for a few months, and it helped a lot with the anorexia, they had no expertise in treating BPD. I was discharged once my weight was stable, but my BPD symptoms were rampant. Two days later I was admitted to an acute psychiatric unit in Derby. But the problem was exacerbated. The team could keep me from self-harming but that was really just by locking me up. They didn't have the time, expertise or staff to actually treat BPD and they had no experience at all of eating disorders and my weight plummeted. I hated my time in the acute psychiatric ward. It was a horrible place to be. I had friends and family to visit me and I made friends with another girl on the ward, which helped. But it was not a nice place to be! After those two months in the acute unit, I was then transferred to another eating disorder unit in Leicester as my weight was getting dangerously low. It was there that I was officially diagnosed with BPD. I had some fantastic sessions with a psychiatrist. He had a good understanding of borderline personality disorder and gave me amazing one-to-one support." Sarah's weight is stable these days, and her eating habits are better than they were, but when she is having a really bad day, she just feels that she does not deserve food. Fighting that thought and making herself eat is exhausting. She is managing her BPD symptoms as best she can, but it is still a pervasive struggle. Sarah has her own theories as to why she developed BPD and anorexia. She would like to keep some of the reasons to herself, but she says she has always felt like she is a very needy and insecure person. She describes her childhood as loving but says she was a little girl who desperately craved love and attention all the time. "I don't blame anyone," says Sarah. "I believe I was born with some of these problems. It's the way I'm wired, but that doesn't mean I don't want to be well. I'd love to lead a normal life. It's a difficult condition and I know it's hard for people to get a firm understanding of it. But I am passionate about breaking down the stigma that those with BPD are merely their label! We are people first and foremost! My life is much more than just this condition. I love to sing, hang out with my friends, create art and watch comedies. I love my cats (and animals in general) and I am passionate about collecting and photographing Lego figures. During a spell when I was well, I travelled the world and also earned a degree in Creative Expressive Therapies. Over the past few years, I have not been well enough to hold down a paid job, but that is something I am working towards! I am learning to feel proud of myself for what I achieve whilst simultaneously battling this condition! The illness is something that I have to fight, it is not who I am!” When the above article was originally written in 2013, there were no services available for people with BPD who live in Derby. Thankfully now this has changed. Sarah has accessed Dialectical Behaviour Therapy and is now having therapy to deal with the deeper roots that cause the symptoms. Sarah still has ups and downs, but the amount of ups is certainly increasing! She had to spend a few months in an acute psychiatric ward in 2016 and had a relapse of anorexia in 2017, but she has also set up a Registered Charity (Borderline Arts) to raise awareness of Borderline Personality Disorder and she is learning British Sign Language. "I still struggle, but I have more hope and resilience now and I am in a better place to tackle the symptoms and to embrace all the good things in life". Note from Sarah: It is now over 11 years since that article was written and I’m pleased to say that I am in a much better place. I work hard these days trying to balance my time well - this includes scheduling a lot of time for rest and attending groups and activities, which help me maintain and improve my well-being. Not taking on too much is vital for me, as I get easily burnt out and it takes a long time to recover. So, I am learning to listen to my body/mind rather than to the impossible pressures of society. I am accepting that it is ok that I cannot ‘keep up’ with the ‘normal’ pace of live nor hold down a full-time job etc., without becoming unwell! I can still have a full life and contribute to society in my own way. When I live life in this way, this much welcome stability means I can enjoy doing some volunteering and small bits of permitted paid work, which I find very fulfilling. Additionally, living this way keeps my stress levels much more under control which has meant that I have not had any psychotic episodes nor attempted suicide for many years! So, whilst it is exhausting to constantly manage the BPD symptoms (and it is!), it is definitely worth it!

• We are extremely loyal and have a keen sense of connection with others despite a social norm of individual disconnectedness. • We love deeply. We have the ability to relate deeply and intensely to others. We have a keen awareness of the creative and destructive traits of others and self. We see both the positive and negative of all things. We can teach about the light and shadow in both themselves and others and share this knowledge with many people. • We are not afraid to change and adapt to our environment. We are fluid in our identities and open to new experiences. We have a self that is highly adaptive in order to facilitate relations with more rigidly defined others. We are able to build ties with people even in unfamiliar environments. We can teach that ‘self’ exists in relation to ‘other’. • We have a wide-ranging approach to life and don't live boxed into various categories. We are open-minded to new experiences. Life is never boring. We are not afraid to live on the edge and release childish inhibitions in order to have a full life. We have a deep urge to explore the ecstatic heights and depths of human experience even at the expense of personal risk. We can teach that ecstatic experience is a fundamental part of human existence. • We feel and express our feelings strongly. We find release for our emotions. We can teach about the importance of healthy release of emotions. • We are open to feelings and experiences. We are not static beings. We are able to experience the full emotional spectrum more than nearly anyone. We have heightened sensitivity to atmospheric shifts in the environment and within the individual. We can teach how to tune in to the surroundings on an emotional level. • We are in touch with the existential darkness. We have a deep-seated thirst for meaningful relationships and experiences that is not easily satisfied with artificial substitutes. We realize that there are times we have needs that need emotionally filled. We realize that we as human beings are not complete and that this is unable to be changed. We can teach that the soul needs nourishment beyond what mainstream society has to offer. • We express our feelings strongly. We have strong reactions to injustice or abuse that sometimes transfer across time and place or individual boundaries. We can teach that anger is an appropriate reaction to injustice and oppression. • We are very sensitive to our environment. We have a connection to realms of experience outside of prescribed "normality" that is cherished and revered in other cultural contexts. We realise that one’s idea of reality is often subjective and that the world around us is all designed by our perception. We can teach that experience is not limited to the five senses and can offer insight into realms beyond the obvious." (Written by someone diagnosed with BPD)

Psychotherapy Psychotherapy involves talking to a professional about your thoughts, feelings, and behaviours, and how they can impact your life and relationships. Many mental health professionals now understand BPD better and recommend therapies like DBT, MBT, Schema Therapy, and CAT for at least a year to build a positive therapeutic relationship and make sense of life's difficulties. Here are some short summaries of these therapeutic approaches and others: Dialectical Behaviour Therapy (DBT) DBT, developed by BPD sufferer Marsha Linehan, is an extension of Cognitive Behavioural Therapy for individuals with BPD. It combines individual and group work and teaches skills for managing relationships, regulating emotions, and tolerating distress. Mindfulness is also a key aspect of the therapy. DBT may be available on the NHS in your area and your GP would be able to advise. Mentalisation Based Therapy (MBT) Mentalisation involves making sense of our thoughts, feelings, and behaviours, as well as those of others. When under stress, understanding our behaviour and the behaviour of others can be challenging. Mentalisation Based Therapy (MBT) helps people develop skills in mentalising to understand how thoughts relate to behaviours in influencing relationships. This therapy is useful for those with relationship difficulties that cause intense emotional experiences and typically involves both individual and group work. MBT may be available on the NHS in your area and your GP would be able to advise. Schema Therapy Schema therapy (available privately) is an extension of CBT for treating BPD. It helps individuals identify early patterns of thoughts or beliefs created in childhood. This therapy helps individuals understand the link between those beliefs and current emotional difficulties. Cognitive Analytic Therapy (CAT) Cognitive Analytic Therapy (CAT) is a time-limited private therapy, typically lasting between 16-24 sessions. It integrates various therapeutic approaches and focuses on the relationships in the individual’s life and patterns of relating. It also emphasises the relationship between the therapist and patient as a way to understand other relationships in the individual’s life. Arts Therapies Arts therapies (such as art therapy, dance movement therapy, drama therapy, and music therapy) are available individually or within a group as part of a treatment programme. These therapies aim to help people express their thoughts and feelings through creating something, with the guidance of art therapists. They are especially helpful to those who struggle to express themselves verbally. Unfortunately, such therapies are not available through the NHS. Read about Art Therapy here (http://www.baat.org/About-Art-Therapy)and find a local private therapist here.(http://www.baat.org/About-BAAT/Find-an-Art-Therapist) Read about Drama Therapy here (http://badth.org.uk/home)and find a local private therapist here.(http://badth.org.uk/therapist-search) Read about Music Therapy here (https://www.bamt.org/music-therapy/what-is-music-therapy.html)and find a local private therapist here.(https://www.bamt.org/british-association-for-music-therapy-resources/find-a-therapist.html) Read about Dance and Movement Therapy here (http://admp.org.uk/dance-movement-psychotherapy/what-is-dance-movement-psychotherapy/)and find a local private therapist here.(http://admp.org.uk/find-a-dance-movement-psychotherapistfind-a-supervisor/) Group Therapies Some therapies like DBT and MBT involve group-based therapeutic work. Although joining group therapy can be anxiety-provoking, it can provide a sense of connection and understanding from others with similar experiences. Group therapy can also help you recognize and change your patterns of relating to others. Family Interventions Families and partners of individuals with BPD may struggle and need support for themselves. They can talk to their GP or enquire with an NHS personality disorder service about psychoeducation and family therapy sessions. Crisis Teams In some areas, crisis teams provide short-term support to people in mental health crises. These teams offer 24/7 phone support and help individuals create safety plans. See our support services directory here. Hospitalisation In some cases, people with BPD may need to stay in an inpatient unit for a short time to stay safe and receive support from mental health professionals. The goal is to help them understand their triggers and feel safe again until they can find support in the community.

If you are experiencing mental health problems or need urgent support, there are lots of places you can go to for help and support.​ As Borderline Arts is focused on challenging the stigma surrounding BPD and increasing awareness of it in society, we're not able to provide individual or emergency support for people in crisis. Click Get Help Now at the top of the page for a list of useful resources. Visit our site's 'What We Do' page to learn about the fun creative groups we run for adults diagnosed with BPD.

As people with BPD get older, their symptoms and/or the severity of the illness usually reduce over time. One study has found that after a period of 27 years only 8% of people still met the criteria for BPD. It is worth noting that many people with BPD go on to have stable relationships and employment. Whilst in the past BPD was thought of as a chronic, life-long condition, we now know with treatment people can go on to live healthy, happy lives.

There is some controversy about the term ‘personality disorder’ because the link between 'what is my personality' and 'what is me' is tricky to define. Therefore this might make a BPD sufferer wrongly feel something is inherently wrong with ‘me’. Some people also feel the term ‘personality disorder’ ignores how their symptoms have formed as an understandable way to cope with distressing emotions and/or experiences. The name ‘Borderline Personality Disorder’ is also quite confusing, and stems from the past when BPD was thought to be on ‘the borderline’ between neurosis and psychosis. This idea is now outdated; however, the name has stuck. Other terms now exist, which some find preferable, such as 'Persistent Distress Disorder' and 'Emotional Instability Disorder'. It has also been suggested that BPD sufferers have C-PTSD (complex post-traumatic stress disorder), to highlight the role of trauma in the development of BPD. However, as mentioned earlier, not everyone with BPD reports a history of trauma, so this might not be fitting for everyone. Both historically and presently, BPD has been met with misunderstanding and confusion. People who have BPD can present in vastly different ways and have very different personalities. With the nine possible symptoms, there exist over 250 different ways for the disorder to present itself, and this heterogeneity is further complicated by the fact that BPD rarely stands alone. A high rate of co-occurrence exists with other disorders, which typically include major depression, bipolar disorder, substance abuse, eating disorders, and anxiety disorders. Often people report being diagnosed with another mental health condition first, before later receiving a more fitting diagnosis of BPD. In the past, people with BPD may have experienced reluctance from mental health professionals to treat them. Thankfully this is changing, and mental health professionals have more knowledge and understanding of BPD and the evidence-based treatments that can help. BPD remains largely unknown to the public and, due to this, misinformation can spread. Lastly, medications are often a source of confusion. It is not uncommon for an individual with BPD to be on a variety of medications. To date, no one medication has been specifically researched and approved for BPD, however, many people with BPD take psychiatric medication for co-existing mental health conditions.

If you think you may have BPD, consult your GP in the first instance. You can also click Get Help Now at the top of the page for a list of useful resources.

Family members, partners, and friends are, understandably, concerned for the safety and well-being of their loved one with BPD. They might feel fearful and helpless and unsure how best to offer support. You can Rachel's story here (http://www.borderlinearts.org/single-post/2015/07/31/Growing-up-with-a-Sister-with-BPD)about having a sibling with BPD. If you feel you are struggling with your own mental health due to supporting a loved one, please speak to your GP or refer to our support services page. Click here (undefined)for a link to helpful message boards.

Famous people suspected of having BPD, include Marilyn Monroe, Amy Winehouse, and Princess Diana. One of our most-read articles covers this topic and can be read here.(https://www.borderlinearts.org/single-post/2018/11/27/do-any-celebrities-have-borderline-personality-disorder-bpd)

Please note, if anyone tells you they are having suicidal thoughts you should believe them and take them seriously. If you can, help them to access support via their local GP or A&E. If the person feels unable to accept help, and you think their life is in imminent danger, then call the emergency services on 999. Some warning signs of suicide include: • Feelings of despair, pessimism, hopelessness, desperation. • Recent self-injury behaviours. • Withdrawal from social circles. • Sleep problems. • Increased use of alcohol or other drugs or overeating. • Winding up affairs or giving away prized possessions. • Threatening suicide or expressing a desire to die. • Talking about “when I am gone”. • Talking about voices that tell them to do something dangerous. • Having a plan and the means to carry it out. • Apologising for past mistakes, seeming to say a ‘goodbye’, appearing fine or happy after a period of intense distress. • Reference: CAMH(https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/suicide)