Borderline personality disorder (BPD) is a highly misunderstood condition. It is characterised by emotional dysregulation, an unstable sense of self, difficulty forming relationships and repeated self-harming behaviours. People with this condition are vulnerable, impulsive, and highly susceptible to criticism – yet they often face stigma and discrimination when seeking care. Most people who suffer from BPD have a near-ubiquitous history of major trauma, often sustained in childhood. This includes sexual and physical abuse, extreme neglect, and separation from parents and loved ones. People with BPD who have a history of serious abuse have poorer outcomes than the few who don’t, and are more likely to self-harm and attempt suicide.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) does not mention trauma as a diagnostic factor in BPD, despite the inextricable link between BPD and trauma.
Australian research reported in 2019 found that BPD is strikingly common, affecting between one per cent and four per cent of Australians. For every 100 patients treated in inpatient psychiatric wards, 43 will have BPD. Around 75 per cent of BPD patients attempt suicide at some point in their life. One in ten eventually take their own life.
People with borderline personality disorder are often treated as if they have a personality flaw, rather than mental health issues stemming from trauma. BPD is better thought of as a trauma-spectrum disorder – similar to chronic or complex PTSD. The similarities between complex PTSD and BPD are numerous. Patients with both conditions have difficulty regulating their emotions; they experience persistent feelings of emptiness, shame and guilt; and they have a significantly elevated risk of suicide. It’s time we change the disorder’s name.