Borderline Personality Disorder (BPD)

Quick Reference

Overview: Unstable sense of self, moods and relationships. Frequent emotional crises, ‘black and white’ thinking, deliberate self-harm, suicide attempts, impulsive and risky behaviours.

Link to Offending: Related to domestic abuse and expressive, impulsive aggression. May also offend as a means of drawing other’s attention to their internal distress.

Tips: Manage ‘splits’ between agencies/staff, be mindful of cycles of idealisation and devaluation. Adopt a boundaried, but validating (empathic) approach with clearly defined roles for all. May need to settle crisis behaviours before offence focused work is possible.

View of Self View of Others Main Beliefs Main Strategy
Bad/vulnerableUncertain MalevolentDangerous IdealisticDevaluing AttachAttack

Profile of a borderline personality

A disorder of emotion regulation, including unstable moods, interpersonal relationships, self-image, and behaviours. Moods may be extreme in nature, experienced with greater intensity and shifting rapidly (i.e. lasting hours rather than days). Their relationships may be very unstable, as their view of others pivots between idealization (highly positive regard) and devaluation (intensely negative feelings). They may quickly form intense and tempestuous attachments to significant others. Individuals with BPD can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness. There is a particular sensitivity to rejection and abandonment, even minor separations may induce intense feelings of anger and distress. Their self-image is also unstable, varying from positive to negative regard. They may express feelings of emptiness and lack of purpose in life. They may respond to their intense mood states and interpersonal conflicts with impulsive behaviours. These are sometimes understood as efforts to regulate their distressing feelings and may include alcohol or drug abuse, promiscuous sex, gambling, self-harm and suicide (with varied levels of intent).

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) identifies common features:

  • Frantic efforts to avoid real or imagined abandonment
  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  • Identity disturbance: markedly and persistently unstable self-image or sense of self
  • Impulsivity in at least two areas that are potentially self-damaging (e.g. promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving)
  • Recurrent suicidal behavior, gestures, threats or self-injuring behavior
  • Affective instability due to a marked reactivity of mood
  • Chronic feelings of emptiness, worthlessness
  • Inappropriate anger or difficulty controlling anger
  • Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.

Relationship to offending

Types of offending can be divided into three subgroups:

  • Reactive acts of aggression to perceived interpersonal difficulties, such as impending abandonment/rejection (e.g. violence to partner/significant other).
  • Impulsive acts of recklessness as a means of emotion regulation (e.g. substance misuse, prostitution, suicide attempts).
  • Expressive acts of need (e.g. fire-setting, or other rule-breaking which results in containment).

Tips for working with BPD

Tips for one-to-one working:

Alternating idealization and devaluation:
Be aware that references to you and others may be objectively out of proportion. Both positions are exhausting. Try not to react to either overly positive or negative references to yourself – they are unrealistic!

Splitting:
As the individual changes between attaching to and attacking others, ‘splits’ can occur within staff groups, leading to conflict: some experience the individual positively and others negatively. This is not a problem as long as you recognise it quickly, and sort it out.

Demanding and overly attached:
Watch out for excessively long ‘counselling’ sessions, multiple crises, lots of practitioners each putting in much hard work. This can lead to huge investment followed by disillusionment in the staff group. Draw up a contract, divide the tasks, set boundaries to the time allocated, and then stick to the plan.

Expressive acts of need:
Repeated and dramatic expressions of distress may become difficult to comprehend or manage, especially if they appear objectively out of proportion to the events described. Most commonly in offenders, it will be self harm, or fantasies and threats to harm others. This raises anxieties in practitioners who then provide too much attention to the behaviour, and/or too little attention to the underlying emotion. Focus on the experience, not the behaviour, and always validate their inner experience – no matter what your subjective view may be.

Tips for general offender management:

Hospital admission:
Compulsory admission to hospital is seen generally as unproductive, particularly for ongoing treatment, and should only be used as a last resort. Brief crisis admissions can be very helpful, if there is good follow up afterwards.

Health versus CJS:
Here is the most likely place for ‘splitting’ to occur. Strive for a partnership, with CJS at the centre, strongly supported by health.

Residential hostel placements:
Provide a level of structure and containment beyond that which outpatient appointments can manage. Do not under-estimate how much a borderline PD offender will miss the hostel, despite causing chaos when living there!

Non-statutory agencies:
Agencies outside of the NHS and CJS may provide support that is uncontaminated by the threat of legal detainment. It may be worth researching voluntary sector services such as crisis houses, groups or day centres which operate in the local area.