Borderline Personality Disorder & Therapy

Meeting at the Borderline: Understanding Borderline Personality Disorder and the impact of a diagnosis 

Borderline Personality Disorder (BPD)—also known as Emotionally Unstable Personality Disorder (EUPD)—is a complex mental health condition that affects emotional regulation, relationships, and one’s sense of self. Despite its prevalence, it remains one of the most misunderstood and stigmatised diagnoses'. In this post, we’ll explore what BPD is, its symptoms, and its origins, and take a closer look at how we can create a space for healing. 

"Labels cannot do justice to human complexity" Elinor Greenberg

Diagnosis: A Double-Edged Sword 

As a humanistic therapist, I hold a conflicted view on mental health diagnoses. For some people, receiving a diagnosis can provide clarity, and offer a framework for accessing essential, necessary support or treatment, while for others, it can feel like a label that marginalises or overshadows their individuality negatively. I believe in line with Elinor Greenburg's work that a diagnosis can be useful in offering therapist and client an orienting device guiding work towards positive interventions and outcomes.

Borderline Personality Disorder has been listed in the Diagnostic and Statistical Manual of Mental Disorders since 1980. While the label offers insight into patterns of behaviour, it’s crucial to consider the story behind the diagnosis: not "What is wrong with this person?" but rather, "What has happened to this person?" 

The Roots of BPD: Trauma and Early Relationships 

Research shows that childhood trauma plays a significant role in the development of BPD. People who have experienced trauma as children are 14 times more likely to receive a diagnosis of BPD (Porter et al). Furthermore, a recent study by The National Institute for Health and Care Excellence found that 75% of BPD diagnoses are given to women. 

So much of what we experience in early childhood shapes how we relate to the world and others. The way we attach to caregivers profoundly impacts our emotional and social development. I align with the view that personality adaptations are created in response to earlier developmental and relational challenges resulting in what has become a diagnosis of BPD. Children exposed to significant or ongoing trauma—such as neglect, abuse, or inconsistent caregiving, go on to develop survival mechanisms that, while adaptive in childhood, may no longer serve them in adulthood. 

Bessel van der Kolk, a pioneer in trauma research, describes developmental trauma as the result of chronic early-life trauma on a child’s development. This kind of trauma affects brain circuits involved in attachment, empathy, stress response, and self-awareness, leaving a lasting impact on how individuals manage emotions and relationships. 

Unlike singular traumatic events, developmental trauma involves repeated relational failures, neglect, and misattunement. These cumulative experiences can profoundly affect emotional development, making it harder for individuals to trust, regulate emotions, or feel safe in relationships. 

The Therapeutic Relationship: A Path to Healing 

The therapeutic relationship offers a unique opportunity to address relational and developmental challenges. In therapy, the focus shifts from labeling pathology to understanding patterns of behaviour, what they represent and how they developed. This approach creates a secure space where clients can feel safe to explore their emotions and experiences. 

By working relationally, therapists can help clients recognise and modify outdated survival strategies, allowing for healthier ways of relating to themselves and others. This healing process emphasises: 

• Safety: Building trust within the therapeutic relationship. 

• Relational Awareness: Exploring how past experiences shape current behaviors. 

• Empathy and Compassion: Supporting clients as they uncover the roots of their pain. 

Breaking the Stigma Around BPD 

BPD is often misunderstood and unfairly stigmatised.  We must move beyond seeing BPD as merely a set of symptoms and recognise it as a response to early-life adversity. When we understand someone’s struggles in the context of their experiences, we can offer support that empowers rather than marginalises. By approaching BPD with compassion, and curiosity,we can focus on the individual’s humanity rather than their diagnosis. Understanding the roots of the patterns of behaviour, and fostering a safe therapeutic environment, we can help individuals reclaim their lives and build healthier relationships. 

If you or someone you know is living with BPD, know that help is available. Therapy, self-awareness, and supportive relationships can create the foundation for healing and growth. 

Let’s continue the conversation about BPD—share your thoughts and experiences below. Together, we can foster greater understanding and compassion for those navigating this journey.