BPD comprises a pattern of personality traits that involves strong emotions, issues with self-image [169], impulsive behaviours and unstable relationships with other people. BPD is also characterised by impulsivity, particularly in relation to behaviours that may be self-damaging. People with BPD experience difficulties regulating their emotions and expressing their feelings to other people. They are often described as having very intense, uncontrollable emotions, that can change suddenly. The distress associated with such overwhelming feelings can result in some people with BPD hurting themselves or others as a way of coping with their intense emotions [169].
As with ASPD, behaviours typically begin in early adolescence or early adulthood, and are pervasive across several areas of a person’s life (e.g., work, study, relationships). The main characteristics of BPD are described in Table 19.
A case study example of how a person experiencing co-occurring BPD and AOD use disorder may present is illustrated in Box 9.
Table 19: Main characteristics of BPD
| Main characteristics of BPD |
Extreme efforts to avoid rejection or abandonment. Such threats of rejection may be real or imagined. A person with BPD may be extremely sensitive to perceived signs of criticism or rejection, because they fear the person may leave or abandon them.
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| A pattern of unstable and intense interpersonal relationships, characterised by the person alternating between idealising a person and devaluing them. |
| Identity disturbance. Markedly and persistent unstable self-image or sense of self. This may result in sudden changes in a person’s goals or life values, jobs or career aspirations, sexual identity, or friends. |
| Impulsivity, particularly in relation to behaviours that are self-damaging (e.g., spending money irresponsibly, binge eating, substance use, unsafe sex, reckless driving). |
| Recurrent suicidal behaviour, gestures, threats, or self-mutilating behaviour (e.g., cutting or burning) are also common. |
| Unstable mood (e.g., intense dysphoria, irritability, anxiety or anger usually lasting only a few hours and rarely longer than a few days). |
| Chronic feelings of emptiness. |
| Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). |
| Transient, stress-related paranoid thoughts or severe dissociative symptoms (i.e., where the person temporarily loses touch with where they are in time and/or space). |