KOCHI: Intense. Ultrasensitive. Dramatic. Difficult.
These are often the labels slapped on people living with Borderline Personality Disorder (BPD). Not because they define the condition, but because misunderstanding still shapes how it is perceived.
Observed annually in May, Borderline Personality Disorder Awareness Month seeks to draw attention to a mental health condition that remains widely misunderstood.
In simple terms, BPD is characterised by persistent difficulties in managing emotions, maintaining stable relationships and coping with stress.
Individuals may experience intense emotional shifts, fear of abandonment, impulsive behaviour, chronic feelings of emptiness and unstable interpersonal relationships. One’s brain is in a constant state of flux.
Mental health experts say BPD often goes undiagnosed for years because its symptoms overlap with anxiety, depression and trauma-related disorders.
According to psychiatrist Dr U Vivek, misconceptions surrounding BPD often prevent people from recognising symptoms early or seeking timely help.
“People with BPD are often labelled arrogant or emotionally volatile,” he says. “Their symptoms are frequently misunderstood as weakness or an attitude problem.”
Mood swings may be dismissed as attention-seeking. Emotional reactions may be viewed as exaggeration. Difficulty coping with stress can be interpreted as a lack of resilience.
Such assumptions can leave people unsupported at the time they need understanding the most. For many, Dr Vivek notes, psychiatric support is sought only after symptoms escalate.
“People usually arrive for consultation during moments of crisis — panic attacks, emotional breakdowns, self-harm or severe conflict in personal, academic or professional settings,” he says.
He recalls the case of a 25-year-old woman who struggled with decreased sleep, anxiety attacks, low mood and problems with colleagues.
“When she felt low or anxious, she would cut her wrist and thigh, which gave her temporary relief,” he says, pointing to a sign of BPD.
Behind such visible crises may lie years of unnoticed emotional struggles.
In some cases, individuals initially seek treatment for anxiety or depression while underlying patterns associated with BPD remain unidentified. This overlap can complicate diagnosis and delay targeted intervention.
Dr Vivek points out that many people with BPD receive treatment for panic attacks or anxiety while broader emotional and behavioural patterns remain unaddressed.
“Instead of treating the person as a whole, only medications to reduce anxiety are given,” he says. “But that’s just one part of the story.”
For Dr Sneha (name changed), the journey to diagnosis was similarly marked by years of confusion and emotional distress.
Diagnosed with BPD at the age of 24 in 2021, Sneha says her struggles intensified during her final year in medical school.
“The pressure became overwhelming. I started isolating myself and developed severe anxiety, panic attacks and depression,” she says.
Initially diagnosed with anxiety and depression, she was later suspected to have Obsessive Compulsive Personality Disorder (OCPD). She remained on medication for nearly a year.
Failing one of her exams convinced her that her mental health struggles were linked solely to academic stress. But difficult relationships, family conflicts and the isolation of the pandemic deepened her emotional turmoil.
After medical school, she immersed herself in work during her internship, which temporarily helped her regain structure and stability. But after the pandemic, her symptoms returned with greater intensity.
“Living at home again brought up unresolved childhood trauma and family conflicts,” she says. “Personal setbacks added to the emotional burden.”
She began experiencing severe anxiety, depressive episodes and multiple panic attacks a day, often accompanied by physical symptoms such as freezing, uncontrollable crying and involuntary salivation.
“At one point, I was taking nearly 10 to 12 tablets a day. Eventually, my parents admitted me to a psychiatric facility,” she recalls.
Doctors later diagnosed her with BPD and reduced her medication to just two, including a mood stabiliser.
“Therapy ultimately became more important than medication,” she says. “It helped me recognise patterns, understand my triggers and realise that recovery is possible, even if it is slow and nonlinear.”
Mental health professionals emphasise that personality disorders do not emerge overnight, nor do they reflect a person’s character or moral failing. Rather, they involve enduring patterns of thinking, feeling and responding that significantly affect daily functioning.
“As the name itself suggests, it is a personality disorder, meaning it may begin developing in childhood and become deeply ingrained over time,” says psychiatrist Dr Arun B Nair. “Genetics play a role, but adverse life experiences — like childhood trauma / abuse — contribute equally.”
Emotional instability, he stresses, is one of the core features of BPD.
“People with BPD often struggle to regulate emotions. If they are sad, they may be triggered towards self-harm or suicidal thoughts. If angry, they may express anger inappropriately, even in public spaces,” he says.
He adds that people with BPD may also form intense emotional attachments very quickly.
“Their feelings become so intense that they may struggle to handle even a small incident, like someone not answering their call,” he says.
This, according to him, is part of what is known as “black and white” thinking.
“A person with BPD may find it difficult to understand that people exist in shades of grey. They may either idolise someone or completely devalue them,” he explains. “This makes personal relationships difficult.”
Although BPD has historically been diagnosed more often in women, Dr Arun notes that emotional distress in men may present differently.
“In men, symptoms can appear more aggressive. Their bodies may look like a battlefield,” he says, referring to physical signs of self-harm.
“They may have a tendency to harm themselves physically when angry, and the expression of anger may also be more pronounced.”
Treatment and support
Treatment for BPD often includes psychotherapy and supportive mental healthcare aimed at helping individuals understand emotional triggers and develop coping skills.
“If diagnosed and treated early, the frequency and intensity of symptoms can be reduced,” says Dr Vivek.
The focus is on reducing behaviours that interfere with daily life while helping individuals build on their strengths.
“You can’t change the personality totally,” adds Dr Vivek. “What we try to do with medication is behaviour management.”
He notes that many people with BPD possess significant strengths and abilities that often become overshadowed by emotional struggles.
Dr Arun says treatment commonly involves a combination of medication and psychotherapy.
“Antidepressants help with the low phases, while mood stabilisers help control mood swings,” he says.
“Alongside medication, Dialectical Behaviour Therapy helps individuals accept themselves while also learning to change behaviours that may be harmful or disruptive. It teaches skills such as mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness.”
He adds that therapy, medication and a supportive environment together can help reduce symptom intensity and improve quality of life.
Yet for many, the challenge is not only coping with symptoms, but also confronting perceptions.
Perhaps the first step towards understanding BPD lies not in judgement, but in recognising the pain and emotional turmoil that often exist beneath that
behaviours that society is quick to brand as ‘too much’.
Common traits
Unstable and difficult relationships
Poor self-image
Self-destructive, impulsive behaviour
Alcohol/drug abuse
Suicidal threats or attempts
Self-mutilation
Extreme mood reactions, including intense, inappropriate anger
Feeling empty or alone
Fear of abandonment
Short-lived psychotic-like distortions of perception or belief, especially under stress
Frequent changes in long-term goals, career plans, friendships, and values.
Signs of BPD frequently emerge in adolescence or early adulthood, though diagnosis may occur years later.
Info: Harvard Health, Psychology Today
Suicide risk
Among mental health disorders, BPD shows one of the strongest associations with suicide attempts, highlighting the importance of early recognition and support.
Hidden diagnoses
BPD commonly overlaps with anxiety disorders, depression and substance-use disorders, which can delay identification and treatment.
Women vs men
Newer research suggests BPD affects men and women more evenly than once believed. Historically, women made up a larger proportion of diagnosed cases in clinical settings. Researchers believe this may partly reflect differences in help-seeking, diagnostic patterns and stigma, rather than actual prevalence.