BPD was once thought of as a condition that was very difficult to treat, but evidence-based therapies can help people experience reduced symptoms and improved quality of life. Psychotherapy can help a person with BPD learn to manage rage and other emotions that feel uncomfortable as well as reduce impulsivity.
People with BPD can benefit by being physically active, practicing self-care, keeping busy, and taking breaks. Dialectical behavioral therapy and group/individual therapy can help someone deal with BPD. Grounding exercises and having an emergency safety plan are recommendations to overcome BPD.
Separations, disagreements, and rejections—real or perceived—are the most common triggers for symptoms. A person with BPD is highly sensitive to abandonment and being alone, which brings about intense feelings of anger, fear, suicidal thoughts and self-harm, and very impulsive decisions.
Often, the borderline person is unaware of how they feel when their feelings surface, so they displace their feelings onto others as causing them. They may not realise that their feelings belong within them, so they think that their partner is responsible for hurting them and causing them to feel this way.
With over 70% of patients acting out aggressively against others within a year, aggression is frequent in BPD (5). Being predominantly reactive in BPD, aggression is triggered by frustration, provocation, or threat, closely related to feelings of anger, and causes severe interpersonal problems (3).
But with some individuals with BPD, you don't want to get into the habit of allowing certain things such as calls after hours, visits to your home without announcing it, borrowing your things and never returning them, driving your car and keeping it longer than they should, etc.
Narcissism is not a symptom of BPD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, as many as 40% of people with BPD may also have narcissistic personality disorder,4 so people with BPD may also show signs of narcissism.
Borderline rage, or borderline anger, is more than just a standard emotional reaction. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), anger in BPD is described as "inappropriate, intense anger or difficulty controlling anger."
When faced with BPD rage – which stems from the BPD person's interpretation of an event – it is important that you react in a calm and validating manner. Take care of your own emotional and mental health and seek therapy for yourself. Encourage and support treatment (when the BPD person is ready)
Even though people with BPD are unpredictable, they need to be included in your plans. You should never ignore them during these times. They will feel disrespected, and this could lead to more fighting. Instead, try to include them in your activities and treat them kindly.
With borderline personality disorder, you have an intense fear of abandonment or instability, and you may have difficulty tolerating being alone. Yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though you want to have loving and lasting relationships.
Antipsychotics are widely used in BPD, as they are believed to be effective in improving impulsivity, aggression, anxiety and psychotic symptoms [Nose et al. 2006; American Psychiatric Association, 2001].
Splitting is a psychological mechanism which allows the person to tolerate difficult and overwhelming emotions by seeing someone as either good or bad, idealised or devalued. This makes it easier to manage the emotions that they are feeling, which on the surface seem to be contradictory.
People with BPD may feel a great deal of anger and may make heavy insults in a fit of rage to loved ones. Although it is unfair to listen and get hurt, arguing suggests that you believe the other person's anger is uncalled-for and this will lead to greater rage.
Setting boundaries for your relationship is important for you and the person with BPD. However, you should not expect your limits to fix the relationship quickly. The person with BPD may feel like these boundaries are a form of rejection, which may cause them to lash out.
People with BPD strongly desire a deep connection with those around them. This is partly because of their fear of abandonment but because they simply love people and crave deep connections.
The impulsive nature, and the association to childhood trauma, dissociation, and frontolimbic abnormalities support the continued protection of borderline personality disorder under the insanity defense.
Borderline patients may become distraught at ordinary criticism, which they experience as a blow to self-esteem; may react with rage to a disappointment or minor slight; or may feel terror at a separation that they experience as virtual abandonment.