Beyond the Surface: Understanding the Lesser-Known Realities of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a complex and often misunderstood mental health condition. While many are familiar with the hallmark symptoms—such as intense emotional instability, chronic fear of abandonment, and impulsive behaviours—there are several lesser-known characteristics that shape the lived experience of those with BPD. Misdiagnosis is also common, particularly with autism spectrum conditions, due to overlapping traits such as emotional dysregulation, social difficulties, and black-and-white thinking.

This article explores both the recognised and lesser-known features of BPD, the reasons behind diagnostic hesitancy, and the nuanced nature of treatment and psychological support.

What Is Borderline Personality Disorder?

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), BPD is defined by a pervasive pattern of instability in interpersonal relationships, self-image, and affect, as well as marked impulsivity. To meet diagnostic criteria, an individual must experience at least five of the following:

• Frantic efforts to avoid real or imagined abandonment

• A pattern of unstable and intense interpersonal relationships

• Identity disturbance (unstable self-image or sense of self)

• Impulsivity in areas that are potentially self-damaging

• Recurrent suicidal behaviour or self-harm

• Affective instability due to marked reactivity of mood

• Chronic feelings of emptiness

• Inappropriate, intense anger or difficulty controlling anger

• Transient, stress-related paranoid ideation or dissociation

However, BPD manifests differently from person to person, and not every trait is visible externally. Many individuals may present as high-functioning, articulate, or even outwardly composed, despite experiencing deep inner turmoil.

Lesser-Known Features of BPD

BPD is not only about extremes in emotion; it’s about the instability of those emotions. Some of the lesser-known or unofficially recognised traits (often discussed anecdotally in communities such as Reddit’s r/BPD or r/BPDlovedones) include:

“Quiet BPD”: Where outward rage or impulsivity is less visible. The person may internalise distress, leading to silent self-criticism, depression, and withdrawal.

“Splitting”: A defence mechanism where others are perceived as all good or all bad, often switching rapidly. This can make maintaining stable relationships particularly challenging.

Hyper-empathetic tendencies: Some individuals with BPD describe feeling overwhelmed by the emotions of others, often confusing their own feelings with those around them.

Identity disturbance: Beyond having a poor self-image, many describe a lack of self altogether—shifting values, careers, or appearance in search of stability.

Unpredictable sensory sensitivities: While not diagnostic, some individuals report sound or touch sensitivities that overlap with neurodivergent profiles.

BPD or Autism? A Diagnostic Challenge

There is increasing awareness of the clinical overlap between BPD and Autism Spectrum Condition (ASC), especially among women and individuals assigned female at birth. Both conditions can involve emotional sensitivity, difficulty interpreting social situations, and sensory processing issues.

However, key differences include:

Feature BPD ASC (Autism Spectrum Condition)
Emotion Regulation Intense, rapidly shifting emotions May appear emotionally flat or overwhelmed
Social Relationships Fear of abandonment, unstable relationships Difficulty initiating or understanding social norms
Self-Image Unstable, reactive to others’ views May have a consistent but idiosyncratic identity
Developmental History Typically emerges in adolescence/early adulthood Often present from early childhood

The clinical distinction matters, particularly when developing a treatment plan. A person with BPD may benefit from emotionally focused interventions, while someone with autism may benefit more from social skills support and environmental adjustments.

Why Psychologists May Delay Diagnosis
Unlike physical conditions, mental health diagnoses can shape identity, relationships, and self-concept in profound ways. With BPD, psychologists often wait before offering a diagnosis, particularly if the client is in crisis or has limited insight into their emotional patterns.

Why?

Emotional reactivity: By its nature, BPD can make receiving a diagnosis difficult. Some clients may experience the diagnosis as a rejection, a label, or even a confirmation of their worst fears.

Risk of stigma: Unfortunately, BPD is still highly stigmatised—even among some healthcare professionals. Introducing the diagnosis prematurely can harm the therapeutic alliance.

Trauma considerations: Many people with BPD have histories of complex trauma. It may be more clinically appropriate to focus on stabilisation and emotional safety before naming the condition.

As one Reddit user reflected, “I didn’t want to be told I had a ‘personality disorder’—I felt broken enough already. But a year into therapy, when my psychologist gently introduced it, it helped everything finally make sense.”

Causes of BPD*
BPD is widely accepted to result from a combination of biological vulnerability and environmental factors, particularly:

• Childhood trauma or neglect

• Invalidating environments (where emotional expression is dismissed or punished)

• Genetic predisposition to emotional sensitivity

• Neurobiological differences in emotion regulation and impulse control

Treatment Options

BPD is highly treatable with the right support. Evidence-based treatments include:

Dialectical Behaviour Therapy (DBT): Focuses on distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness.

Mentalisation-Based Therapy (MBT): Helps individuals understand their own and others’ mental states more accurately.

Schema Therapy: Targets longstanding patterns of thought and behaviour developed in childhood.

Transference-Focused Psychotherapy (TFP): A psychodynamic approach focused on relationships and identity.

Medication is not a primary treatment for BPD but may be used to manage specific symptoms like anxiety or depression.

People with BPD are often highly emotionally intelligent, deeply empathetic, and capable of strong insight and connection. With support, many go on to develop healthier relationships, clearer identities, and greater emotional resilience.

At the London Psychologist Clinic, we work sensitively with individuals who may be struggling with emotional intensity, identity confusion, or unstable relationships—whether or not they have a formal diagnosis. Therapy is not just about labels; it’s about understanding, healing, and building a more secure sense of self.

When to Seek Help
If you relate to aspects of BPD—or are unsure what you're experiencing but feel overwhelmed—professional support can help. Therapy offers a safe, non-judgemental space to explore your thoughts, feelings, and behaviours, and to develop tools to manage them. Whether you’ve been diagnosed or are still exploring, help is available, and recovery is possible.