Compass

Tag: anxiety

  • Waiting For The Other Shoe To Drop

    Waiting For The Other Shoe To Drop

    Spring Light

    My dearest daughter. I am writing this on the most glorious spring day. The house is full of light for the first time in months. The dog is curled up on top of his crate in a sun patch. Outside, the clematis has erupted into a wall of white flowers. The washing machine is chuntering away. You are fast asleep upstairs. All feels curiously well with the world.

    I am having a delicious week off work. And for the first time in what seems like forever, I find myself able to do things around the house.

    Clearing Out

    I’ve gone through two kitchen cupboards and taken out all the years-old spices, the packets of beans never used, the detritus that has collected over the past years. I’ve taken all my clothes that no longer serve to the charity shop and the tip. I’ve completely cleared the bed in the front garden where the new shed will go — all those pestilential dogwoods, gone at last.

    And you have gone through all your clothes too. A far bigger job than mine. The chaotic floordrobe we’ve both survived with for the past year is no more, the carpet is back and we have functioning wardrobes again.

    Something has shifted. Not dramatically. But enough that we are both, it seems, ready to do some things differently.

    What’s Changed For You

    This week you worked four days in a row — unheard of. In the past you weren’t given that many shifts. I get the impression that you are more confident now and able to do more – I wonder if that’s why you’ve been offered the extra work? Also, you previously turned down shifts you didn’t get plenty of warning on — you’ve needed to know what you’re doing well in advance, which meant you missed out on work. Last night you agreed to another shift for tomorrow! Just working two shifts at the weekend used to be enough to leave you in bed for days, recovering. No wonder you are still asleep upstairs…

    I’d say I’ve noticed a change in you since you started DBT group therapy. You have of course been doing one-to-one DBT for a couple of years, but the group therapy is new. I wonder if you’re getting more out of it because you’ve already gone through a lot of the skills in your individual sessions – you’re not having to learn everything and process the group dynamics at the same time.

    I’d love to understand more about what’s helping. But I’m also scared of somehow spoiling this good thing if I prod at it too much. It feels so young and delicate, this change, and as much as I want to know the inner workings, I get that it’s also personal and private and maybe more for observing than understanding at this stage.

    What’s Changed For Me

    You’ve pointed out that you think I’ve changed too. That I’m “better” now. I’m not sure if I am, exactly, but I am trying.

    I’ve been taking a course called Managing Suicidality and Trauma Recovery, run by NEABPD (an American charity) for parents living with on-going fear about their child’s safety.

    It’s been tough – I’ve felt a bit sorry for myself having to stay up late in the evening because of the time difference (you know how I like an early night), but I haven’t found anything equivalent in the UK. And talking to strangers about something so distressing — trauma, shame, fear, all of it — that’s my idea of hell. A lot of the time I’ve been dissociating, not really taking it in. It’s only now, as the course ends, that I feel more comfortable and able to listen. But something must have been sinking in despite this.

    I’ve also been working on building something — an app to support caregivers of people with BPD. Still very early days, but the process of thinking about what I’d actually want to support me, and trying to apply what I’ve learnt from this course and countless other sources over the years, has been surprisingly helpful. More on that another time.

    The Other Shoe

    As I write this, something has started to tug at me. The fear of jinxing it. It’s not just the changes in you that feel fragile — it’s the changes in me, and in our relationship. Is it right to talk about it all when it is so new?

    I guess I’m waiting for the other shoe to drop. We’ve had peaceful times before — the odd day, even the odd week — and then it all descended into chaos, conflict and distress again. How long have we got this time?

    And yes, I say this fully aware that this ‘easier time’ hasn’t been perfect. We’ve had our descents — times you’ve been dysregulated, times I’ve triggered you by saying or doing something or other — and things haven’t escalated the way they have in the past. Which suggests we may be travelling somewhere new – still a bumpy road, yes, but not the dirt track full of crevasses and jagged rocks we’ve been careening down thus far.

    And yet, and yet… what if it’s not? What if you wake up today and everything goes wrong, reverts back to how it was before?

    OK, I had a bit of a spiral there so I used one of my new found skills… I redirected my attention to my surroundings – the dog in his sun patch, a fly buzzing against the window. And I remembered a slide from the course that has stuck with me: Interrupt fear patterns by gently saying to yourself ‘I don’t know’.

    I don’t know how this will pan out for us, my dearest one. And I’m trying to learn to sit with that.

    One thing is for sure though: Wherever you are, whatever you are going through, I’m still here for you — not perfect, not particularly wise, but trying to do better.

    Crikey – who knew that things feeling a bit easier could be so challenging?

  • Why You Feel Dreadful (When It’s Not You Who’s Ill)

    Why You Feel Dreadful (When It’s Not You Who’s Ill)

    In this article I talk about crisis, but I don’t necessarily mean a medical emergency.  I mean any episode of extreme emotional intensity and dysregulation. In the aftermath of a loved one’s crisis, many caregivers instinctively replay what happened — what was said, what was done, what they should have said instead — to make sense of their distress. But mental replay provides only part of the picture. The body was there too, experiencing all of it, and my theory is that understanding what happens at the body level could be the key to recovery.

    What the Research Tells Us

    There hasn’t been a great deal of research into the physical and mental impact on caregivers who have a loved one with BPD, but what has been done shows that the impact can be profound.

    A systematic review by Bailey & Grenyer (2013), published in the Harvard Review of Psychiatry, found that caregivers of people with BPD experience higher levels of burden and grief than caregivers of other serious mental illnesses, including schizophrenia.

    Their follow-up study (2014) found that BPD caregivers reported symptoms at levels consistent with mood disorders, anxiety, and PTSD.

    More recently, a 2025 study (Tempia Valenta et al.) noted significant psychological and somatic distress in BPD caregivers — physical symptoms caused or worsened by chronic stress, such as headaches, stomach problems, and sleep disruption.

    I haven’t found research that explores why caregivers experience this level of physical and psychological impact. What follows is my attempt to provide one answer to that question — drawing on established science around the body’s stress response and applying it specifically to the experience of caring for someone with BPD.

    Your Body Has a Plan

    When your brain perceives a threat — whether a physical danger or your loved one in crisis — it triggers a cascade of changes designed to keep you alive. Adrenaline surges, your heart rate climbs, muscles tense, breathing quickens. Cortisol follows, keeping you alert and mobilising energy. Blood flow redirects away from both digestion and your “thinking brain” toward the systems that help you survive.

    This is the fight-or-flight response. It evolved to handle physical threats requiring immediate action. The stress hormones flood your system, you fight or run, and the exertion uses up that mobilised energy. Then your parasympathetic nervous system kicks in to restore calm. Threat over. Cycle complete. System resets.

    The key word is “complete.” The stress response has a beginning, middle, and end — and researchers like Peter Levine have argued that physical action is what closes the loop, the body’s way of saying: the danger has passed, stand down.

    What Happens When the Cycle Can’t Complete

    When your loved one with BPD is highly dysregulated, or in crisis, your body can experience this as a threat. It then mobilises exactly as it’s designed to, but the context of caregiving — the love, the responsibility, the need to stay in relationship — means the stress cycle may never complete. And this is true regardless of how you respond:

    • Holding everything in. You stay calm on the surface while your nervous system screams underneath. The energy mobilised for action has nowhere to go — it stays in the muscles, the clenched jaw, the tight shoulders, the buzzing restlessness that lingers long after the crisis is over.
    • Fighting back. You shout, argue, match the intensity. It looks like stress is being discharged, but what often follows is guilt and self-recrimination — one incomplete cycle giving way to another.
    • Walking out. You leave the room, drive away. This comes closest to completing the flight response, but worry, guilt, and hypervigilance about what you’ll return to can keep your nervous system activated even though you’ve physically moved away.
    • Shutting down. You go numb, feel detached, experience a strange flatness. This is the freeze response — the nervous system’s last resort when neither fight nor flight seems possible. It can be the hardest state to recognise as stress, because it doesn’t feel like agitation. It feels like nothing.
    • Fawning. You pour all that activated energy into appeasing and accommodating, doing whatever it takes to de-escalate. Outwardly calm, but underneath the nervous system is working overtime.

    There are also approaches that can help people with BPD and their loved ones respond more skilfully in times of crisis, in ways that reduce stress on both sides — and future articles will explore these. But even with better tools, the fundamental challenge remains: your body is likely activating a survival response in a situation where survival instincts aren’t always what’s needed.

    Whatever your response looks like, it’s the situation itself — not a personal failing — that makes the stress cycle so hard to complete.

    What “Stuck Stress” Feels Like

    When a stress cycle doesn’t complete, the after-effects show up in the body in one of two ways:

    Agitation: a restless, buzzing energy that won’t settle. Your body is still primed for action that never happened — the energy sitting in your muscles, waiting to complete a response that got interrupted.

    Crash: a heavy, flu-like exhaustion that descends hours or sometimes days after a crisis. Your body went through a significant physical event, even though from the outside it might have looked like you were just standing in your kitchen.

    Neither is a sign of weakness. Both are signs of a body that has been through something real and hasn’t yet completed its natural recovery.

    Over time, when these cycles repeat without resolution, the effects can become chronic — persistent headaches, stomach problems, disrupted sleep, unexplained aches. I believe this may be the mechanism behind the somatic distress that research is now documenting in BPD caregivers.

    Why the Standard Advice Sometimes Misses the Mark

    If you’ve been told to try yoga, take a bath, go for a walk, or practise deep breathing — and sometimes it helps and sometimes it doesn’t — there are good reasons for that.

    If your body mobilised for a sprint, a gentle stroll doesn’t match the energy that was prepared. When your system is highly activated, stillness can feel like being trapped rather than calm. And when your nervous system is dysregulated, your thinking brain goes partially offline — so strategies that rely on reasoning your way through it may not reach the part of you that needs them.

    These techniques aren’t useless — but they’re not always the right tools for the moment.

    Why This Matters

    Understanding the stress cycle answers a question many caregivers ask: my loved one is the one suffering, not me — so why do I feel physically and mentally dreadful? Because your body has been through something real, repeatedly, and it deserves help completing its natural recovery.

    Where This Takes Us Next

    If stress gets stuck because the cycle can’t complete, the obvious question is: what helps it complete? There’s a growing body of research offering practical answers — and future articles in this series will explore them.

    Sources and Further Reading

    Bailey, R. C. & Grenyer, B. F. S. (2013). Burden and support needs of carers of persons with borderline personality disorder: A systematic review. Harvard Review of Psychiatry, 21(5), 248–258.

    Bailey, R. C. & Grenyer, B. F. S. (2014). Supporting a person with personality disorder: A study of carer burden and well-being. Journal of Personality Disorders, 28(6), 796–809.

    Tempia Valenta, S. et al. (2025). Psychoeducation for caregivers of individuals with borderline personality disorder: A randomized controlled trial of multiple family group therapy. Personality and Mental Health.

    Levine, P. A. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.

    Porges, S. W. (2011). The Polyvagal Theory. Norton.

    Payne, P., Levine, P. A. & Crane-Godreau, M. A. (2015). Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology.

    Gerritsen, R. J. S. & Band, G. P. H. (2018). Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Frontiers in Human Neuroscience.

    NEABPD (2025). Managing Suicidality & Trauma Recovery (MSTR): A Course for Parents in Distress.

  • When It’s Not Just BPD: What We Know About Overlapping Conditions

    When It’s Not Just BPD: What We Know About Overlapping Conditions

    Introduction

    If you have borderline personality disorder (BPD), there’s a good chance other conditions are part of the picture too. That’s common: it’s having BPD and nothing else that’s relatively unusual.

    This article summarises what we know (and don’t yet know) about comorbidity in BPD, and why it matters when you’re trying to get the right help.

    How common are comorbidities?

    One large American study suggests that 85% of people with BPD have at least one additional psychiatric diagnosis. Over a lifetime, most people with BPD will experience more than one other condition alongside it.

    Commonly co‑occurring conditions include depression, anxiety disorders, post‑traumatic stress disorder (PTSD), attention‑deficit/hyperactivity disorder (ADHD), eating disorders, substance‑use disorders, and autism.

    These conditions don’t just sit side by side. They can amplify each other, complicate diagnosis, and make treatment harder to access or sustain.

    Why does this happen?

    No one knows for sure, but a few well‑supported explanations are often discussed:

    • Shared vulnerability (including genetics). Some people may inherit a higher baseline sensitivity to emotional dysregulation, impulsivity, anxiety, or mood instability.
    • Trauma and chronic invalidation. Adverse experiences can increase risk for multiple mental health difficulties, including BPD traits.
    • One condition can raise the risk of another. For example, untreated ADHD can lead to repeated failures, conflict, and shame, which may increase vulnerability to later difficulties.

    The diagnostic puzzle

    Mental health services often use categories and labels, to help decide treatment.  And many people want a label to make sense of what they’re experiencing. But symptoms rarely fit neatly into one discrete box.

    For example, difficulties with emotion regulation can be seen in BPD, ADHD, autism, bipolar disorder, trauma‑related conditions, and more.

    In one study, 40% of people with BPD had previously been misdiagnosed with bipolar disorder – which suggests to me that the current labelling system faces huge challenges in correctly identifying what’s actually going on.

    The latest NHS mental health report (APMS 23/24) made a point of highlighting the additional issue of diagnostic overshadowing: when having one diagnosis stops a clinician from investigating whether a behaviour may actually be caused by another condition.  The same report also acknowledged that BPD can overlap with autism and complex PTSD.

    Why the system struggles

    In practice, support is often commissioned and organised around single diagnoses (for example, ADHD, autism, eating disorders, or in some areas personality disorder services). People with complex presentations can fall between services, or face eligibility rules that make it hard to get care that matches what they actually need. For example, personality disorder services often exclude people with active substance misuse.

    NHS talking therapies are also generally time‑limited. Specialist treatments like Dialectical Behaviour Therapy (DBT), where available, vary in length depending on where you live, what is available and what is deemed suitable (from skills groups of 2 or 3 months to full programmes lasting roughly a year).

    Transitions between child and adult services can be another weak point. For example, a young person with ADHD does not automatically transfer into adult ADHD care everywhere; reassessment waits can be long. During that gap, distress can escalate and additional problems can develop.

    What does the research suggest about treatment?

    Treating co‑occurring conditions can improve outcomes. For example, someone whose ADHD symptoms are effectively managed may find it easier to engage in therapy for BPD.

    DBT was developed for chronic suicidality and BPD, but it has also been adapted and studied for related problems such as depression symptoms, eating‑disorder behaviours, and PTSD/trauma‑related presentations.

    While DBT has evidence for treating multiple conditions, this doesn’t mean every DBT therapist is equipped to treat every condition. Finding someone with expertise across a specific combination of conditions can be genuinely difficult, and this gap isn’t always acknowledged.

    What does this mean in practice?

    If you’re seeking help for yourself, or for a loved one, it can help to keep these points in mind:

    • BPD alongside other conditions is common. If things don’t add up, consider whether something is being missed.
    • Choose your battles. Pushing for multiple assessments at once can be exhausting; it’s OK to prioritise.
    • ‘Complex needs’ can feel vague, but it often reflects reality—and it usually means there isn’t a quick fix.
    • If a short course of therapy hasn’t touched the surface, it doesn’t mean you’ve failed. It may mean the offer wasn’t matched to the level of need.

    Conclusion

    You’re not imagining it: ‘something else’ may be going on alongside BPD, and that’s common.

    Complexity is hard—but understanding it can help you advocate for the right treatment for you or your loved one.

    There is a growing understanding that BPD often comes with other conditions – and that treatment needs to reflect this. The frustration is that services haven’t caught up with this new understanding – yet.

  • Bold Beautiful Borderline

    Bold Beautiful Borderline

    PODCAST DETAILS

    Title: Bold Beautiful Borderline

    Host: Sara Abbott

    Platform/Availability: Spotify, Apple Podcasts, and all major podcast platforms

    Episode: Borderline Rage “I will ruin your fucking life”

    Year: re-released 7th December 2025

    Host background: Sara is a Licensed Clinical Social Worker with lived experience of BPD.

    1. WHY I CHOSE TO LISTEN TO THIS

    I decided to see if I could find some podcasts about BPD and this was one of the first to come up in the search. A therapist with lived experience is such a powerful combination and I was keen to tap into her wisdom.  

     I picked this recent re-release episode as a starting point because I find rage extremely challenging – both my own and other people’s. And my daughter experiences a lot of rage.

    2. WHAT IT COVERS

    Sara breaks down in detail a recent argument she had with her husband: what she was feeling and why, and how it was resolved. She then goes back and gives examples from her past of when she experienced rage and dealt with it less well. She reads out responses she had from people with BPD as to what rage feels like to them. She goes into some of the theory behind BPD rage, DBT skills and guidance for people who might be on the receiving end of it.

    3. STRENGTHS

    Sara is highly articulate and speaks passionately and with great clarity about her own experience and as a therapist. I loved the ‘case studies’ from her own life.

    4. LIMITATIONS

    FYI there is the occasional swear word – in case you’re thinking of listening to it in a public space!

    Sara does give some brief advice to people who are on the receiving end of BPD rage, but this isn’t the focus of the episode.

    5. TONE AND SENSITIVITY

    She describes her podcast as raw, honest and sometimes humorous and that’s what I got from this episode. She has great empathy for her listeners who have BPD – their strengths and their struggles.

    6. PERSONAL REFLECTION

    I think I’m going to re-listen to this episode as there was so much for me to digest. Listening to her journey – things she did when she experienced rage when she was younger, to how she handled it in this recent argument with her husband left me with hope. My daughter is working so hard in therapy, but it’s a long, slow haul and sometimes it’s hard to see the progress, so it’s heartening to hear from someone who has stuck with it and is now in such a different place.

    7. WHO IT IS FOR

    I think it’s primarily for people with lived experience of BPD, but as someone supporting a loved one with it I also found it really useful.

    8. STANDOUT QUOTE

    It’s OK to feel anger for longer periods of time, it’s OK for all of those things to live there, it’s just simply what we do with it.

    9. FINAL THOUGHTS

    This podcast is now on my subscribed list!

    LINKS

    🎧Listen to the Podcast
    📷Sara on Instagram

  • The Pecking Order of Distress

    The Pecking Order of Distress

    I keep thinking about a conversation we had earlier, dearest daughter. The one where I told you about the recent NHS survey suggesting that as many as 1 in 10 young women may have Borderline Personality Disorder (BPD).

    I’m not sure how I was expecting you to react – I think I hoped it would make you feel less alone. But your initial reaction was disbelief. You pointed out that you don’t see hordes of young women having episodes out in public — and surely you would, if there were really 10% young women out there with the condition.

    I got defensive

    I’d spent so long looking at the report, trying to understand what it was saying, how the screening for BPD worked, that you refusing to believe it felt like you were saying my article was wrong — even though I was just reporting the results.

    And I got that familiar feeling of frustration that has come from many years of me saying something and you automatically saying the opposite. Like disagreement is your reflex — even when I’m not arguing, just reporting.

    Athough, in this instance, I think you have a point. One in ten young women potentially having BPD does seem impossibly high. But even it’s an overestimate and the real number is closer to one in twelve, or one in fifteen, that’s still a huge number of people.

    Quiet suffering still counts?

    Wanting to defend the statistic, I suggested that maybe some had a different, quieter form. After all, there are many different “flavours” of BPD — not everyone explodes in public.

    You replied with your trademark bluntness: then they don’t really have a problem and shouldn’t count.

    TikTok and self-diagnosis

    You talked about TikTok and how frustrating you find it, seeing people doing posts, self-diagnosing themselves with serious mental health conditions like BPD — the “oh I get anxious and I wanted to kill myself once so I must have BPD” brigade.

    I can see why this would irritate you. The not understanding. The seeming desire to jump on a bandwagon. The undeserving taking a slice of your pie.

    But I also hate pecking orders of distress. The way people like to judge suffering and decide whether it is ‘better’ or ‘worse’ than an imaginary legion of others. It wouldn’t be so bad if these judgements were kept private, but they never are. People feel honour-bound to tell you your suffering isn’t as bad as someone else’s. You get put in your place — usually to shut you up.

    I say this because it’s definitely not just you who judges, I do it — we all do. It has been part of society since forever. Perhaps it’s worse now because of social media. I don’t know. What I do know is that it needs to stop. There has to be another way.

    A spectrum, not a tick box

    I reflected on this new way of thinking about personality disorder — how it is now to be seen as a spectrum, not a tick box. This new framework may be more accurate but I fear it will turn people’s suffering into one long pecking order of distress.

    Given that the NHS has limited resources, how will decisions be made as to whether you qualify for treatment for a personality disorder? How far down the continuum will you need to be? Will there be a magic algorithm that sifts through all the crisis team referrals and the hospitalisations and decides who is deserving? Not saying the system is any better now of course, but if the system is going to change, I’d like it to be for the better.

    TikTok and your diagnosis

    But then you talked about how TikTok was useful in your own journey to diagnosis.

    You were at college and struggling and saw all these videos where people were describing what they felt and did. They called it BPD and you thought they meant bipolar. But when you looked up bipolar specifically, you thought: this isn’t me. So you were confused, and you talked to me about it.

    I said BPD stands for Borderline Personality Disorder, not bipolar. That you having a BPD diagnosis was something I’d discussed with CAMHS a few years before, but they were reluctant to assess you at that age because emotional intensity and instability can look like ‘normal teenage’ stuff. But that maybe it was time to get you properly assessed – you were 19 at the time.

    So I found a psychiatrist privately. Things were so bad I didn’t want to wait months or possibly years to find this out. And hey presto, we’d both been correct. Or rather, the psychiatrist agreed with us. She diagnosed you as having BPD.

    Diluting the experience

    The other thing you said that gave me pause: you refused to believe the 1 in 10 statistic because if it was true, it would give people an excuse to treat it as less serious. Like the volume somehow diluted the severity of experience.

    And maybe what you were really reacting to wasn’t the statistic at all, but the risk that other people would use it against you. That they’d hear “mainstream” and translate it as: Not that bad. Not that urgent. Not worth resources.

    Bandages

    It made me think of the times we used to go to therapy after I adopted you. When we got ready for the journey home, you’d sometimes fake a fall and insist on bandages for an “injured” limb.

    Even when we all knew what you were doing, you still needed it. Because pain that can’t be seen has a habit of being doubted.

    Mental ill-health and trauma can feel brutally lonely for that reason: it’s invisible. And you found a clever way of making the invisible visible.

    You’ve fought so hard to get me — and others — to understand how serious your pain is. So I can see why anything that hints your suffering is now commonplace might feel like it’s pushing you back into being unseen.

    But what if….

    … there are hundreds of thousands of young women like you out there — suffering and not being understood?

    Maybe at the heart of this is a dialectical truth: you can be desperately unwell — and you can be one of many. Both things can be true at the same time.

    If 1 in 10 young women do have BPD, that statistic doesn’t make it trivial. It makes it very, very urgent.

  • A Dive Into The APMS

    A Dive Into The APMS

    The Adult Psychiatric Morbidity Survey (APMS) 2023/4 is a large NHS survey that gives a “snapshot” of adult mental health in England. It follows the same basic approach as the last APMS in 2014, so we can make some comparisons over time.

    The survey results were published at the end of 2025.

    This wasn’t an online poll. Researchers interviewed a random sample of adults in private households, and people answered the most sensitive questions privately on a laptop. Because it’s a household survey, it doesn’t include people living in settings like prisons or inpatient units, and it’s likely to under-represent people who aren’t in stable housing — all groups where mental illness rates are often higher.

    This post focuses on what the survey suggests about Borderline Personality Disorder (BPD).

    Boxes vs Spectrums

    The report notes that personality disorder diagnosis is changing. Older systems tried to put people into categories (like “BPD”), even though many people don’t fit neatly into one box. Newer thinking treats personality disorder more like a spectrum: traits become a “disorder” when they’re so intense or inflexible that they seriously disrupt everyday life and relationships.

    The APMS sits between the two approaches — it reports both category screens for BPD and antisocial personality disorder (ASPD), and a broader screen for general personality disorder traits.

    The report also notes a debate: critics worry a broad “general personality disorder” label could widen the net and increase stigma and pressure on services, while others argue personality disorder has been underdiagnosed and better recognition could improve care.

    What Screened Positive Means

    The APMS did not check people’s NHS records or diagnose them in clinic. It used questionnaires designed to work out if it’s likely someone has a condition like BPD.

    So these figures do not mean a confirmed diagnosis after a full assessment — they mean screened positive on a questionnaire.

    Key BPD Numbers

    • We can compare data regarding numbers who screened positive for BPD with data from 2014
    Bar chart comparing BPD screen-positive rates in adults aged 16–64: 2.4% in 2014 and 2.5% in 2023/4.
    BPD screening hasn’t budged much in a decade (16–64): 2.4% → 2.5%.
    • If you look at all adults 16 years and older, 1.9% screened positive for BPD
    Infographic showing 1.9% of adults aged 16+ screened positive for BPD, equating to around 900,000 adults in England (illustrated with people icons).
    1.9% sounds small — until you realise it’s about 900,000 adults in England.

    Young Women: A Standout Finding

    One of the most striking sets of results is for women aged 16–24. They suggest that young women are experiencing personality disorder and self-harm (a common feature of BPD) at among the highest rates in the survey.

    Infographic listing women aged 16–24: 35.3% screened positive for general personality disorder traits, 9.8% screened positive for BPD, and 31.7% reported lifetime self-harm without suicidal intent.
    Young women (16–24) are the outlier: PD traits, BPD screening, and self-harm all spike.

    The BPD statistic alone is cause for concern.

    Infographic stating that 9.8% of women aged 16–24 screened positive for BPD (approximately 1 in 10).
    About 1 in 10 young women (16–24) screen positive for BPD.

    The report also notes that some critics see “personality disorder” labels as a way of medicalising understandable responses to trauma, inequality, and social pressure.

    Are we diagnosing a biological disorder — or measuring the weight of modern society on young women?

    A Big Caution: Overlap And “Diagnostic Overshadowing”

    The report points out that BPD and general PD criteria can overlap with autism and complex PTSD, which can contribute to “diagnostic overshadowing” (thinking a symptom is linked to one condition when it’s really caused by a different one).

    However, the report doesn’t publish a breakdown of any overlap between people who screened positive for BPD and autism or complex PTSD. Presumably because only 99 people in the survey screened positive for BPD, which limits how much detail you can reliably analyse.

    For me, this is a key area of concern. How can the right treatment be given, if we don’t fully understand what is causing the behaviour?

    The Soup Of Distress (What Tends To Cluster With PD Traits)

    What the report does show clearly is that people screening positive for general personality disorder traits are more likely to be facing wider pressures — including unemployment and financial hardship, and higher rates of depression/anxiety and limiting physical health conditions.

    The Treatment Gap: Pills vs Therapy

    The report suggests a mismatch between recommended care and what people report receiving.

    Horizontal bar chart for people screening positive for BPD: 47.8% reported no treatment, 43.8% reported medication, and 21.6% reported psychological therapy; note that treatments can overlap
    Nearly half get no treatment — and meds beat therapy by about 2 to 1.

    The report concludes this points to a need to improve treatment and service provision (while also noting the small BPD sample size means we should be careful about over-interpreting).

    One Hopeful Note – And One Hard Reality

    A hopeful note is that the much lower screen-positive rates in older age groups challenge the idea that BPD symptoms must be lifelong for everyone (though the APMS can’t track individuals over time).

    Chart showing BPD screen-positive rates are highest in younger age groups and lower in older age groups.
    BPD screening peaks in young adulthood — then drops with age.

    But the report also notes that this isn’t a trivial condition. It cites earlier UK research in people treated by specialist NHS mental health services (beyond GP care) where life expectancy was estimated around 18 years shorter than the general population, and notes many were likely to have had a BPD diagnosis.

    Conclusions

    My conclusion is that it’s great to have this big-picture overview of mental health in England — but the survey now raises questions that need much more granular research.

    For example, my daughter has first-hand experience of diagnostic overshadowing: there are services for other conditions that won’t engage with her because she has a BPD diagnosis. That has been a major barrier to her getting better. The authors of this report suggest she isn’t the only one — but where is the data to confirm this pattern, measure its impact, and show what improves outcomes? Without clear evidence, it’s harder to push services to change.

    The figure of around 1 in 10 young women screening positive for BPD is a wake-up call. Even allowing for the limits of screening tools, this is too common to ignore. It should trigger urgent research into what’s happening for young women — and why.

    And the treatment picture won’t surprise anyone who has tried to access therapy for themselves or a loved one with BPD. It’s also not surprising that medication is used so often, even though there isn’t a drug that specifically treats BPD. When waiting lists are long and therapy is hard to access, people in crisis understandably want something — anything — that might ease their pain.

    Now that this report is out, the question is: will we treat these findings as a headline, or as a prompt for real change — better data, better access to psychological help, and fewer people falling through the cracks?

  • Me and the Voice in my Head

    Me and the Voice in my Head

    Title: Me and the Voice in My Head
    Channel: Channel 4 (available via Channel 4 Player)
    Year: 2024
    Production Company: Hungry Bear Media
    Format: Documentary

    1. Why I Chose to Watch This

    It seems that, at present, the only way to get a documentary about mental health commissioned by a TV channel is to attach a celebrity to it. I find this frustrating — the whole celebrity thing makes me less inclined to watch something, not more.

    This documentary is another in that ilk, however the good news is comedian and actor, Joe Tracini is absolutely brilliant and has something genuinely important to say about Borderline Personality Disorder.

    2. What It Sets Out to Do

    Joe is brutally honest about his experience of life and the way he thinks about himself and others, helping to illuminate what it actually means to live with BPD.

    This could easily have been a very dark and overwhelming watch, but Joe has a gift for comedy and highlighting the absurd. There are laughs and lighter moments even when he’s tackling incredibly tough topics, including suicidal thoughts.

    3. Summary of Content

    The documentary follows Joe over ten weeks as he tries to get his career back on track by preparing and performing a stand-up routine about his mental health. Alongside this, he speaks to a therapist to learn more about BPD, introduces us to his girlfriend and parents, and explores his childhood in search of clues as to why adulthood has been such a mental-health struggle for him.

    4. Strengths

    The standout moments for me were the scripted sections in which a man behind the camera interviews both Joe and his alter ego, Mick — the name he gives the voice in his head that says cruel things — together on a couch. It was interesting to hear Mick say so many of the things my daughter has said over the years. I thought that voice was unique to my daughter, but it seems not. And Joe’s performance, conveying the brutality of what it says with humour, is an incredible feat.

    5. Limitations

    Joe does visit a clinical psychologist who specialises in BPD to learn more about the condition, but overall the documentary focuses on his personal experience rather than exploring current research or the full range of available therapies.

    6. Tone and Sensitivity

    The tone of the programme is unlike most portrayals of mental health on television. It is frank, dark, irreverent, and surprisingly funny.

    7. Personal Reflection

    As the parent of a young adult with BPD, I found myself reflecting on my daughter’s childhood while watching Joe reflect on his own – painful to do, but it gave me new insights.

    My daughter is the bravest person I know, and seeing Joe stand up to Mick showed just how brave people with BPD are. Choosing to keep going when you have a voice like Mick’s in your head is an act of great courage.

    8. Who It’s For

    The documentary is designed for a general audience, but will be especially meaningful to people with lived experience and their loved ones.

    9. Standout Moment or Quote

    “The more I talk about how f*d up I am, the less f*d up I feel — which is mental.”

    10. Final Thoughts

    I’m delighted that Me and the Voice in My Head won Best Documentary at the Grierson British Documentary Awards 2024. Joe and the team at Hungry Bear Media deserve recognition for creating such a brave, unique, and enlightening look at BPD.

    You can find Joe on social media

    📸 Joe on Instagram
    𝕏 Joe on X