Tag: health

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.
March 7, 2026
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.
February 2, 2026
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
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
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.

Young women (16–24) are the outlier: PD traits, BPD screening, and self-harm all spike.

The BPD statistic alone is cause for concern.

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.

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).

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?
January 4, 2026
Review of the Aeri Breathing App
1. App Details
Name: Aeri
Type: Breathing / nervous-system regulation app
Platform: iOS / Android
Cost: Free and advert-free

2. What the App Is Designed to Do
This app provides five different breathing routines designed to support sleep and calm the nervous system.

3. Why I Tried It
I’m always on the lookout for tools that might help me calm down and unwind after work, and to help regulate myself after my daughter has had an episode—a time when I often get palpitations, headaches, and generally feel pretty dreadful.

4. My Experience Using the App
I found the app easy to understand and straightforward to use.

The five breathing routines are:
- LVL UP breathing – to increase your resilience
- Resonance breathing – to calm your mind
- Breathing to reset – to centre yourself
- Calm breathing – to relieve tension
- Breathing for sleep – to drift into sleep more easily
Once you press start on any routine, a line appears on the screen. It travels upwards as you breathe in, goes flat when you hold your breath, and moves downwards when it’s time to breathe out.

This visual is paired with sound cues: a rising tone as you inhale, a soft blip when you hold, and a descending tone as you exhale. You can also enable phone vibration for additional guidance.

A timer is displayed so you can see how long is left in the routine.

5. What I Found Helpful
The routines last around 10–12 minutes, which is long enough for me to feel a noticeable physical shift. If they were any longer, I think I’d be put off doing them.

My favourite routine is the Calm Breathing session. It’s incredibly simple, and every time I use it I wonder why on earth I need an app for something so basic. But the truth is that it’s much easier to keep to a steady rhythm when something is guiding you.

6. Limitations or Things to Consider
It’s not a magic wand that will make all your problems disappear—if only!

If I’ve felt particularly trapped or started dissociating when my daughter is episoding, I often need to move my body first— go for a walk, or perhaps do a bit of yoga — something to discharge some of the stored up stress, before I can settle into a breathing exercise.

7. Who I’d Recommend It For
I’d recommend it to anyone who wants to see whether a short, structured breathing routine might help them calm down or improve their sleep.

8. Final Thoughts
I like this app because I find it effective, it’s easy to use, and it is completely free and advert-free (at the time of publishing). However, there are plenty of other breathing apps out there to explore, if this particular one doesn’t work for you.

Download the app:

▶️ Get Aeri on Google Play

🍎 Get Aeri on the Apple Store
November 16, 2025