It can be very challenging to cope with the symptoms of borderline personality disorder (BPD), both for the person with the diagnosis and the people around them. Understanding the condition and the triggers for emotional responses, especially anger or rage, can help you to manage the condition and the impact it has on your life.

What is BPD?

Borderline Personality Disorder is a mental health condition that causes emotional instability, difficulties maintaining relationships with friends and partners, a fear of abandonment or rejection, low self-esteem, thoughts of self-harm and suicide, and reckless or impulsivebehaviors [1].

BPD is diagnosed more in females than males, and typically formed in adolescence [2], although it can affect any gender or age. The exact cause of the development of BPD is not known, but it is often attributed to childhood experiences of neglect, abandonment, abuse, or trauma. It may also be more likely in those with a close family member with the diagnosis [3].

There is no cure or exact treatment for BPD, but it can be managed with a combination of medication, therapy, support, and understanding of the condition, triggers, and symptoms. With proper intervention, many people with a BPD diagnosis are able to experience a good quality of life, with positive relationships and success in their personal and professional lives [3][4].

What is BPD rage?

Intense or uncontrollable anger is one of the 9 criteria outlined in the American Psychiatric Association’s The Diagnostic and Statistical Manual of Mental Disorders (DSM V) (2013, text revision 2022) [1], for the diagnosis of Borderline Personality Disorder.

It is a commonly seen symptom in those with the diagnosis and can have huge impacts on interpersonal and professional relationships [5][6]. It can be confusing or shocking to others, particularly those who have little understanding of the condition, and may seem disproportionate or unwarranted in certain situations.

Typically, people with BPD have trouble controlling their emotions or responses to certain situations, which can lead to extreme feelings of sadness and anger, due to an inability to regulate emotions or emotional responses to situations [7].

This anger can be very upsetting for the person with the diagnosis and the people around them. It often appears suddenly, as an explosive bout of rage. It may last just a few seconds, or go on for some time, and can be very difficult to control or stop [1][8].

If you experience BPD rage, the best way to manage these situations is to gain a better understanding of your triggers and learn positive coping strategies, so that you can prevent these episodes from occurring, or stop them when you notice your anger rising.

What triggers BPD rage?

People with BPD have often experienced some sort of trauma in their childhood, so the ways in which rage episodes are triggered are often related to their previous experiences, typically involving relationships or feelings of self-worth [2][6].

Break up or argument within a romantic relationship

A common symptom of BPD is an intense fear of abandonment or rejection. If a person with BPD experiences an argument within their relationship, or the relationship is ended by their partner, this then creates or reinforces this fear. Often, this will result in feelings of low self-worth, believing that they are unlovable, or a failure, and they will have an extreme emotional response.

The reason for this extreme rage response may be due to feelings of frustration, either with themselves or their partner, as a response to emotional pain, or as a way of attempting to regain lost control [7].

This type of emotional response is often the reason that people with BPD struggle to maintain romantic relationships, thereby further reinforcing their fear of rejection and feelings of low self-worth, causing a seemingly unbreakable cycle of unhealthy and short-lived relationships.

Feeling ignored or left out

If a person with BPD feels that their friend has ignored them, for example, they don’t receive a response to a call or message, or are not invited to a social event, this can also cause a similar response. Again, this is due to feeling rejected, regardless of whether this is actually the case.

In these situations, people with BPD often struggle to consider alternative reasons for their perceived rejection, typically believing the worst about themselves and the situation [6]. This can then cause them to lash out, becoming angry with their friend, which may then put further strain on their friendship.

Reacting to a negative event

A rage episode could be triggered by a negative event, something that may be manageable to someone without BPD, but may feel disastrous or intolerable to someone with the condition.

For example, making a mistake at school or work, losing a game, or misplacing something, all may reinforce feelings of low self-worth, feeling like a failure, or a fear of being punished or reprimanded, resulting in extreme feelings of anger.

Non-specific or personal triggers

Unfortunately, there is no set list of specific triggers for a BPD episode, and they can sometimes be a sudden or unexpected response, occasionally to something that seems trivial or unimportant to someone else.

BPD rage episodes can occur for a variety of reasons and individuals may have entirely different responses to certain situations. Often these episodes are unpredictable and can be the result of an internal emotional response, which may be related to past trauma or experiences, potentially triggered by a seemingly unrelated occurrence.

Learning and understanding your own triggers can be the best way of preventing and managing these episodes.

How to deal with BPD rage

Therapy

There are many useful types of therapy that can help with managing BPD rage.

Dialectical Behavioral Therapy (DBT) [9], developed by Dr Marsha Linehan, has been found to be a helpful tool for understanding and communicating about BPD and personal triggers, while learning positive coping strategies to manage the condition [3][10].

Similarly, Cognitive Behavioral Therapy (on which DBT is based), is also a useful therapy to aid in the development of positive coping strategies and responses to emotional difficulties [3].

There are various other types of therapy available, including individual psychotherapy. Other options include family therapy, which can help loved ones develop a better understanding, to receive and provide support; and group therapy, which can help provide a support system and reduce feelings of aloneness [11].

Therapy can help you to identify your own triggers and to develop an understanding of why these triggers exist. This can be hugely important in managing your symptoms, as you may be able to avoid certain situations, notice anger building up, prevent an episode from occurring, or recognize when to utilize your coping strategies [10].

Medication

A doctor may prescribe medication to help manage the symptoms of BPD, such as antidepressants, anti-anxiety medications, or antipsychotics. It is important to take your medication exactly as prescribed by your doctor, as missing doses, taking extra, or suddenly stopping or starting a medication can negatively impact your physical and mental health.

Communication

As interpersonal relationships are often greatly affected by BPD rage episodes, it can be very useful to develop open and positive communication with your loved ones around these events [3].

This communication could help loved ones understand your triggers, know what might be helpful or unhelpful to say or do during an episode, and help them to feel less attacked if the rage is directed at them [11].

An example of this is developing a plan to allow either you or they to leave a situation that feels triggering or aggressive, without worsening feelings of abandonment and rejection, and without forcing either party to remain in a situation that feels upsetting. After the episode of rage passes, there should be the potential to revisit the conversation later.

Calming activities

You might find it useful to develop a plan for when you feel triggered. This could involve moving to a ‘safe space’, putting on music, drawing or coloring, meditating or practicing breathing exercises, reading a book, or utilizing specific DBT techniques you have learnt. These actions could help you to defuse your anger and prevent an episode before it becomes unmanageable.

Exercise

Some people find exercise to be a good release of emotion, or a time to reflect on a situation. For example, team sports, going to the gym, yoga, running, or walking, may all be positive outlets for emotional distress or ways to calm the mind. Engaging in regular exercise can also be a positive way to improve physical and mental health in general, thereby reducing emotional difficulties.

Avoiding unhealthy coping strategies

It is very common for people with BPD to engage in harmful coping strategies, such as drinking alcohol, taking drugs, smoking, and self-harm [2][3]. While these activities may blunt or mask emotions in the moment, they are ultimately very harmful to your mental and physical health, and will only reinforce and worsen emotional responses.

If you need help reducing or managing substance use or self-harming behaviors, speak to your doctor or a mental health professional, who can advise you on suitable techniques and organizations to assist you in this.

Resources:

  1. American Psychiatric Association. (March 2022). Personality Disorders. In The Diagnostic and Statistical Manual of Mental Disorders(5thed., text rev.). APA. Retrieved from https://doi.org/10.1176/appi.books.9780890425787.x18_Personality_Disorders
  2. Biskin, R.S., & Paris, J. (2012). Diagnosing Borderline Personality Disorder. CMAJ: Canadian Medical Association Journal, 184(16), 1789-1794. Retrieved from https://doi.org/10.1503/cmaj.090618
  3. National Institute of Mental Health (NIMH). (Reviewed 2022). Borderline Personality Disorder. NIMH. Retrieved from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
  4. Optimum Performance Institute (OPI). (n.d). Coping with Borderline Personality Disorder.OPI. Retrieved from https://www.optimumperformanceinstitute.com/bpd-treatment/coping-with-borderline-personality-disorder/
  5. Russell, J.J., Moskowitz, D.S., Zuroff, D.C., Sookman, D., & Paris, J. (2007). Stability and Variability of Affective Experience and Interpersonal Behavior in Borderline Personality Disorder. Journal of Abnormal Psychology, 116(3), 578–588. Retrieved from https://doi.org/10.1037/0021-843X.116.3.578
  6. Berenson, K.R., Downey, G., Rafaeli, E., Coifman, K.G., & Paquin, N.L. (2011). The Rejection-Rage Contingency in Borderline Personality Disorder. Journal of Abnormal Psychology, 120(3), 681-690. Retrieved from https://doi.org/10.1037/a0023335
  7. Neukel, C., Bullenkamp, R., Moessner, M., Spiess, K., Schmahl, C., Bertsch, K., & Herpertz, S.C. (2022). Anger Instability and Aggression in Borderline Personality Disorder - An Ecological Momentary Assessment Study. Borderline Personality Disorder and Emotional Dysregulation, 9(29). Retrieved from https://doi.org/10.1186/s40479-022-00199-5
  8. Stiglmayr, C.E., Grathwol, T., Linehan, M.M., Ihorst, G., Fahrenberg, J., & Bohus, M. (2005). Aversive Tension in Patients with Borderline Personality Disorder: A Computer-Based Controlled Field Study. Acta Psychiatrica Scandinavica, 111(5), 372-379. Retrieved from https://doi.org/10.1111/j.1600-0447.2004.00466.x
  9. Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
  10. May, J.M., Richardi, T.M., & Barth, K.S. (2016). Dialectical Behavior Therapy as Treatment for Borderline Personality Disorder. The Mental Health Clinician, 6(2), 62-67. Retrieved from https://doi.org/10.9740/mhc.2016.03.62