Borderline Personality Disorder (BPD), also referred to as Emotionally Unstable Personality Disorder (EUPD), is a diagnosis given to some people who experience the complex difficulties described above. No two people with BPD have exactly the same symptoms, which is one reason we’re undertaking this research. Tragically, around 10% of people diagnosed with BPD die by suicide, making it a life-threatening condition.

Some individuals never receive a diagnosis, while others do but find it doesn’t lead to effective treatment. For many, the diagnosis can be stigmatizing and detrimental to their health and well-being. BPD is most common among people who have experienced trauma, particularly early in life, which can impact brain development and stress responses. Some suggest that "complex post-traumatic stress disorder" (CPTSD) might be a more helpful diagnosis, as it highlights the role of trauma.

Despite advances, we still know too little about how to help people with BPD. While psychological treatments are available, they can be hard to access. Additionally, despite the fact that over 90% of people with BPD are prescribed psychiatric medications, there is no clear scientific evidence that these medications are effective.

BPD is often a stigmatised diagnosis, leading to prejudice and differential treatment. People with BPD are sometimes blamed for their difficulties and denied access to specialist services.

There is debate about whether the BPD diagnosis causes more harm than good. Symptoms associated with BPD often overlap with other conditions like depression, early psychosis, and eating disorders, raising questions about whether the diagnosis should remain. We will work closely with people who have lived experience to use language and terms that feel comfortable and respectful. We also recognize that for some, the BPD diagnosis provides clarity and helps them access support.

The Hub includes a wide range of experts from different fields, including team members who work from a lived experience perspective. This includes people who have been diagnosed with BPD and who understand complex emotions from a personal as well as an academic or practitioner perspective.

We will conduct much-needed research into the problems associated with complex emotions and what is currently known as BPD. Over 5 years, we will carry out research that explores these issues from different angles and which uses new research methods. We aim to understand the experiences and what drives them within the context of people’s lives, before developing and testing solutions that will be helpful. We want to find better ways to make sense of people’s experiences in order to provide better care and help. 

We will collect different types of data so that we can be sure we are understanding and addressing the difficulties people face holistically and compassionately.

We’re a team with different forms of expertise, including people who have lived experience of complex emotions and some who have received a BPD diagnosis. These colleagues will lead aspects of the work, and we will recruit a diverse Lived Experience Advisory Panel (LEAP). The LEAP will provide oversight and accountability across the lifetime of the Hub, and will meet around 4 times per year. 

We value our experts by experience. LEAP members will be paid for their time and we will provide opportunities for skill development and creative contributions. Our goal is for this to be rewarding and fulfilling for everyone involved.

The hub will be carried out in distinct stages which we call ‘work packages’ (WPs). 

Bringing together existing research

We will start by reviewing existing BPD and related research to show differences and similarities in people’s experience of BPD, and how different symptoms relate to and affect each other. We will also look for different theories about complex emotions and BPD to test later.

In-depth understanding of experience

We will explore people’s experiences of their complex emotions to understand how emotions vary and what triggers them. This will involve interviewing people to understand their lives and situations, and how these influence their experiences of complex emotions. We will look at how patterns of complex emotions might differ between individuals, for example among those who are neurodivergent, and also how the social environment and challenges in their lives influence their experiences.

We will also undertake studies in which people record their feelings, emotions and experiences using smart tech (such as a phone app or smart watch) on a a regular basis. This will enable us to see how real-world triggers and events impact on people’s symptoms in real time. We will work with our lived experience partners to find the best ways to do this, and to see whether adding objectively measured information from devices like smart-watches or other consumer wearable devices can be useful.

Understanding how settings and cultures influence care 

We will study people’s experiences of care for complex emotions. We will focus on the relationships between clinicians and service users and how these impact people’s recovery. We will also focus on how individual characteristics, such as someone’s race or gender identity, impact on the care they receive, as we know that people from marginalised communities often don’t receive the standard of care that they should.

Developing new treatments

We will use what we have learned to develop new ways of helping people who experience complex emotions specifically linked to BPD. These new approaches to treatment and care will be developed collaboratively with experts by experience. We will adopt a very open approach to things which might help and ways to provide these, and we will test the feasibility and acceptability of the most promising interventions. 

Co-designing better support for professionals

We will use our findings to produce training and to guide support for health professionals to help them provide good care for people with complex emotions and BPD. We will combine examples of good practice from around the country with recommendations from this research to promote a change in thinking and practice for professionals working with people with complex emotions and BPD. This will be done in partnership with people with experts by experience.

This research is crucial for several reasons:

• Addressing Unmet Needs: Current approaches to understanding and treating complex emotional difficulties, including Borderline Personality Disorder (BPD), are limited. Many individuals struggle to find effective care, and the treatments that do exist can be hard to access. Our research aims to close this gap by developing better interventions that are rooted in the real experiences of those affected.

• Challenging Stigma and Misunderstanding: People with BPD often face stigma, prejudice, and a lack of understanding, even within healthcare settings. This can prevent them from receiving the support they need. Our work will not only advance scientific knowledge but also challenge harmful stereotypes, ultimately contributing to a more compassionate and informed approach to care.

• Preventing Harm and Improving Lives: BPD is a serious condition, with a significant risk of suicide. By improving our understanding of complex emotions and developing better treatments, we hope to reduce this risk and help people live fuller, more meaningful lives. Our research could lead to more effective care strategies that reduce suffering and improve mental health outcomes.

• Informing Policy and Practice: The insights gained from this research will provide an evidence base that can inform mental health policies and clinical practices, ensuring that care is more responsive to the needs of those with complex emotional difficulties. By working collaboratively with people who have lived experience, we aim to create solutions that are both practical and impactful.