What the Amber Lee Hughes case reveals about borderline personality disorder and its impact on behaviour

South Africans have been gripped by the shocking case of Amber Lee Hughes, a former preschool teacher accused of the rape and murder of four-year-old Nada-Jane Challita in 2023.

During court proceedings, Hughes admitted to drowning her ex-boyfriend’s daughter but claimed that she had been suffering from borderline personality disorder (BPD) at the time of the crime.

The case has sparked widespread debate. Can a mental health disorder like BPD drive someone to commit such a violent act? Or does invoking a diagnosis risk stigmatising thousands of people who live with BPD without ever harming others?

To unpack this, we need to understand what BPD really is and what it isn’t.

What is borderline personality disorder?

"Independent Media Lifestyle" reached out to Dr Happy Setsiba, a clinical psychologist at Mediclinic Medforum, who said BPD is a complex mental health condition marked by extreme emotional sensitivity, unstable relationships, impulsive behaviour, and difficulty regulating emotions.

Along with strong emotions, people with BPD can also experience intense anger, known as borderline rage. According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), people with BPD may experience:

• Intense fear of abandonment.
• Unstable or rapidly shifting relationships (idealising someone one moment, devaluing them the next).
• Inability to self-soothe
• Impulsive, risky, or self-destructive behaviours.
• Episodes of rage, deep sadness, or anxiety that feel overwhelming and hard to control.
• Chronic feelings of emptiness.
• Self-harming behaviours or suicidal thoughts.

Psychotherapist Dr Courtney Tracy, known as the “Truth Doctor”, explains BPD as “thinking and feeling faster and deeper than most people in an environment that wasn’t able to meet you where you were.”

She notes that many people with BPD were raised in emotionally invalidating or unstable environments, which can leave them without the skills to regulate overwhelming emotions.

How does BPD affect the brain?

Research from the National Institute of Mental Health shows that people with BPD often have differences in the prefrontal cortex (responsible for decision-making and impulse control) and the amygdala (which processes fear and threat).

This means emotions rise faster, hit harder, and take longer to calm down.

While an average person might feel irritated after a stressful moment and calm down quickly, someone with BPD can spiral into rage, panic, or despair and act impulsively to escape those emotions.

Can BPD trigger violent behaviour?

This is where nuance matters. While studies published in the "Journal of Personality Disorders" report that people with BPD are far more likely to hurt themselves than others, the link between BPD and violence toward others is not straightforward.

Around 70% of people with BPD attempt self-harm, and 10% die by suicide, making it one of the most dangerous mental health conditions for self-directed harm. Most individuals with BPD do not act violently towards others.

According to a "Verywell Mind" article, BPD is one of the most common diagnoses made in prison inmates, especially in those who have experienced domestic violence. It is usually in the form of reactive aggression that occurs when they feel provoked, rejected, or threatened.

Setsiba explained that untreated BPD can increase the risk of violent or self-destructive behaviour. "Most people with BPD often show patterns of self-harm, such as cutting, suicidal actions like overdosing, and risky behaviours like binge drinking," said Setsiba. 

In simple terms, people with BPD are often highly sensitive individuals who grew up in environments that couldn’t meet their emotional needs. Over time, their brains develop patterns of instability, fear of rejection and impulsivity.

However, in rare cases, especially when combined with stress, trauma triggers, or co-occurring conditions such as substance abuse, impulsivity, and intense anger, they can result in dangerous behaviour.

Psychiatrist Dr Lisa Firestone, writing in "Psychology Today", notes that individuals with untreated BPD may sometimes lash out when they feel abandoned or betrayed. “Their emotional brain goes into survival mode, making rational thinking nearly impossible in those moments,” she explains.

This doesn’t excuse violent actions, but it does shed light on how distorted emotional processing can escalate into tragedy.

Cases like Amber Lee Hughes are the exception, not the rule, but when they occur, they highlight how untreated or poorly managed BPD can fuel impulsive, destructive behaviour.

AsTracy says, “It’s not about being ‘too much’. It’s about having felt alone with too much for too long.”

In South Africa, mental health remains underfunded and stigmatised. According to the South African Depression and Anxiety Group (SADAG), less than 10% of people living with a mental health condition receive treatment.

This lack of care can worsen conditions like BPD, leaving individuals and families struggling without support.

How can BPD be treated?

Despite the stigma, people living with BPD can and do go on to live fulfilling lives with the right treatment.

Dialectical Behaviour Therapy (DBT), developed by Dr Marsha Linehan, is one of the most effective treatments. DBT teaches people how to regulate emotions, tolerate distress, and improve relationships

Medication can help with other issues like depression or anxiety, but therapy is most important. Support from family and friends also matters a lot, since people with BPD often feel alone or misunderstood.

The death of little Nada-Jane Challita is devastating, and no explanation can ever undo the harm.

Experts are clear: a diagnosis is never an excuse for crime, but it can be a context for understanding behaviour.

• If you or someone you know needs help, reach out to the South African Suicide Crisis Helpline at 0800 567 567 or contact SADAG at 0800 456 789.