Borderline Personality Disorder
Borderline personality disorder is a mental health condition that affects how you feel about yourself and others, making relationships and everyday life challenging. But with effective treatment, many people with this condition learn to live stabler, more fulfilling lives.
Table of contents
- What is Borderline Personality Disorder?
- Common Signs and Symptoms
- What Causes Borderline Personality Disorder?
- Related Mental Health Conditions
- How is BPD Diagnosed?
- Treatment Options
- Living with BPD
What is Borderline Personality Disorder?
Borderline personality disorder, or BPD, is a mental health condition that affects your ability to manage your emotions[1]. It influences how people feel about themselves and others, making it hard to function in everyday life[1]. The condition affects an estimated 1 out of every 100 people in the United States, or about 1.4% of American adults[4][3].
People with BPD often experience periods of feeling intense and often uncontrollable emotions after a triggering event[4]. This emotional instability can affect the way you see yourself and cause you to act impulsively, which can disrupt relationships in your life[4]. Some people with this condition have described BPD as the feeling of having an exposed nerve ending, essentially leaving someone to be easily triggered by small things[3].
Borderline personality disorder is one of a group of conditions called “Cluster B” personality disorders. These are long-term conditions that cause unstable moods and emotions, impulsive behaviors, and social dysfunction[4]. The condition is most commonly recognized among personality disorders and usually begins by early adulthood[1][7].
Common Signs and Symptoms
Borderline personality disorder affects how you feel about yourself, relate to others, and behave[1]. The symptoms can range from manageable to very severe, and each person’s experience with BPD is different[4]. Not everyone with borderline personality disorder experiences all symptoms, and the severity, frequency, and duration are unique to each person[4].
The symptoms of BPD can be grouped into four main areas: emotional instability, disturbed patterns of thinking or perception, impulsive behavior, and intense but unstable relationships with others[7].
Fear of abandonment is one of the most prominent symptoms. You might feel very strong emotions when you’re alone, which might lead you to track down loved ones or push people away to avoid rejection[4]. Even though people with BPD want to have loving and lasting relationships, the fear of being abandoned often leads to mood swings and anger[1].
People with BPD often experience unstable relationships. Healthy relationships may be difficult to manage because you may quickly change your view of someone from love to hate unpredictably[4]. This includes believing someone is perfect one moment and then suddenly believing the person doesn’t care enough[1].
Identity disturbances are common in BPD. You may have a negative view of yourself in your mind and struggle with your sense of self[4]. This emotional instability impacts a person’s self-image, likes and dislikes, and goals, often making them confused about their sense of self[3]. You might suddenly change the way others see you by choosing a new friend group, hobby, or opinion[4].
Impulsive behaviors are a key feature of BPD. You may act without thinking about the consequences, like driving well over the speed limit, overspending, or overconsuming addictive substances[4]. This impulsiveness often leads to self-injury that may push others away[1].
Suicidal ideation and self-harm are serious symptoms of BPD. You may openly talk about or threaten suicidal behavior to others or perform self-harm behaviors[4]. Many people with the condition self-harm and attempt suicide[7].
Mood changes are frequent in BPD. You might feel intense emotions like uncontrollable anger, fear, anxiety, hatred, sadness, and love[4]. These moods change often and quickly, usually lasting only a few hours and rarely more than a few days[4].
Many people with BPD consistently feel sad, bored, or unfulfilled—a persistent feeling of emptiness[4]. Feelings of worthlessness and self-loathing are common too[4].
Intense anger is another symptom. You may have a lot of trouble controlling your temper, which could lead to physical fights or frequent outbursts[4]. You may feel shame or guilt after these episodes[4].
Extreme stress may cause stress-related dissociation, including disconnected thoughts, an out-of-body feeling, and hallucinations[4]. Many people with BPD experience dissociation and paranoia when most distressed[3].
What Causes Borderline Personality Disorder?
The causes of BPD are unclear and appear to result from a combination of genetic and environmental factors[7]. Due to the wide variety of suspected risk factors, it’s hard to determine who will develop it[3].
Environmental factors play a significant role. Adverse childhood experiences may contribute to the development of borderline personality disorder[4]. Early childhood adversity, such as child abuse or neglect, may be a cause[3]. Common negative experiences include neglect, physical and/or sexual abuse, and removal, separation, or loss of a caregiver, parent, or loved one[4]. People with BPD come from many different backgrounds, but most will have experienced some kind of trauma or neglect as children[7].
Genetics also appears to be a factor. Research suggests that it may be an inherited genetic condition or linked with other mental disorders among family members[3].
Brain abnormalities are thought to be contributing causes of the disorder. When certain brain chemicals responsible for mood regulation don’t function properly, there are changes in some areas of the brain[3]. This has been linked to aggression, difficulty regulating destructive urges, and depression[3].
Related Mental Health Conditions
Many people diagnosed with borderline personality disorder experience other conditions at the same time[3]. Effective treatment involves addressing these related disorders[3].
Common conditions that occur alongside BPD include:
- Depression[3]
- Anxiety disorders[3]
- Eating disorders[3]
- Post-traumatic stress disorder (PTSD)[3]
- Bipolar disorder[3]
- Substance use disorder[3]
Additional mental health conditions and behavioral problems include misusing alcohol, generalized anxiety disorder, misusing drugs, and another personality disorder, such as antisocial personality disorder[7].
How is BPD Diagnosed?
Personality disorders, including borderline personality disorder, are diagnosed based on a detailed interview with your doctor or a mental health professional, a mental health evaluation that may include completing a series of questions, your medical history and exam, and discussion of your symptoms[8].
If you’re experiencing symptoms of BPD, make an appointment with a doctor. They may ask about how you feel, your recent behavior, and what sort of impact your symptoms have had on your quality of life[7]. This is to rule out other more common mental health conditions, such as depression, and to make sure there’s no immediate risk to your health and wellbeing[7].
A diagnosis of borderline personality disorder usually is made in adults—not in children or teenagers[8]. That’s because what may appear to be symptoms of borderline personality disorder in children or teenagers may go away as they get older and mature[8]. The symptoms begin to manifest during the early teenage years and gradually improve during adult life[3].
To be officially diagnosed, a person has to exhibit five or more related symptoms that are ongoing and impact various aspects of life[3].
Treatment Options
Borderline personality disorder is mainly treated using psychotherapy, which is also known as talk therapy[8][4]. Medicine may be added as well[8]. Treatment can help you learn skills to manage and cope with your condition, and you should be treated for any other mental health conditions that often occur along with borderline personality disorder[8].
Many people with borderline personality disorder can benefit from psychological or medical treatment. Treatment may involve a range of individual and group psychological therapies carried out by trained professionals working with a community mental health team[7]. Effective treatment may last more than a year[7]. Over time, many people with BPD overcome their symptoms and recover, and additional treatment is recommended for people whose symptoms return[7].
With treatment, you can feel better about yourself and have a stabler, more fulfilling life[8]. Many people with this condition get better with treatment and can learn to live stabler, more-fulfilling lives[1].
Talk Therapy
Talk therapy is a basic treatment approach for borderline personality disorder. Your mental health professional may adjust the type of therapy to best meet your needs[8]. Talk therapy seeks to help you focus on your ability to function, learn to manage emotions that feel uncomfortable, reduce your impulsiveness by helping you note feelings rather than act on them, work on making relationships better by being aware of your feelings and those of others, and learn about borderline personality disorder[8].
Treatment for BPD should only be delivered by a trained professional, who will usually be a psychiatrist, psychologist, or other trained mental health professional[10]. Management of borderline personality disorder mainly focuses on making sense of difficult emotional moments[8].
Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy (DBT) is a type of therapy specifically designed to treat people with BPD[10]. It is a structured outpatient treatment based on cognitive-behavioral principles developed for the treatment of borderline personality disorder[11]. DBT is currently the only empirically supported treatment for BPD, with randomized controlled trials showing its efficacy[11].
DBT is based on the idea that two important factors contribute towards BPD: you are particularly emotionally vulnerable, and you grew up in an environment where your emotions were dismissed by those around you[10]. These two factors may cause you to fall into a negative cycle where you experience intense and upsetting emotions, yet feel guilty and worthless for having these emotions[10].
The goal of DBT is to break this cycle by introducing two important concepts: validation (accepting your emotions are valid, real, and acceptable) and dialectics (a school of philosophy that says most things in life are rarely “black or white” and that it’s important to be open to ideas and opinions that contradict your own)[10].
Traditional DBT is structured into four components: skills training group, individual psychotherapy, telephone consultation, and therapist consultation team[11]. These components work together to teach behavioral skills that target common symptoms of BPD. The skills include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance[11].
DBT usually involves weekly individual and group sessions, and you’ll be given an out-of-hours contact number to call if your symptoms get worse[10]. DBT has proved particularly effective in treating women with BPD who have a history of self-harming and suicidal behavior[10].
Medication
Given the often comorbid psychiatric symptoms with BPD in patients participating in therapy, medication interventions are often considered appropriate additional care[11].
Living with BPD
The condition is most serious in young adulthood. Mood swings, anger, and impulsiveness often get better with age[1]. However, the main issues of self-image and fear of being abandoned, as well as relationship issues, continue[1].
If you have borderline personality disorder, know that many people with this condition get better with treatment[1]. Your doctor may also recommend that you stay in the hospital if your safety is at risk[8]. BPD can be a serious condition, and many people with the condition experience self-harm and attempt suicide[7].
These behaviors may seem normal to you because it’s how part of your brain is wired. But the location of these wires isn’t permanent. A healthcare provider can help you find healthier ways to manage your emotions[4].
