Borderline personality disorder (BPD) is a mental health condition that causes intense mood swings and changes in self-image and thought patterns. You may feel angry, depressed, or anxious; have trouble getting along with others; or struggle with your emotions. The disorder usually shows up in young adults and may improve over the years.
12 Signs and Symptoms
People with borderline personality disorder often have extreme feelings that change from day to day, making relationships difficult and affecting daily life. Look for these symptoms:
1. Real or imagined fears of being abandoned or rejected
2. Self-image that shifts from one extreme to another
3. Unstable relationships and quickly changing feelings about others
4. Anger out of proportion to a triggering event
5. Feelings of distrust for others
6. Dangerous or compulsive behavior like overspending, gambling, or binge drinking
7. Being out of touch with reality or having paranoia caused by stress
8. Feelings of emptiness
9. Impulsive or erratic actions, such as ending a relationship or quitting a job
10. Intense mood swings ranging from happiness to hopelessness
11. Ongoing feelings of emptiness
12. Recurrent thoughts of self-harm or suicide
To diagnose borderline personality disorder, a doctor will consider the number of symptoms you’re experiencing and how much they affect your relationships and responsibilities. Symptoms vary in degree and in the lengths of time they last, and you may not have all of them. These symptoms may be triggered by ordinary events, such as being separated from someone you love or being given constructive criticism at work.
4 Ways to Get Help
If you know you have symptoms, talk to a mental health provider or doctor. If you have thoughts of self-harm or suicide, do one of these immediately:
• Call 911 or the emergency number for your area.
• Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
• Call your doctor or mental health provider.
• Get in touch with someone in your faith community.
If someone you love shows signs and symptoms, encourage him or her to get help. If that person refuses and his or her actions are affecting your well-being, it might help for you to talk to someone.
Causes and Risk Factors
Researchers don’t fully understand borderline personality, but they know these three factors play a role:
2. Brain structure
Genetics and brain structure can be underlying causes. If you have someone in your family who has BPD, you’re more likely to have it too. If you have structural changes in the regions of your brain that control impulses and emotions, you’re also at risk. An imbalance of chemicals that regulate emotions, such as serotonin or dopamine, may contribute to feelings of aggression and impulsivity.
If a family member has borderline personality disorder, or if you had a tough childhood, you may be more prone to developing symptoms. Not everybody who has one or more of these factors will develop borderline personality disorder, but you could also develop it despite having none of the risk factors.
6 Ways BPD Affects Your Life
Having borderline personality disorder makes it more difficult to maintain relationships, a successful career, or a fulfilling social life. The effects of the condition may show up in all areas of your life, including these:
• Job stability
• Marriage, parenting, or other relationships
• Other health problems or self-harm
• Legal problems like divorces or frequent fighting
• Conflict in all areas of life
• Risky behavior, such as car accidents, unplanned pregnancies, or drug use
• Suicidal thoughts and/or attempts
Mental illness often involves coexisting conditions, making it more difficult to cope with the illnesses or to treat them than you would face with a single condition. If you have borderline personality disorder, you may be more prone to other types of personality disorders. You’re also at an increased risk for depression, anxiety, bipolar disorder, and attention deficit/hyperactivity disorder (ADHD). You’re more likely to have a problem with alcohol or drug abuse, post-traumatic stress disorder (PTSD), or eating disorders.
Diagnosis of Borderline Personality Disorder
A licensed mental health practitioner, such as a clinical social worker, psychologist, or psychiatrist, can diagnose borderline personality disorder. At first, you’ll discuss your symptoms and answer questions about the problems you’re having. Then, a doctor will perform a thorough medical exam to rule out other illnesses that may contribute to the symptoms. Someone will then ask about your medical history, including both physical and mental illnesses, and related conditions in your family. These professionals will also look for coexisting conditions that complicate the disorder.
Treatment Is Available
Although BPD is difficult to treat, its long-term prognosis may be better than that of depression or bipolar disorder. You can get better, but you need specific kinds of help from trained professionals. You can learn to change the dysfunctional patterns of acting, thinking, and feeling you’ve come to accept, but it takes persistence and determination. There will be successes and setbacks, but it’s worth it in the end.
There’s isn’t a medication for BPD, but doctors may prescribe drugs that help with symptoms like anxiety, depression, and coexisting disorders. Treatment might require trial and error, and you may need to see more than one professional before you find the formula that works best for you. Your doctor will explain side effects, tell you what to expect from the medication, and follow your progress.
Psychotherapy involves one-on-one interactions between the therapist and the patient. It may take place privately or in a group session. Therapy centers on teaching people with borderline personality disorder to have better interpersonal skills like expressing their feelings and interacting with others.
For the therapy to succeed, a bond needs to exist between the therapist and the person in counseling. Because people with BPD often have trouble getting along with other people or with trusting them, treatment requires a delicate balance. Two common examples of psychotherapy used to treat BPD are dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT).
Dialectical behavior therapy was designed for the specific treatment of individuals with BPD but may be used for other mental illnesses. It teaches you to be aware of events that trigger your emotions and to respond more calmly. It can help you cope with intense emotions, reduce self-destructive behaviors, and even improve your relationships.
Cognitive behavioral therapy assists individuals in dealing with core beliefs and behaviors that are negative and inaccurate, giving them clearer perceptions of themselves and others. CBT can help reduce symptoms of anxiety or moodiness and even make suicide or self-harm less likely.
Besides learning to control negative emotions and focus on the present, talk therapy makes it easier for you not to react, improves interpersonal skills and empathy, and teaches you what to expect from BPD. Two other kinds of psychotherapy used to treat BPD include humanistic therapy and holistic therapy. Humanistic therapy encourages self-awareness, and holistic therapy incorporates other practices and concepts to balance the mind, body, and spirit.
5 Other Kinds of Psychotherapy
Other kinds of therapy may be used in addition to DBT or DBT:
1. Schema-focused therapy (MBT) to identify unmet needs and to meet them in a positive way
2. Systems training for emotional predictability and problem-solving (STEPPS), a 20-week therapy that involves family, friends, and caregivers
3. Transference-focused therapy (TFP), or psychodynamic talk therapy, to understand emotions and interpersonal skills
4. Mentalization-based therapy (MBT) to identify negative thoughts and to encourage thinking before acting
5. Psychiatric management to oversee a comprehensive approach to medication, counseling, education, and group therapy
Clinics or Hospitals
Individuals with borderline personality disorder, especially when it occurs with other mental illnesses, sometimes benefit from being treated in a psychiatric clinic or hospital. Hospitalization can protect you from hurting yourself and help you deal with suicidal thoughts. It also gives doctors a chance to try and to adjust new medications to the perfect dosage.
If you have BPD, you’ve established dysfunctional patterns of emotions, behaviors, and thoughts over the years, and it will take time to change the way you think and behave. In therapy, you’ll learn ways to feel more content and to function more effectively, but some symptoms may always be a challenge. They may also get better or worse, depending on factors like stress and your physical health.
To benefit from talk therapy, find a therapist you can relate to and view your work as a partnership. Always be honest and willing to share your thoughts and feelings, regardless of what they may be, and be persistent. Change takes time and hard work. If you aren’t comfortable around a mental health provider, or if you aren’t getting better, look for someone else. Your therapist’s experience with BPD and your ability to work together is essential to your recovery.
Tips for Living with BPD
BPD is a serious condition, but you can take steps to make your life easier. First, make a safety plan before an emergency occurs. It’s hard to think when you’re in a crisis, and you need to be prepared. Share your plan with family and friends, and talk it over with a mental health provider.
Your condition will be easier to manage if you take good care of yourself. Eat a balanced diet, get plenty of exercise, and make time for activities you enjoy. Whether it’s yoga or fishing, your favorite pastimes increase the release of feel-good chemicals from your brain and calm frayed nerves. Get a massage, listen to soothing music, or take some time for meditation. They soothe your mind, body, and spirit.
Finally, ask for support from friends, family, and health care providers. Find a support group nearby or online. Psychology Today reports that lonely people are 50% more likely to die prematurely than their peers, and the quality of your relationships matters more than the number.
Researchers say 1.5% of Americans have BPD, and 75% of those are women. Around 70% of individuals with the disorder will attempt suicide at least once, and 8-10% will die from suicide. The suicide rate is over 50 times higher than that of the general population, possibly from lack of treatment or from misdiagnosis.
Although it can affect anyone, BPD often goes misdiagnosed in young adults and teens. One study shows that over 30% of patients with borderline personality disorder started self-harming by the age of 12. Another 30% start between the ages of 13 and 17 years. Symptoms usually begin before adulthood and can be diagnosed if they continue for at least one year.
If you’re a teen or young adult, the symptoms of borderline personality disorder may become less intense as you get older. While some residual signs may linger, a diagnosis is not a lifetime sentence. The key to recovery is hard work, early intervention, and good therapy.