Borderline Personality Disorder
Overview
Borderline Personality Disorder (BPD) is a condition characterized by difficulties regulating emotion. This means that people who experience BPD feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event.
This difficulty can lead to impulsivity, poor self-image, stormy relationships and intense emotional responses to stressors. Struggling with self-regulation can also result in dangerous behaviors such as self-harm (e.g. cutting).
Symptoms & Signs
People with BPD experience wide mood swings and can feel a great sense of instability and insecurity. Some key signs and symptoms may include:
- Frantic efforts to avoid real or imagined abandonment by friends and family.
- Unstable personal relationships that alternate between idealization (“I’m so in love!”) and devaluation (“I hate her”).
- Distorted and unstable self-image, which affects moods, opinions, goals and relationships.
- Inappropriate, intense or uncontrollable anger—often followed by shame and guilt.
- Chronic feelings of boredom or emptiness.
- Self-harming behavior including suicidal threats or attempts.
- Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.
- Impulsive behaviors that can have dangerous outcomes, such as excessive spending, frequent relationships, reckless driving, or misuse or overuse of substances.
- Dissociative feelings—disconnecting from your thoughts or sense of identity or “out of body” type of feelings—and stress-related paranoid thoughts. Severe cases of stress can also lead to brief psychotic episodes.
A psychiatrist experienced in diagnosing and treating mental disorders can diagnose borderline personality disorder, based on a thorough interview and a discussion about symptoms.
Causes
The causes of BPD are not fully understood, but scientists agree that it is the result of a combination of factors, including:
- Genetics. While no specific gene or gene profile has been shown to directly cause BPD, research suggests that people who have a close family member with BPD may be at a higher risk of developing the disorder.
- Environmental factors. People who experience traumatic life events—such as physical or sexual abuse during childhood or neglect and separation from parents—are at increased risk of developing BPD.
- Brain function. The emotional regulation system may be different in people with BPD, suggesting that there is a neurological basis for some of the symptoms. Specifically, the portions of the brain that control emotions and decision-making/judgment may not communicate optimally with one another.
Treatments
Borderline personality disorder has historically been viewed as difficult to treat. But with newer, evidence-based treatment, many people with borderline personality disorder experience fewer and less severe symptoms, improved functioning, and an improved quality of life.
It is important for patients with borderline personality disorder to receive evidence-based, specialized treatment from an appropriately-trained mental health professional. Other types of treatment, or treatment provided by someone who is not appropriately trained, may not benefit the patient.
Many factors affect the length of time it takes for symptoms to improve once treatment begins, so it is important for people with borderline personality disorder and their loved ones to be patient and to receive appropriate support during treatment. It is important to seek—and stick with—treatment.
Suicide and Self-Harming Behaviors: Borderline personality disorder is associated with higher rates of suicide and self-harming behaviors. Patients with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away. If you or a friend or family member is experiencing suicidal thoughts or self-harming behaviors, Call the Hotline, 24 hours a day, 7 days a week. The service is available to everyone.
Take seriously any comments about suicide or wishing to die. Even if you do not believe your family member or friend will attempt suicide, the person is clearly in distress and can benefit from your help in finding treatment. For more information on suicide, please click on Self-Harm & Suicide
The treatments described below are just some of the options that may be available to a person with borderline personality disorder.
Psychotherapy
It is the first-line treatment for people with borderline personality disorder. It can be provided one-on-one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with borderline personality disorder how to interact with others and how to express themselves effectively. It is important that people in therapy get along with and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with this disorder to maintain a comfortable and trusting bond with their therapist.
Two examples of psychotherapies used to treat borderline personality disorder include Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT).
DBT, uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills to control intense emotions, reduce self-destructive behaviors, and improve relationships.
CBT can help people with borderline personality disorder identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
Medications
Medications are not typically used as the primary treatment for borderline personality disorder as the benefits are unclear. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms, such as mood swings, depression, or other mental disorders that may occur with borderline personality disorder.
Other Elements of Care
Some people with borderline personality disorder experience severe symptoms and require intensive inpatient care.