What Is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a serious psychological condition characterized by unstable moods and emotions, relationships, and behavior. During a BPD episode, a person may act impulsively, engage in risky behaviors, switch moods quickly, have higher levels of anger, appear numb, or experience paranoia.

An estimated 1.4% of the adult population has borderline personality disorder, with roughly three-quarters of the diagnoses occurring in women. However, it is suggested that this is due to high rates of misdiagnosis in men.

BPD is one of the many personality disorders recognized by the American Psychiatric Association (APA). It is categorized as a cluster B personality disorder, meaning that someone with this type is more likely to be dramatic, overly emotional, and unpredictable in their thoughts or behaviors.

Personality disorders are psychological conditions that begin in adolescence or early adulthood, continue over many years, and, when left untreated, can cause a great deal of distress. Thankfully, the right treatments can help significantly.

Types of Borderline Personality Disorder

Some experts propose that there are different types or subtypes of BPD. However, they often differ on what these types or subtypes may be.

For example, in one 2017 study, researchers classified BPD patients into three clusters: those with "core BPD" features only and those that feature other personality disorders, such as:

• Core BPD symptoms (high frequency of BPD symptoms without any significant overlap with other personality disorder symptoms)
• Extravert/externalizing features (histrionic, narcissistic, antisocial)
• Schizotypal/paranoid features

Another study supports the notion of three subtypes of borderline personality but lists them as:

• Affect dysregulation (which was associated with co-occurring diagnoses of generalized anxiety and panic disorders)
• Rejection sensitivity
• Mentalization failure (the latter of which predicted post-traumatic stress disorder)

A 2015 study of hospitalized BPD patients suggests that there are five subtypes. According to this approach, the different subtypes, in order of their prevalence, are:

• Impulsive (37%)
• Dependent (29%)
• Affective (26%)
• Empty (5%)
• Aggressive (4%)
  

Symptoms of Borderline Personality Disorder

Borderline personality disorder can interfere with a person's ability to enjoy life or achieve fulfillment in relationships, work, or school. Because it is a personality disorder, someone may not show signs of BPD until their personality develops, with diagnoses occurring only after patients are over 18 years of age.

Symptoms of borderline personality often appear and can create significant problems in the following areas:

• Behaviors: BPD is associated with a tendency to engage in risky and impulsive behaviors, such as going on shopping sprees, excessive drug or alcohol use, engaging in promiscuous or risky sex, or binge eating. They're also more prone to engage in self-harming behaviors, such as cutting or burning and attempting suicide.
• Emotions: Emotional instability is a key feature of BPD. Individuals feel like they're on an emotional roller coaster with quick mood shifts (i.e., going from feeling okay to feeling extremely down or blue within a few minutes). Mood changes can last from minutes to days and are often intense. Anger, anxiety, and overwhelming emptiness are common as well.
• Relationships: People with borderline personality disorder tend to have intense relationships with loved ones characterized by frequent conflict, arguments, and break-ups. BPD is associated with an intense fear of being abandoned by loved ones. This leads to difficulty trusting others and attempts to avoid real or imagined abandonment, putting a strain on relationships. It's also common for someone with BPD to have a 'favorite person,' or someone they feel they cannot live without.
• Self-image: Individuals with BPD have difficulties related to the stability of their sense of self. They report many ups and downs in how they feel about themselves. One moment, they may feel good about themselves, but the next, they may think they are bad or even evil.
• Stress-related changes in thinking: Under conditions of stress, people with borderline personality disorder may experience changes in thinking, including paranoid thoughts (for example, thoughts that others may be trying to cause them harm) or dissociation (feeling spaced out, numb, or like they're not really in their body).

Diagnosis of Borderline Personality Disorder

BPD is diagnosed by evaluating an individual's symptoms and reviewing their medical history. A healthcare provider may also perform a physical exam and order lab tests to rule out medical illnesses that might be contributing to the symptoms.

At this time, there is no definitive borderline personality disorder test. Instead, to be diagnosed with BPD, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) indicates that the individual must experience five or more of the nine symptoms of BPD, which are:

• Efforts to avoid abandonment
• Emotional instability
• Feelings of emptiness
• Identity disturbances
• Impulsive behaviors
• Inappropriate, intense anger
• Unstable interpersonal relationships
• Suicidal or self-harming behaviors
• Transient paranoid or dissociative symptoms

Conditions with Similar Symptoms

When making their diagnosis, a health provider or therapist will also rule out other mental health conditions that can cause symptoms similar to those experienced with BPD. Conditions that have overlapping symptoms with borderline personality disorder include:

• Bipolar disorder
• Histrionic personality disorder
• Narcissistic personality disorder

Making this differentiation is important to finding the right treatment. For example, when comparing borderline personality disorder vs. bipolar disorder, the mood changes in people with BPD are often shorter in term, while people with bipolar tend to experience mood changes that last days or weeks.

Co-Occurring Conditions

It's common for borderline personality disorder to co-occur with certain other mental conditions, known as comorbidities, sometimes making it more challenging to diagnose. Conditions often co-existing with BPD include:

• Anxiety disorders
• Bipolar disorder
• Depression
• Eating disorders
• Post-traumatic stress disorder
• Substance use disorder
  

Causes of Borderline Personality Disorder

Like most psychological disorders, the exact cause of BPD is not known. However, research suggests that some combination of nature (biology or genetics) and nurture (environment) is at play.

A few of the proposed causes of borderline personality disorder include:

• Brain structure: There is evidence of differences in brain structure and function in individuals with BPD, especially in the parts of the brain that affect impulse control and emotional regulation. However, it's unclear if these differences are a result of having BPD or if they are part of the cause.
• Genetics: There appears to be a genetic component to borderline personality disorder, as it's not uncommon for close family members to have this condition.
• Negative experiences: Many people diagnosed with BPD have experienced childhood abuse, trauma, or neglect, or were separated from their caregivers at an early age. At the same time, not all people with BPD had one of these childhood experiences, and conversely, many people who have had them do not develop BPD.

Risk Factors for Borderline Personality Disorder

Certain factors may increase your risk of developing BPD. They include:

• Being abandoned during childhood or adolescence
• Experiencing abuse (sexual, physical, or emotional)
• Having a disruption in your family life
• Poor communication skills within the family unit

Treatment for Borderline Personality Disorder

At one time, experts believed that borderline personality was unlikely to respond to treatment. However, research has since shown that BPD is very treatable. Since BPD is associated with risky behaviors, self-harm, and suicide, treatment can help curb these behaviors.

Getting help from a mental health professional is critical. With consistent treatment, you can live a better quality of life with fewer symptoms. Find someone who specializes in BPD and can provide treatments targeted to this condition. This is important because if you aren't getting the right treatment, it may not be as effective.

The usual order of treatment for borderline personality disorder includes psychotherapy, medication, then other treatments.

Psychotherapy

Psychotherapy is the standard treatment for BPD. Depending on your situation, this treatment option may also include the involvement of your family, friends, or caregivers.

Examples of psychotherapy that are specific to BPD include:

• Dialectical behavior therapy (DBT), a type of cognitive behavioral therapy (CBT) that teaches you how to be present, also builds skills related to coping with stress, emotional regulation, and relationship improvement
• Mentalization-based treatment (MBT), which helps someone with borderline personality disorder better recognize how their thoughts and feelings are associated with their behaviors
  
• Group therapy, or engaging in treatment with others who also have BPD, also learning from them and their experiences

Medication

Your mental health professional may recommend that you take medication to help treat certain borderline personality disorder symptoms, such as depression or mood swings. Medications prescribed to help treat BPD symptoms often fall into one of the following categories:

• Antidepressants
• Antipsychotics
  
• Anxiolytics (anxiety medications)
• Mood stabilizers

Other Treatments

In times of crisis, hospitalization or more intensive treatments may be necessary for someone with borderline personality disorder. Inpatient treatment for BPD is common, with roughly 79% of individuals with this condition being hospitalized at least once and 60% having multiple hospitalizations.

Complications of Borderline Personality Disorder

If left untreated, people with BPD have a higher risk of developing depression and other behaviors that can negatively impact their health, some of which include:

• Drug or alcohol misuse
• Engaging in self-harm behaviors
• Suicide attempts
  

Coping With Borderline Personality Disorder

If you have borderline personality disorder, there are things you can do that will help improve your ability to function and cope. Steps you can take that can improve your quality of life include:

• Seek appropriate treatment: If you think that you or a loved one may have BPD, it's imperative to seek the help of a licensed mental health professional, such as a mental health counselor, social worker, psychologist, or psychiatrist.
• Get an accurate diagnosis: It's important to remember that many of the symptoms of BPD are symptoms that everyone experiences from time to time. Also, some borderline personality disorder symptoms overlap with other mental and physical conditions. Only a licensed professional can diagnose BPD.

Borderline Personality Disorder Discussion Guide

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• Work with your health provider or therapist on a treatment plan: The good news is that once a diagnosis of borderline personality disorder is made, there is hope. Your therapist or healthcare provider can help determine a plan of action, which may include psychotherapy, medications, or other treatments.
• Stick to your treatment plan: Research has shown that with good, consistent treatment, BPD symptoms can be reduced significantly. Some people who were once diagnosed with borderline personality no longer meet the criteria for the disorder with treatment and time.
• Know your triggers. Triggers for borderline personality disorder can include memories of a past experience or feeling rejected or abandoned by a family member or close friend. Recognizing your triggers can help you create strategies for dealing with them effectively when they appear.
• Give it time: For reasons that are unclear, the symptoms of BPD tend to decrease during middle age, with many people starting to see improvements around age 40.

Final Thoughts

BPD symptoms can affect a variety of areas—including work, school, relationships, legal status, and physical health—which is why treatment is so critical. Despite the obstacles that borderline personality disorder can cause, many people with BPD lead normal, fulfilling lives when they stick with their treatment plan.