What Is Borderline Personality Disorder (BPD)?

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Borderline personality disorder (BPD) is a serious psychological condition that's characterized by unstable moods, emotions, self-image, relationships, and behavior. It's one of the 10 personality disorders recognized by the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Personality disorders are conditions that begin in adolescence or early adulthood, continue over many years, and, when left untreated, can cause a great deal of disruption to a person's life. There is no "cure" for BPD but thankfully, with the right treatment, symptoms of BPD can be controlled and improve.

Woman with anxiety disorder, biting fingernails, talking to mental health professional

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BPD is marked by:

  • A pattern of emotional instability
  • Efforts to avoid real or imagined abandonment
  • Impulsive behavior
  • Unstable self-image
  • Unstable relationships

People with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.

Prevalance

The reported prevalence of BPD in the United States is estimated at 1.6% but may be much higher.

Symptoms

BPD can often interfere with the ability to enjoy life or achieve fulfillment in relationships, work, or school. Symptoms typically present during the teenage years, although earlier signs may be detected in childhood.

Some people only have a handful of BPD symptoms, while others have many, these can include:

  • Emotional instability: People may experience sudden changes in how they feel about others, themselves, and the world around them. Irrational emotions—including uncontrollable anger, fear, anxiety, hatred, sadness, and love—change frequently and suddenly. They may be quick to lash out at others and have trouble calming down when they're upset.
  • Disturbed patterns of thinking or perception: People with BPD often struggle with suspicious thoughts about others’ motives. When under stress, they may even lose touch with reality and become paranoid or experience a state known as dissociation where they feel disconnected from their surroundings or themselves.
  • Impulsive behavior: Episodes of reckless driving, fighting, gambling, substance abuse, and unsafe sexual activity are common among people with BPD. Self-destructive behavior can be difficult to control. People with BPD are also more prone to engage in self-harming behaviors, such as cutting or burning and attempting suicide.
  • Intense but unstable relationships with others: People with BPD tend to have intense relationships with loved ones characterized by frequent conflicts, arguments, and break-ups. BPD is associated with an intense fear of being abandoned by loved ones and attempts to avoid real or imagined abandonment. This usually leads to difficulty trusting others, which can put strain on relationships.
  • Unclear or shifting self-image: When someone has BPD, their sense of self is typically unstable. Sometimes they feel good about themselves, but other times they hate themselves or even view themselves as evil. They probably don’t have a clear idea of who they are or what they want in life. As a result, they may frequently change jobs, friends, partners, values, goals, or even sexual identity.

Diagnosis

There are a number of psychiatric disorders that can cause symptoms very similar to those associated with BPD including:

  • Bipolar disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder

For this reason, it is important to see a medical professional who can listen to your concerns, conduct a thorough assessment, and make an accurate diagnosis.

In order to be diagnosed with BPD, an individual must experience five or more of the following nine symptoms in a variety of contexts:

  • 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

One study found that about 85% of people with BPD also meet diagnostic criteria for at least one other personality or mood disorder.

The DSM-5 defines BPD in terms of nine symptoms that span affective, interpersonal, and intrapersonal disturbances. A diagnosis requires the presence of any five symptoms, which allows for 256 combinations by which an individual could receive a BPD diagnosis.

Causes

Like most psychiatric disorders, the exact cause of BPD is not known. However, researchers believe BPD results from a combination of genes and biological and environmental factors.

Contributing factors that may increase the risk of BPD 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. But is it unclear whether these changes were risk factors for the disorder, or caused by the disorder.
  • Family history: Having a parent or sibling with BPD may also increase the risk of developing the 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. Others may have been exposed to unstable, invalidating relationships, and hostile conflicts. However, many people who have had these experiences do not develop BPD.

Treatment

Historically, medical experts believed that BPD was unlikely to respond to treatment but research has shown that BPD is very treatable. The symptoms of BPD can affect work, school, relationships, legal and physical health, which is why treatment is so critical.

Despite the obstacles that BPD can cause, many people with BPD lead normal, fulfilling lives when they stick with their treatment plan.

Psychotherapy

Psychotherapy is the first-line treatment for people with BPD. It can be provided one-on-one between the therapist and the person or in a group setting. It is important that people in therapy establish a sense of trust with their therapist. The nature of BPD can make it difficult for people with this disorder to maintain a comfortable and trusting bond with their therapist.

Examples of psychotherapies that are targeted to BPD include:

  • Dialectical behavior therapy (DBT), which teaches coping skills and strategies for dealing with urges related to self-harm and suicide, regulating emotions, and improving relationships.
  • Mentalization-based therapy (MBT) is a psychotherapy that helps people better identify what others may be thinking and feeling.
  • Transference-focused therapy (TFP) helps people better understand and deal with their emotions and interactions by examining them through the relationship between the patient and therapist.

Medication

No medications are currently approved by the FDA for the treatment of BPD but a mental health professional may also recommend medication to help treat certain symptoms such as:

  • Antidepressants: These can help improve a depressed mood, anger, or impulsivity.
  • Antipsychotics: These may be beneficial for people who often lose touch with reality.
  • Mood stabilizers: These prevent mood swings and reduce irritability and aggression.

Coping

If someone has BPD, there are things they can do that will help improve their ability to function and cope. Steps they can take that can improve their quality of life include:

  • Stick to their treatment plan: Research has shown that with good, consistent treatment, BPD symptoms can be reduced significantly. Some people who were once diagnosed with BPD no longer meet the criteria for the disorder with treatment and time.
  • Know their triggers: One of the keys to coping with BPD is to recognize the emotional patterns and triggers. In conjunction with a therapist, someone should be able to identify strategies that help them deal with strong emotions.
  • Practice self-care strategies. Regular exercise and consistent eating and sleeping schedules can help prevent mood swings and manage anxiety, stress, and depression. It’s also important to avoid drugs and alcohol, which can exacerbate symptoms and interact with medications.

Seek Help

If you or a loved one are struggling with borderline personality disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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Article Sources
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