What Is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a mental health condition involving challenges with mood, relationships, and self-image. Nearly 1.5% of adults in the United States have BPD, and about three-quarters of them are women.

BPD can be severe, even life-threatening. However, people who have this condition can live fulfilled, happy lives with the right treatment and coping methods. Learn about the symptoms, causes, treatments, and more.

Borderline Personality Disorder Symptoms

People with borderline personality disorder have symptoms that can change quickly in response to things they experience. For example, a person with BPD may be in a good mood, laughing and interacting positively with a friend. But, if the friend accidentally says something the person with BPD perceives negatively, they may quickly become angry and no longer consider that person a friend.

Such extreme mood swings are often misinterpreted as bipolar disorder. However, mood swings in BPD typically have a clear trigger and last a few hours. Mood swings in people living with bipolar disorder are typically more random and last for longer periods, often days to weeks, as part of a manic or depressive episode.

Symptoms include:

• Acting out of fear of being abandoned by family or friends (e.g., being overly affectionate or overly distant)
• Extreme shifts in relationships from positive and affectionate to negative and cut off
• Feelings of emptiness or boredom that last a long time
• Impulsive behavior patterns, such as overspending, substance misuse, or risky sexual behavior
• Intense mood swings
• Self-image or view of self that is not accurate or changes
• Sudden anger, outbursts, or fighting
• Recurrent suicidal thoughts, gestures, or attempts; or self-harming behaviors such as cutting
• Brief periods of paranoia related to stress or severe dissociative symptoms; often manifesting as trouble trusting others or worrying about the intentions of others without reason
  

BPD can be severe, and even life-threatening. People with BPD are at an increased risk of suicide, and nearly 10% will take their own lives. This can be prevented with diagnosis, treatment, and lifelong support.

Causes of BPD

The causes of borderline personality disorder are not fully understood. It is believed to be a combination of genetics, chemical imbalances in the brain, brain development issues, and your environment and experiences, especially during childhood. However, this does not mean that everyone who experiences these risk factors will develop BPD.

Risk factors of BPD include:

• Childhood trauma, abuse, or an extremely stressful event
• Having a family member with BPD
• Imbalance of serotonin, a chemical in the body that affects mood
• Unstable relationship with parents during childhood
• Unusual activity levels in certain areas of the brain or parts of the brain that are underdeveloped

Diagnosis

Borderline personality disorder can be difficult to diagnose. Some of the symptoms are similar to the symptoms of bipolar disorder, post-traumatic stress disorder (PTSD), and major depressive disorder (MDD), and these conditions can occur together with BPD. Because of this, BPD is often diagnosed as bipolar disorder, PTSD, or MDD.

There are no tests to diagnose BPD. Instead, it is diagnosed by talking about what the person is experiencing.

A mental health professional, such as a psychologist or psychiatrist, can diagnose the condition by talking about:

• Symptoms you're experiencing
• How your interactions and relationships with others are going
• Your thoughts and actions
• Other mental health conditions that may occur with BPD
  

Treating BPD

Borderline personality disorder is a lifelong condition. However, with treatment, symptoms can be managed.

It is common for people with BPD to get their symptoms under control enough to be considered in remission. This is a phase where the signs and symptoms of the condition are either gone or very low, but the person still has BPD. Symptoms may return after remission, but they are usually milder.

Treatments for BPD include psychotherapy and medications.

Psychotherapy

Psychotherapy, also known as talk therapy, is a conversation-based treatment for mental health conditions provided by a mental health professional, such as a psychologist or therapist. This is generally the first option for treatment and has been shown to be effective. It can help people to recognize and change their thoughts, feelings, and behaviors.

Types of talk therapy for BPD include:

• Dialectical behavioral therapy (DBT) involves mindfulness and bringing awareness to emotions and emotional patterns to change behavior patterns.
• Mentalization-based therapy (MBT) involves learning how to consider thought patterns so they can be changed, which leads to changes in behaviors.
• Schema-focused therapy involves identifying areas of needs that were not met in the past, how that impacts thought, feeling, and behavior patterns, and making changes to meet needs and form new patterns.

Medication

There are no medications currently approved to treat borderline personality disorder. However, medications are sometimes used to treat mental health challenges and symptoms that occur with BPD. For example, someone with both anxiety and BPD may take medications to treat the anxiety.

Coping

In addition to talk therapy treatment and medications for additional health challenges, there are things people with BPD can do to help cope. These include:

• Self-soothing: Sing a favorite song or hold a comforting object
• Distraction: Exercise or watch a favorite film
• Relaxation: Practice meditation or yoga; listen to music
• Pause and reflect: Keep a journal to track symptoms and possible events, thoughts, and feelings linked to them
• Have a crisis plan: List things you can do, places you can go, and people you can reach out to when you are in emotional distress
  

Summary

Borderline personality disorder is a mental health condition that involves extreme mood swings and relationship challenges. Symptoms include fear of being abandoned by friends or family members, self-harm, and angry outbursts. Mental health professionals, such as psychiatrists and psychologists, can diagnose this condition. Talk therapy can help people with BPD manage symptoms and live well despite having a lifelong condition.

A Word From Verywell

Being diagnosed with and living with borderline personality disorder can be challenging. If you or someone you know suspects or has been diagnosed with BPD, help is available. Reach out to a healthcare provider for support. With treatment, many people with BPD live a happy, fulfilled life.