Signs and Symptoms of Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental illness characterized by extreme instability in moods, self-image, and relationships. People with this mental disorder often engage in impulsive and risky behaviors. Those with BPD can experience anxiety, depression, and anger that lasts from a few hours to a few days. They may also have fear of abandonment, feelings of emptiness, and self-harm behaviors. Symptoms typically present during the teenage years or early adulthood, although earlier signs may be detected in childhood.

BPD is strongly associated with a history of childhood trauma and a family history of mental illness and substance abuse, and PTSD. Recent research shows that BPD affects men and women equally, but it is commonly misdiagnosed as PTSD or depression in men.

The prevalence of borderline personality disorder is 1.6% in the general population, with a lifetime prevalence of 5.9%.

A woman feeling anxious

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Signs and Symptoms

A hallmark of borderline personality disorder is emotional and relational instability. Symptoms of BPD include:

  • Fear of abandonment
  • Unstable and intense relationships with rapid changes from idealization to devaluation
  • Identity disturbance
  • Impulsivity like spending a lot of money, unsafe sex, and substance abuse
  • Recurrent suicidal behavior, threat of committing suicide or self-injurious behavior
  • Emotional instability
  • Chronic feelings of emptiness
  • Inappropriate anger, uncontrolled aggression
  • Stress-dependent paranoid ideation or dissociative symptoms

A diagnosis of BPD is based on the presence of at least five of these symptoms.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

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

Emotional Characteristics

Despite its association with intense and highly changeable moods, borderline personality disorder is not solely defined by emotions, but rather, the way in which those emotions are experienced. 

Affective instability, a core feature of BPD, refers to the tendency to experience rapid and intense mood swings that are difficult to control. It manifests with extreme and often excessive reactions and a slow return to the baseline emotional state. People with BPD “feel” with extreme intensity—whether they be positive emotions or negative ones.

It's not uncommon for people with BPD to feel suicidal despair and then feel very differently a few hours later. Some people may feel better in the morning, and some in the evening.

People with BPD are also prone to dysphoria (a generalized unease or dissatisfaction with life) and depression. Their thoughts tend to turn inward (internalization), meaning they try to hide their true and full feelings from others.

Interpersonal Relationships

Instability of interpersonal relationships in people with borderline personality disorder can be attributed to their hypersensitivity to rejection and extreme fear of abandonment, as well as alternating between experiencing others as all good or all bad. These feelings can prompt a person with BPD to engage in extreme behaviors to try and prevent abandonment, including:

  • Constantly texting or calling a person
  • Suddenly calling someone in the middle of the night
  • Physically clinging on to that person and refusing to let go
  • Making threats to harm or kill yourself if a person ever leaves you

Alternatively, fear of abandonment may prompt a person with BPD to preemptively cut off communications with others in anticipation of abandonment.

People with BPD also exhibit insecurity, ambivalence, and avoidant behaviors in relationships. They may feel that others are smothering or controlling them, causing them to emotionally withdraw from a relationship or acting in ways to make others go away. This often results in a love-hate relationship with others.

Many people with BPD also seem to be stuck with a very rigid "black-white" view of relationships. Either a relationship is perfect and a person is wonderful, or the relationship is doomed and a person is terrible. They seem unable to tolerate any gray areas.

Borderline personality disorder can be differentiated from everyday struggles with intimacy by the ever-shifting sense of identity common with this condition, which strains relationships as the person tries to gain a sense of who they are through the people they love.

Behaviors

The behaviors of people with borderline personality disorder can be described as excessive, impulsive, and self-damaging. These can include:

  • Unsafe sex with multiple partners
  • Reckless spending
  • Gambling
  • Binge eating
  • Reckless driving

These behaviors often have devastating consequences. Researchers found that these behaviors may be triggered by emotional stress. Impulsivity in BPD has also been conceptualized as a consequence of malfunctioning emotion regulation mechanisms. One theory proposes that difficulties in emotion regulation, stemming from childhood adversities, lead to an increased use of impulsive coping strategies that help temper negative emotions and therefore impulsivity is mainly a response to stress.

Cognition and Self-Cognition

Dissociation refers to the feeling of being cut off or disconnected and detached from oneself (depersonalization) and one’s surroundings (derealization). In this state, a person is removed or distanced from feelings, thoughts, and memories. This can happen under stress in BPD. The experience may feed into the unstable sense of self and belonging that is characteristic of borderline personality disorder.

Self-Harm and Suicide

BPD is associated with an increased risk of self-harm and suicide. It has been estimated that up to 10% of BPD patients will die by suicide, and that BPD patients have a mean of three lifetime suicide attempts, mostly by overdose. Patients may report their motivation as a wish to escape, typically following stressful life events like breakups or job loss.

Self-harm, or non-suicidal self-injury, typically involves cutting. It is used as a means to redirect or release overwhelming emotions creating severe internal distress. Research suggests that cutting relieves emotional tension, but does not reflect a wish to die.

Other Personality Disorders

Borderline personality disorder shares many symptoms with other psychiatric disorders.

Differences in symptoms between BPD and other disorders include:

  • Antisocial personality disorder (ASPD): While BPD consists of extreme emotions, mood swings, and an inability to regulate emotions, ASPD consists of fewer emotions, an inability to show concern or empathy, and charming behaviors aimed at dominating others. People with BPD also tend to have negative self-image not present in ASPD. 
  • Bipolar disorder type 1: While BPD can include unstable moods, people with bipolar disorder exhibit mood episodes that are more persistent and may also include hallucinations and delusions. Sleep patterns are also notably different whereby people experiencing a bipolar-related manic episode report a decreased need for sleep and can even be awake for days without reporting fatigue. Sleep patterns in BPD are commonly less impacted by the disorder.
  • Histrionic personality disorder: While the overlap in symptoms can make these two disorders almost appear similar to each other, a core feature of histrionic personality disorder is dramatic and shallow expressions of emotions in the service of attention-seeking.
  • Major depressive disorder (MDD): While MDD can co-occur with BPD, and their symptoms overlap, it is also it is a distinct disorder differentiated by the fact that it has a persistent set of symptoms that may respond to antidepressant therapies.
  • Narcissistic personality disorder (NPD): Those with NPD have a pervasive pattern of grandiosity in their minds, believing they are superior, special, or unique, whereas this is not a core feature of BPD.
  • Premenstrual dysphoric disorder (PMDD): This is a disorder characterized by depressive, anxious, and irritable moods occurring in the week before menstruation. While BPD symptoms have been shown to increase during the premenstrual stage, this is not the only time they present.
  • Schizophrenia with paranoia: While people with BPD can experience paranoid ideations under stress, Schizophrenia is associated with more persistent psychosis and cognitive impairments than BPD.

A Word From Verywell

While the symptoms of borderline personality disorder can be distressing and disabling, this is a mental illness that has a high rate of remission. Treatment for this condition is not only available, but it is also extremely effective. In fact, the rate of remission tends to increase with each subsequent year of psychotherapy treatment in people with BPD. This means staying the course is an effective way to reduce overall symptoms and restore normal functioning.

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