Signs and Symptoms of Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental illness characterized by extreme mood swings and an ever-changing self-image and behavior. People with this mental disorder often engage in impulsive and risky behaviors and unstable relationships. 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, 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 intensive relationships with rapid changes
  • Identity disorder
  • 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
  • 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 common for people with BPD to feel suicidal with despair and then reasonably positive 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 reserve their true and full feelings from others in an attempt to downplay their symptoms or hide their pain and sadness from others.

Interpersonal Relationships

Instability of interpersonal relationships in people with borderline personality disorder has been attributed to their hypersensitivity to rejection and extreme fear of abandonment. These negative feelings can prompt a person with BPD to engage in extreme behaviors to 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 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

The extreme changeability of emotions can make it hard for a person with BPD to concentrate. This further punctuates feelings of being “out of control,” which, in turn, can lead to dissociating to block out negative thoughts and emotions.

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 experience feeds into the unstable sense of self and belonging that is characteristic of borderline personality disorder.

It can last anywhere from a few hours to days to weeks. The longer it lasts, the higher the risk that it will severely impede one’s ability to function in their daily life. 

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 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 disorders, specifically a persistent pattern of behaviors and experiences that impair functioning and cause distress, but there are also important differences.

Differences in symptoms between BPD and other personality disorders include:

  • Antisocial personality disorder (ASPD): While BPD consists of extreme emotions, mood swings, and a perceived or actual 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-views not present in ASPD. 
  • Bipolar disorder type 1: While BPD can include manic and depressive behaviors, people with bipolar type 1 exhibit true cycling between extremes that can 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 indistinguishable from each other, the difference is that the depth and intensity of emotions are typically more severe in those with borderline personality disorder.
  • Major depressive disorder (MDD): While MDD can co-occur with BPD, it is also a distinct disorder differentiated by the fact it responds well to antidepressant therapies (unlike BPD). Treatment of depression does not result in remission of BPD symptoms.
  • Narcissistic personality disorder (NPD): Those with NPD have a favorable self-perception, believing they are superior, special, or unique, whereas those with BPD have a predominately negative self-image.  
  • Premenstrual dysphoric disorder (PMDD): This is a disorder characterized by depressive, anxious, and irritable moods occurring in the week or two weeks 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, their frequency is much less than that of those in people with schizophrenia with paranoia. Schizophrenia is also associated with more severe 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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