Everything to Know About Living With Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health condition that affects approximately 1.4% of adults in the United States. People with BPD experience an ongoing pattern of mood instability, behavior, and self-image, often resulting in impulsive actions. Relationship issues are common for people who have BPD.

Read on to learn more about what it's like to live with BPD.

What Does BPD Mean?

People with BPD have difficulties regulating emotion. They often experience intense emotions and find it hard to return to a stable baseline afterward.

The exact cause of BPD is not known, but current evidence suggests the development of BPD is influenced by:

• Genetics/inheritance
• Biology (such as certain "wired" personality or temperamental characteristics)
• Environmental (and possibly cultural) experiences

Symptoms

Symptoms of BPD vary between people and can fluctuate over time. Some people experience many symptoms, while others experience only a few.

Symptoms of BPD include:

• Fear of and efforts to avoid abandonment (real or imagined)
• Unstable personal relationships
• Unstable sense of self or self-image
• Engaging in impulsive and/or dangerous behaviors (such as unprotected sex (also referred to as condomless sex), reckless driving, misuse of substances, "spree" spending, gambling, or binge eating)
• Engaging in self-harm (such as cutting) or recurring thoughts of suicide
• Intense mood swings and periods of intense depressed mood, irritability, or anxiety that last from a few hours to a few days
• Feeling empty or bored
• Intense or uncontrollable anger, which can be followed by feelings of shame or guilt
• Feelings of dissociation (disconnecting from themselves, living outside reality)
• Difficulty trusting others/irrational fear of others' intentions
• Quickly-changing interests and values
• Viewing things in extremes, such as all good or all bad
  

Symptoms of BPD can be triggered by objectively minor or ordinary events, such as a loved one traveling on a business trip. The nature of the symptoms, such as severity, frequency, and duration, depend on the individual.

By some estimates, up to 75% of people with BPD engage in at least one instance of non-suicidal self-injury (such as cutting or burning with a cigarette), in an attempt to bring relief from intense emotional pain. This behavior usually begins in early adolescence. Up to 10% of people with BPD die by suicide.

Things People With BPD Say

Symptoms of BPD are a result of efforts to cope with the constant emotional pain many people with BPD live with.

People with BPD may relate to thoughts such as:

• "I have trouble controlling my anger."
• "I have trouble maintaining healthy relationships."
• "I try anything I can to avoid being abandoned."
• "I often feel empty inside."
• "I have a hard time knowing who I really am."
• "I feel anxious and irritable."
  
• "I engage in risky behaviors that could be harmful to me."
• "I think about ending my life."
• "I harm myself."
  

Common Stigmas

People who have mental illnesses often face stigmas, such as beliefs that people with mental illnesses are:

• Unpredictable
• Dangerous
• Ethically flawed
• Inferior
• Not capable of caring for themselves or others
• Unable to integrate into society

BPD is one of the most misunderstood, misdiagnosed, and stigmatized mental health conditions. People with BPD face stigmas such as beliefs that they are:

• Dangerous to themselves and others
• Manipulative
• Attention-seeking
• Difficult to work with
• Resistant to treatment

These stigmas are not just hurtful, they are harmful to people with BPD, especially when they occur within the healthcare system.

People with BPD experience structural stigma and stigma from individual healthcare providers. One study found that over 80% of mental health providers viewed people with BPD as more difficult to treat than people with other illnesses.

These misleading and harmful beliefs affect the quality of care people with BPD receive and can lead to:

• Poor therapeutic conditions
• Premature termination of treatment
• Rationalization of treatment failures
• Decreased likelihood of forming an effective treatment alliance between caregiver and person with BPD
• Emotional and social distancing
• Trouble empathizing
• Lack of belief in recovery
• Negative or inaccurate perceptions of people with BPD
• Worsening of the fear of abandonment for the person with BPD
  

Ways to counter stigma within society and medical/mental health environments include:

• Increasing contact between those who have a mental health diagnosis and those who do not
• Providing education about mental illness and how to recognize stigma
• Discussing experiences living with a mental illness and the stigmas they face
  
• Changing the language associated with BPD
• Providing psychoeducation and training to healthcare providers, mental health professionals, and the families of people with BPD

Tips for Living With BPD

BPD affects many areas of a person's life. Despite the difficulties this creates, there are measures that can be taken to make it easier to manage.

At Work

It can be difficult for people with BPD to gain and maintain employment, despite the desire to work.

A 2019 study suggests that further research into how reducing symptoms, addressing stigma, and increasing support for employment could improve success in the workplace for people with BPD.

A job preparedness pilot project involving a program called “The Connections Place” showed great promise. It was aimed at helping people with BPD overcome emotional barriers to employment and preparing them to enter/reenter the workplace.

Relationships

Relationship difficulties are a hallmark of BPD, but that doesn't mean people with BPD can't have fulfilling relationships.

Early diagnosis and treatment of BPD can help improve the person's ability to form stable relationships.

Therapy that includes partners, family members, and loved ones can help improve relationships for people with BPD.

Therapy that helps people with BPD understand the perspectives of others can also be a way to strengthen relationships.

Self-Image

Internalized stigma can cause people with BPD to feel guilt and shame.

Learning to identify thoughts and emotions, use coping strategies, and understand themselves can help a person with BPD develop a stronger sense of self. This fosters a desire and willingness to engage in the recovery process, and can improve treatment outcomes.

Physical Health 

Studies have shown that without adequate treatment, people with BPD are:

• More likely to have other chronic medical or mental health conditions
• Less likely to make healthy lifestyle choices

In addition to receiving quality treatment for BPD, people with BPD can help their physical health by:

• Getting enough good quality sleep
• Eating nutritious foods and eating at regular meal times
• Being physically active
• Keeping track of BPD symptom triggers (people, places, situations, etc.)
  

BPD by Age 

BPD presents across the lifespan and may be thought of in stages:

1. Premorbid stage (starts in childhood)
2. Subclinical stage (early adolescence)
3. First full BPD episode (middle or late adolescence)
4. Remission and relapse (from middle to late adulthood)

Not everyone with BPD follows this pattern. Other trajectories are possible.

Adolescence

BPD tends to first manifest in adolescence. A reliable BPD diagnosis can be made in adolescents as young as 11 years old.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association's handbook for diagnosing mental health conditions, BPD can be diagnosed in people under the age of 18 if symptoms are:

• Pervasive
• Persistent
• Not limited to particular developmental stage or a different mental disorder
• Present for at least one year
  

BPD symptoms can be distinguished from typical adolescent development. Some studies have shown that 30% of adults with BPD report having engaged in self-harm before the age of 13, while another 30% say they started this behavior between the ages of 13 and 17.

For adolescents without mental illness, impulsivity, identity issues, and affective instability typically diminish over the course of adolescence. For adolescents with BPD, these symptoms tend to increase over time.

Prevalence rates of BPD in adolescents vary widely. Regardless, education around BPD should be given to professionals who work with adolescents, such as youth and social workers, and school health staff.

Adolescents identified as having BPD should always be seen by a healthcare provider to explore their potential suicidal risk, as there are high rates of suicide attempts and completion in adolescents with BPD.

Adulthood

Adults with BPD may see a switch from the symptoms of impulsivity and suicidality predominantly seen in adolescence, to symptoms of maladaptive (negative) interpersonal functioning and enduring functional impairments.

Studies show diagnoses of full BPD generally decreases from young to middle adulthood, but relapse after remission is common.

Older Adults 

BPD is understudied in people over age 50, limiting the understanding of BPD in late life. Studies suggest a decline in BPD from middle adulthood to advanced age.

Symptoms such as impulsivity, rule-breaking, and emotional turmoil may decline, while fear of abandonment, selfishness, and lack of empathy may remain.

The loss of a spouse/partner or a transition to a nursing home/assisted living facility may contribute to a late-onset exacerbation of symptoms of a personality disorder. This may be related to the loss of social support, which had previously helped compensate for symptoms, and/or a renewed fear of abandonment.

While younger people may self-harm in ways such as cutting, older adults are more likely to self-harm by refusing food, necessary medication, or medical treatment.

More research is necessary to gain accurate information on the prevalence and presentation of BPD in older adults.

Treatment Options

While BPD has a reputation for being difficult to treat, newer, evidence-based treatments are offering people with BPD improved quality of life with fewer and less severe symptoms.

Psychotherapy

Psychotherapy (talk therapy) is the most-used treatment for BPD. It can be done individually or in a group setting.

Psychotherapies used to treat BPD include:

• Dialectical behavior therapy (DBT): Uses mindfulness and acceptance. Teaches skills that can help people with BPD control intense emotions, reduce self-destructive behaviors, and improve relationships.
• Cognitive behavioral therapy (CBT): Helps people with BPD identify and change problematic core beliefs and behaviors. It may help reduce some mood and anxiety symptoms and lower the number of suicidal or self-harming behaviors.
• Mentalization-based therapy (MBT): Helps a person with BPD develop more adaptive ways of thinking about and expressing emotions, stabilize their sense of self, and managing ups and downs.

Medication

Medication is not typically used as a treatment for BPD, but may be prescribed if other mental health conditions are present, or to treat symptoms, such as:

• Mood swings
• Depression
• Anxiety
  

Summary

BPD is a mental health disorder that affects mood, behavior, and self-image. It typically begins in adolescence, followed by a decrease in symptoms after young adulthood, though relapses are common. People with BPD may face difficulties at work and in relationships.

BPD is often stigmatized, frequently in health care. Healthcare workers and mental health professionals should receive training to combat this stigma. BPD is typically treated with psychotherapy, but medication may be prescribed if necessary.

A Word From Verywell

Living with BPD can be challenging for both you and those around you. Know that help is available. Therapy can help you be mindful of your triggers, manage your symptoms, and improve your level of functioning. Talk to your healthcare provider or a mental health professional about which treatment options are right for you.