Borderline Personality Disorder

Borderline Personality Disorder: Signs & Symptoms, Causes, and Treatment

Relationships, emotions, likes and dislikes, behaviors, and self-image change abruptly, like the weather, reacting to the slightest changes in the environment. Frequent mood swings, seeing things in extremes, impulsiveness, intense fear of rejection and abandonment, difficulty managing emotions, “all good or all bad” — for the person with borderline personality disorder, every aspect of life may feel unstable.

Borderline personality disorder (BPD) is widely discussed today also in terms of one the most stigmatized condition. It prevents people from getting the effective treatment they need. Often, they try to handle the symptoms alone and deal with the preconceptions of others.

When trying to share their worst experiences with their close circle of people and discuss what’s going on with them, it’s common to hear something like:

  • “That’s just how you react to stuff around you”
  • “It’s just your character”
  • “You’d better get a job and go in for sports”
  • “You’re making this up, you just want to attract attention!” etc.

Lack of support aggravates mental health problems in people with borderline personality disorder and makes their lives unbearable. All their feelings and behaviors are overwhelming and very difficult to live with. They need full understanding and support. With the appropriate help of healthcare professionals and the right treatment, it’s possible to learn to live a fulfilling life.

What does borderline personality disorder feel like, and when to see a doctor? What are the causes? Is it treatable? How can therapy help? Find out these and more below.

What Is Borderline Personality Disorder?

Borderline personality disorder is also known as emotionally unstable personality disorder (EUPD).

About 1.6% of the US population live with BPD, but the number may be as high as 5.9%, with women 3 times more likely than men to develop this disorder.

It’s characterized by:

  • Impulsivity
  • Emotional instability
  • Distorted self-image
  • High anxiety levels
  • Intense anger, irritability
  • A feeling of emptiness
  • A pattern of unstable relationships
  • Dissociative symptoms
  • Feelings of shame and guilt
  • Sensitiveness to criticism and failure
  • Seeing the world in white and black extremes
  • Self-destructive behavior, etc.

Mostly, BPD is diagnosed during adolescence or early adulthood.

Why is borderline personality disorder called “borderline”?

Earlier, mental illnesses were classified into “psychoses” and “neuroses” groups. And BPD has been described as a “mild form of schizophrenia,” being at the “border” of psychosis and neurosis.

As a personality disorder diagnosis, BPD was recognized only in 1980. Today, many clinicians agree that the term “borderline” is controversial, stigmatizing, has no descriptive value, and should be changed.

Research is currently focused on problems with emotional regulation, thinking and behavioral patterns, relationship and interpersonal problems as core aspects of borderline personality disorder. One of the term alternatives for BPD is emotional dysregulation disorder.

What Are the Causes of Borderline Personality Disorder

The exact causes of borderline personality disorder are yet to be discovered. There are some potential factors that may play a role in the development of this disorder:

  • Early childhood stressful experiences, adversity
  • Trauma
  • History of emotional, physical, sexual abuse
  • Separation or loss of a caregiver
  • Emotional detachment in the parent-child relationships
  • Neglect of a child’s opinions and feelings
  • PTSD
  • Genetic predisposition
  • Structural and functional changes in the brain and neuroregulatory systems

About 70% of people with borderline personality disorder experienced maltreatment during childhood.

However, not everyone who had these experiences will have BPD. And it’s more likely that a combination of factors is responsible for the development of this disorder rather than a single reason.

What Are the Borderline Personality Disorder Symptoms & Signs?

Borderline personality disorder isn’t easily diagnosed. Every person is different, and their experience of BPD differs, too. Not all people with BPD have all symptoms below, and experiencing some of them doesn’t mean having BPD.

To receive a diagnosis, a person must meet 5 out of 9 DSM-5 diagnostic criteria:

Intense worry about real or imagined abandonment 

People with BPD can be alone but don’t tolerate abandonment — both imagined and real — and are desperate to avoid it. The thought of their favorite person (not necessarily a romantic partner) abandoning or rejecting them is unbearable.

Also, it’s extremely difficult for people with BPD to leave someone. So it’s common for them to stay in an unhealthy or abusive relationship, although they would like to be in healthy ones.

They may experience anger outbursts, panic, and feel helpless when faced with real time-limited separation or changes in daily life plans.

For example, should a loved one not answer the call, be late for a meeting, or not put heart emoji in a goodnight message, a person with BPD can plunge into self-devaluation (“I’m bad and not worthy to be with them, my partner doesn’t love me, our relationship is a lie.”) or show aggression towards the “offender” (“How dare you?!”)

Others may be shocked by this behavior and often consider a “bad character” the main reason for this, not suspecting the disease or not taking it seriously.

Unstable interpersonal relationships and seeing the world in extremes

Due to frequent mood swings and unexpected changes in attitudes either to oneself or to a partner, a relationship with the BPD person turns into a rollercoaster. They may idealize their partner and then devalue them — they now can be the best, but if a partner says something “wrong,” they hate them. Sometimes, this happens almost simultaneously.

The perception of the world only in black and white, when there are two extremes, two sides — all good or all bad — makes life very difficult.

Distorted self-image and a weak sense of self

People with BPD have a very vague sense of self and may feel in a new way every time. There is a constant balancing on the border — “I am nothing, and then a genius.” The opinion about themselves directly depends on how others perceive them. Usually, these opinions are inadequate since they are based on the last impression.

People with borderline personality disorder can “adopt” habits, behavioral patterns, interests of their favorite person whom they perceive as their “mirror reflection.” They don’t know who they are and what they need. Today it may be one thing, tomorrow is another.

Therefore, they constantly rush, change, adjust. They change their values, goals, career, partners, religion, sexual orientation, etc. Often, such people are not taken seriously and suffer from their internal instability. All these contribute to the development of depression, anxiety, and stress-related disorders.

Impulsive, self-damaging behavior in at least two areas

A person with BPD tends to engage in risky behaviors, have reckless decisions and intense emotional reactions that lead to accidents. Their impulsivity may easily lead them into dangerous situations, especially when distressed:

  • Impulsive money spending
  • Reckless driving
  • Binge eating
  • Sexual promiscuity
  • Substance abuse
  • Extreme tourism
  • Law violation etc.

Self-harm and suicidal behavior 

People with BPD sometimes feel that only physical pain can drown out unbearable mental pain or fill the emptiness inside. Self-harm in them is common. Through self-mutilative acts, a person tries to feel that they are alive and exist.

Also, one of the most important diagnostic signs of BPD is recurrent suicidal tendencies. According to statistics, about 10% of people with BPD die as a result of suicide.

People in crisis need help right away. If you experience suicidal thinking or behavior, call 911 or your local emergency number.

Reactivity of mood and emotional instability

  • People with BPD experience extreme mood swings
  • Have trouble dealing with intense emotions
  • Tend to suppress their emotions
  • Have difficulty developing stable relationships with others or
  • Establishing healthy boundaries
  • Often act in impulsive and potentially self-damaging ways

Usually, their emotional responses are not proportional to the situation.

They can often find themselves in and out of crisis and intense emotional states that they just cannot control. People with BPD react more intensely to emotional situations because of the sudden and unpredictable nature of their emotional reactions. They can be sweet one moment and then lash out in anger for a few hours.

This inconsistency in the reaction can leave others wondering what caused this sudden shift, take a toll on their relationships with a BPD person, and affect their mental health.

Also, sufferers can become extremely frustrated because they cannot communicate their feelings effectively or regulate their emotions.

Chronic feeling of emptiness

They often suffer in silence, make decisions in secrecy, abandoning social relationships, and feeling an emptiness. Often, it’s described as a feeling that a person is missing something inside and has a strong desire, a thirst to fill it. This feeling of emptiness is sharp, constantly present, and not familiar to many people.

People with BPD often engage in maladaptive behavior or self-harm to fill the void. For example, they try to self-medicate the feeling of emptiness with alcohol.

Intense anger or poor anger management

Anger in people with BPD has a much longer duration than usual. They may try to control situations with threats, acting impulsively or, often, aggressively. They may not listen to what others say, which leads to escalating arguments.

Additionally, speaking up may trigger their distress or hurt their feelings, leading them to act even more aggressively.

It’s difficult for them to control anger, and after the displays of temper, they can experience:

  • Shame
  • Guilt
  • Frustration
  • Self-pity
  • Detachment
  • And rumination

It’s a vicious cycle that intensifies anger and increases its duration. Eventually, they end up often acting out in ways that are destructive to themselves and others.

Also, recurrent physical fights and self-directed anger are some of the displays of aggressiveness.

Paranoid ideation and severe dissociative symptoms

When these people are under stress, they may have short episodes of paranoia, psychotic-like symptoms (such as hallucinations), or dissociation. They can “block” intense painful emotions.

Feeling of the unreality of what is happening (derealization) or a feeling of distance from your body or thoughts (depersonalization) are also common borderline personality disorder symptoms.

People with BPD can “forget” about themselves, existing in other, imaginary worlds. They are often obsessed with books, movies, and various fandoms and associate themselves with some characters.

Diagnosis 

Considering all that has been said, don’t worry if you recognize yourself in most symptoms. This doesn’t automatically mean that you have BPD.

But if you suspect that you or your loved one has borderline personality disorder, and if the symptoms are devastating for both you and the people around you, see a mental health professional.

You can take a huge number of tests on the Internet and find all the symptoms in yourself. However, only a qualified clinician can make an accurate diagnosis based on clinical assessment.

Associated Mental Health Problems

People with BPD may also have comorbid mental health conditions:

  • Generalized anxiety disorder
  • Bipolar disorder
  • Depression
  • Substance use disorders
  • PTSD
  • ADHD
  • Eating disorders
  • Dissociative disorders
  • Other personality disorders

Other personality disorders and borderline personality disorder may be confused since they have certain symptoms in common. That’s why sometimes it’s difficult to distinguish the features and diagnose disorders accurately. However, a person can be diagnosed with more than one personality disorder if they meet the criteria.

It’s especially common for people with borderline personality disorder to be misdiagnosed with bipolar disorder and vice versa because of symptomatic overlap.

How is BPD different from bipolar disorder?

  • Borderline personality disorder is a personality disorder, while bipolar disorder is a mood disorder.
  • Mood swings in BPD and bipolar disorder have different durations. For example, in people with bipolar disorder, depressive episodes may be much longer than in people with BPD.
  • A bipolar person between the episodes of mania or depression can demonstrate stability in daily functioning and relationships, which is not typical for BPD.
  • BPD has psychological aspects, while bipolar disorder is more rooted in biological ones.
  • In bipolar disorder, environmental changes have no impact on moods — e.g., a positive event can’t lift a depressed mood, while in borderline personality disorder, it can significantly impact the mood.

Treatment Approaches for Borderline Personality Disorder 

The truth is that many people who suffer from borderline personality disorder symptoms don’t know that they have it. There is a lot of misinformation about it, and it’s important for them to get the right help they need and deserve.

People with BPD may feel misunderstood, neglected, stigmatized, or belittled a lot of the time. They fear vulnerability and often suffer in silence.

For this reason, it is especially important to have a support system of family, friends, and healthcare professionals who are on hand to help you cope with the symptoms.

Borderline personality disorder is treatable, and recovery takes time. While there is no absolute cure, there are many ways that people with this disorder can deal with the symptoms and lead happy, stable, healthy lives.

If left untreated, BPD can be devastating not only to the person but also to their loved ones.

So, what are the treatment approaches?

  • Psychotherapy
  • Self-care activities (journaling, meditation, mindfulness, regular exercising, healthy diet, quality sleep, developing social support, etc.)
  • Medications

Medications

Currently, there are no FDA-approved medications for BPD treatment. However, some medications can help reduce certain symptoms of this disorder and co-existing ones (depression, anxiety, etc.):

  • Mood stabilizers
  • Antidepressants
  • Antipsychotics
  • Anxiolytics

To develop the best strategy to get the symptoms under control, see your doctor and mental health professional.

Note that medication treatment alone often doesn’t work effectively. It doesn’t address negative behavior or thinking patterns. It should be used in conjunction with talk therapy.

Psychotherapy

Psychotherapy is the fundamental treatment approach for dealing with borderline personality disorder. People with BPD may experience intense emotions and impulsiveness lifelong. However, those who undergo therapy often show improvements from the 1st year and successfully stabilize their relationships by their 30s-40s.

There are some effective evidence-based approaches to treat borderline personality disorder:

Dialectical behavior therapy (DBT)

The DBT approach aims to teach:

  • Coping skills
  • How to control intense emotions
  • Manage distress
  • Reduce self-destructive behaviors
  • Improve relationships

It’s focused on mindfulness and teaching how thoughts can lead to actions.

DBT helps people identify their capabilities, thus increasing their ability to regulate emotions and cope with the challenges they face in everyday life. DPT is often used to treat people with a high risk of self-harm and suicide.

DBT is a form of cognitive-behavioral therapy (CBT). It helps to change the way of thinking in order to change mood and behavior. Together with the therapist, a person works to identify negative thinking patterns and behavioral responses to difficult situations. They develop more balanced and constructive ways to respond to challenges.

Schema therapy

The name of the approach emphasizes the idea that the person with BPD acts according to a schema formed in childhood. Such a schema may be formed under the influence of traumatic events or mistreatment and is activated in adulthood, provoking a certain perception of the world and reactions to it.

The goal of schema therapy is to help the person become aware of their schema, embrace it instead of adopting a new model and find healthy ways to react to events by changing maladaptive behavior patterns.

Mentalization-based therapy (MBT)

MBT refers to the ability of people to reflect on and understand their and others’ feelings, emotions, beliefs. It helps in:

  • Learning emotion regulation skills
  • Understanding how a person impacts their life events, problems, and relationships with others
  • Understanding others and develop compassion for them

Transference-focused psychotherapy (TFP)

The goal of TFP is to help the person become aware of this distortion, develop a more stable and realistic self-image and perception of others, and learn to treat others in a healthier way through transference.

Conclusion

Borderline personality disorder is a serious mental health illness. The symptoms people with BPD experience every day are devastating for them and can significantly affect the lives of their loved ones. They need understanding and support from people around and qualified help from healthcare professionals.

If you think that you or someone you love may have borderline personality disorder, see a doctor and psychiatrist or psychotherapist. Only they can make an accurate diagnostic assessment.

BPD is treatable, although it takes time and effort. You can reduce the impact of borderline personality disorder on your life through treatment by:

  • Addressing traumatic events
  • Learning healthy ways of dealing with emotions
  • Speaking up about your problem and experiences
  • Learning how to understand yourself and others better, etc.

Also, you can change your daily routines and practice self-care to control more aspects of your well-being. Seek a strong support system and professional help from an online therapist. You deserve to live a healthy, happy life!

Kate Skurat

Kate Skurat

Licensed Mental Health | Washington, United States

Kate has a B.S. in Psychology and M.A. in Clinical Psychology from Pepperdine University and has worked in healthcare since 2017. She primarily treated depression, anxiety, eating disorders, trauma, and grief, as well as identity, relationship and adjustment issues. Her clinical experience has focused on individual and group counseling, emergency counseling and outreach. Read more