Understanding Borderline Personality Disorder (BPD)

Symptoms, Causes, Treatment, and When to Get Help

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Borderline personality disorder (BPD) is a serious psychological condition that's characterized by unstable moods and emotions, relationships, and behavior. It's one of several personality disorders recognized by the American Psychiatric Association (APA). Personality disorders are psychological conditions that begin in adolescence or early adulthood, continue over many years, and, when left untreated, can cause a great deal of distress. Thankfully, treatment that's targeted to BPD can help significantly.

Symptoms

BPD can often interfere with your ability to enjoy life or achieve fulfillment in relationships, work, or school. It's associated with specific and significant problems in interpersonal relationships, self-image, emotions, behaviors, and thinking, including:

  • Relationships: People with BPD tend to have intense relationships with their friends, family, and loved ones characterized by a lot of conflicts, arguments, and break-ups. BPD is also associated with a strong sensitivity to abandonment, which includes an intense fear of being abandoned by loved ones and attempts to avoid real or imagined abandonment. This usually leads to difficulty trusting anyone and may cause significant strain on interpersonal relationships.
  • Self-image: Individuals with BPD have difficulties related to the stability of their sense of self. They report many ups and downs in how they feel about themselves. One moment they may feel good about themselves, but the next they may feel they are bad or even evil.
  • Emotions: Emotional instability is a key feature of BPD. Individuals with BPD may say that they feel as if they are on an emotional roller coaster with very quick shifts in mood (for example, going from feeling okay to feeling extremely down or blue within a few minutes). These mood changes can last from minutes to days and are often intense. Feelings of anger, anxiety, and overwhelming emptiness are common as well.
  • Behaviors: BPD is associated with a tendency to engage in risky and impulsive behaviors, such as going on shopping sprees, drinking excessive amounts of alcohol or abusing drugs, engaging in promiscuous or risky sex, or binge eating. Also, people with BPD are more prone to engage in self-harming behaviors, such as cutting or burning and to attempt suicide.
  • Stress-related changes in thinking: Under conditions of stress, people with BPD may experience changes in thinking, including paranoid thoughts (for example, thoughts that others may be trying to cause them harm), or dissociation (feeling spaced out, numb, or like they're not really in their body).

Causes

Like most psychological disorders, the exact cause of BPD is not known. However, there is research to suggest that some combination of nature (biology or genetics) and nurture (environment) is at play. Contributing factors that may increase your risk include:

  • Negative experiences: Research has shown that many people diagnosed with BPD have experienced childhood abuse, trauma, or neglect or were separated from their caregivers at an early age. However, not all people with BPD had one of these childhood experiences and, conversely, many people who have had these experiences do not have BPD.
  • Brain structure: There is also evidence of differences in brain structure and function in individuals with BPD, especially in the parts of the brain that affect impulse control and emotional regulation. However, it's still unclear if these differences are a result of having BPD or if they are part of the cause.
  • Family history: Having a parent or sibling with BPD also means you may be a higher risk of developing it.

Remember that a risk factor is not the same as a cause; just because you have risk factors doesn't mean you will develop BPD, just as many people who don't have these risk factors develop it anyway.

Treatment

Although at one time experts believed that BPD was unlikely to respond to treatment, research has now shown that BPD is very treatable. Getting help from a mental health professional is critical because, with consistent treatment, you can live a better quality of life with fewer symptoms. Since BPD is associated with risky behavior, self-harm, and suicide, treatment can also help curb these behaviors. Find someone who specializes in BPD because you will need treatments that are targeted specifically to BPD. If you aren't getting the right treatment, it may not be as effective.

Treatment options include:

  • Psychotherapy: This is the standard treatment for BPD. Examples of psychotherapy that are targeted to BPD include dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT). This may include your family, friends, or caregivers as well.
  • Medication: Your mental health professional may also recommend medication to help treat certain symptoms such as depression or mood swings.
  • Other treatments: Hospitalization or more intensive treatments may be necessary as well in times of crisis.

The symptoms of BPD can affect a variety of areas, including work, school, relationships, legal status, and physical health, which is why treatment is so critical. Despite the obstacles that BPD can cause, many people with BPD lead normal, fulfilling lives when they stick with their treatment plan.

When to Get Help

If you or a loved one are having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. Calls are free and your information is kept confidential.

If you think that you or a loved one may suffer from BPD, it's imperative that you seek the help of a licensed mental health professional, such as a mental health counselor, social worker, psychologist, or psychiatrist. It's important to remember that many of the symptoms of BPD are symptoms that everyone experiences from time to time. Also, some of the symptoms of BPD overlap with other mental and physical conditions. Only a licensed professional can diagnose BPD.

The good news is that once a diagnosis is made, there is hope. Your therapist or doctor can help to determine a plan of action, which may include psychotherapy, medications, or other treatments. Research has shown that with good, consistent treatment, BPD symptoms can be reduced significantly. Some people who were once diagnosed with BPD no longer meet criteria for the disorder with treatment and time.

View Article Sources
  • American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: 2013.
  • National Institute of Mental Health (NIMH). Borderline Personality Disorder. National Institutes of Health. U.S. Department of Health and Human Services. Updated December 2017.
  • National Institute of Mental Health (NIMH). Borderline Personality Disorder: What Is Borderline Personality Disorder? NIH Publication No. QF 17-4928. National Institutes of Health. U.S. Department of Health and Human Services.