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Borderline Personality Disorder

What is borderline personality disorder?

Borderline personality disorder (BPD) is a serious mental illness, one of a group of conditions called personality disorders. BPD is one of four personality disorders within Cluster B, the erratic and dramatic group of disorders. People with these disorders have intense, unstable emotions and a distorted self-image. People with BPD also display unpredictable and impulsive behavior, have unstable relationships, and suffer from identity confusion. BPD can be summarized as an inability to regulate emotions, especially regarding relationship issues.

The instability often felt by people with this disorder can disrupt family and work life, as well as impact their self-identity. People with BPD are likely to have other mental health problems, as well, such as substance abuse, anxiety disorders, eating disorders, and depression. BPD is more common in women than men. It usually surfaces in the teen years or early adulthood.

What are the symptoms of borderline personality disorder?

People with BPD have extreme and long-standing instability in their emotional lives, which affects their behavior and self-image. Symptoms that are common in people with BPD include the following:

  • Intense but chaotic personal relationships
  • Unpredictable, dangerous and/or impulsive behavior, such as excessive spending, risky sex, reckless driving, substance abuse, shoplifting, and binge eating, or physically self-destructive behavior, such as self-injury or suicide attempts
  • Rapid mood swings, and periods of intense depression, irritability, and anxiety (which might last only hours)
  • Intense or inappropriate anger
  • Confusion regarding self-image, sexual orientation, and choice of careers or friends
  • Recurring feelings of emptiness and boredom
  • Frantic avoidance of real or imagined abandonment
  • Discomfort with being alone
  • Brief periods of confused thinking and perception during times of great stress
  • Extreme "black and white" views of people and experiences (They are either entirely good or entirely bad.)

What causes borderline personality disorder?

The exact cause of borderline personality disorder is not known, but most researchers believe that it is caused by a combination of biological and psychological factors. People with this disorder might be born with a vulnerability to the disorder, which is then triggered by stress or other factors.

For example, research suggests that a malfunction in the brain might be responsible for the impulsiveness, mood instability, anger, and negative emotions that are common in people with this disorder. Psychological "triggers" might include childhood trauma, such as abuse, neglect, prolonged separation, or inconsistent parenting. A disruptive family life and poor communication within the family also are risk factors for the development of BPD.

How is borderline personality disorder diagnosed?

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various diagnostic tests—such as X-rays and blood tests—to rule out physical illness as the cause of the symptoms.

If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for a personality disorder.

Because the symptoms of BPD include erratic behavior and profound mood swings, it is difficult to distinguish from bipolar disorder (formerly manic-depressive disorder). A qualified health care professional will determine if the symptoms best indicate BPD, bipolar depression, or both.

How is borderline personality disorder treated?

Treatment for borderline personality disorder often includes psychotherapy (a type of counseling) and medication. Medication generally is given to target specific symptoms—rather than to treat the disorder itself—and might include drugs to stabilize mood, or to treat depression or anxiety. Anti-psychotic medications might also be used if the person suffers from severe periods of distorted thinking.

Psychotherapy is the main treatment for most personality disorders, including BPD. The focus of therapy is on increasing self-awareness and stability in relationships, as well as on helping the individual become less impulsive, and to use better judgment in his or her behavior and decisions.

A special type of behavior therapy, called dialectical behavior therapy (DBT), might be useful for people with BPD. The focus of DBT is on acceptance and change, and therapy is aimed at enhancing the person’s behavioral abilities and improving motivation to change negative behavior. DBT is usually an intensive treatment process, involving group and individual therapy.

Brief stays in the hospital might be necessary during times of high stress or when symptoms are particularly distressful. Many people with this disorder attempt suicide, prompting hospitalization.

What are the complications of borderline personality disorder?

Without treatment, people with borderline personality disorder are at greater risk for:

  • Substance abuse
  • Eating disorders
  • Depression
  • Self-injury
  • Suicide

In addition, BPD is linked to high conflict, divorce, and separation from family members and friends. It also can lead to various financial and legal problems.

What is the outlook for people with borderline personality disorder?

The outlook for people with borderline personality disorder varies. Although BPD can be a life-long problem, people with the disorder can get better. In most cases, however, recovery is slow and difficult. With help, some people are able to improve and lead rewarding work and social lives. Others are unwilling or unable to stick with treatment, leading to a poor outlook. For unknown reasons, however, this disorder tends to "burn out" in middle age, and people with BPD often begin to see improvement in function by the time they reach 35 to 40 years old.

Can borderline personality disorder be prevented?

There is no known way to prevent BPD.

© 1995-2010 The Cleveland Clinic Foundation. All rights reserved.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/13/2010…#9762