Borderline Personality Disorder (BPD)
What is borderline personality disorder (BPD)?
Borderline personality disorder (BPD) is a serious mental illness. People with BPD have trouble regulating their emotions, controlling their behavior and maintaining stable relationships. They’re likely to engage in dangerous or harmful behavior, such as reckless driving or risky sex.
If you have BPD, you may experience intense feelings that change suddenly. You might feel the urge to harm yourself. Providers treat BPD with psychotherapy (talk therapy), medication or both. BPD symptoms usually appear during adolescence or early adulthood. They may gradually become less severe over time.
How common is borderline personality disorder (BPD)?
Healthcare providers don’t know exactly how many people have borderline personality disorder (BPD). They estimate that up to 6% of people in the United States have the condition.
Who is likely to get borderline personality disorder (BPD)?
Women are more likely than men to get a borderline personality disorder (BPD) diagnosis. Men are often misdiagnosed with depression or post-traumatic stress disorder (PTSD) instead. Although anyone can develop the disorder, it’s more common if you have a family history of BPD. People with other mental health disorders (such as anxiety, depression or eating disorders) are at higher risk.
Symptoms and Causes
What causes borderline personality disorder (BPD)?
Healthcare providers believe borderline personality disorder (BPD) results from a combination of genes and environmental factors. Causes of BPD include:
- Abuse and trauma: People who have been sexually, emotionally or physically abused have a higher risk of BPD. Neglect, mistreatment or separation from a parent also raises the risk.
- Genetics: Borderline personality disorder runs in families. If you have a family history of BPD, you’re more likely to develop the condition.
- Differences in the brain: In people with BPD, the parts of the brain that control emotion and behavior don’t communicate properly. These problems affect the way the brain works.
What are the symptoms of borderline personality disorder (BPD)?
Symptoms of borderline personality disorder (BPD) usually appear in the late teenage years or early adulthood. A troubling event or stressful experience can trigger symptoms or make them worse. Over time, symptoms usually decrease and may go away completely.
Some people have a handful of BPD symptoms, while others have many. Symptoms can range from manageable to very severe. Because BPD symptoms are similar to those of bipolar disorder, people sometimes confuse the two conditions. The most common signs of BPD include:
- Frequent and intense mood swings: If you have BDP, you may experience sudden changes in how you feel about others, yourself and the world around you. Irrational emotions — including uncontrollable anger, fear, anxiety, hatred, sadness and love — change frequently and suddenly. You may be quick to lash out at others and have trouble calming down when you’re upset.
- Fear of abandonment: It’s common for people with BPD to feel uncomfortable with being alone. They have a strong fear of being abandoned or rejected. They might track their loved ones’ whereabouts or stop them from leaving. Or they might push people away before getting too close to avoid rejection.
- Difficulty maintaining relationships: People with BPD find it challenging to keep healthy personal relationships. Their friendships, marriages and relationships with family members are often chaotic and unstable.
- Impulsive and dangerous behavior: Episodes of reckless driving, fighting, gambling, substance abuse and unsafe sexual activity are common among people with BPD. Self-destructive behavior can be difficult or impossible to control.
- Self-harm: People with BPD may cut, burn or injure themselves (self-injury) or have suicidal thoughts. They have a distorted or unclear self-image and often feel guilty or ashamed. They also tend to sabotage their own progress. For instance, they may fail a test on purpose, ruin relationships or get fired from a job.
- Depression: Many people with BPD feel sad, bored, unfulfilled or “empty.” Feelings of worthlessness and self-loathing are common, too.
- Paranoia: If you have BPD, you may worry that people don’t like you or want to spend time with you. People with BPD may feel confused, lose touch with reality or have “out-of-body” experiences.
Diagnosis and Tests
How is borderline personality disorder (BPD) diagnosed?
There isn’t a medical test to confirm a borderline personality disorder (BPD) diagnosis. Your provider may do a physical exam or order a blood test to rule out health conditions that may be causing your symptoms. Healthcare providers diagnose BPD after several interviews with you. Your provider might also talk to your family members or friends.
The interviews will include questions about your symptoms, relationships, behaviors and mental health history. BPD often occurs along with other mental health conditions. Your provider will work with you to get a clear picture of your unique symptoms and overall health.
Management and Treatment
Can borderline personality disorder (BPD) be treated?
Borderline personality disorder (BPD) can be treated. Many people with BPD manage the condition and lead fulfilling lives. But effective treatment takes time, patience and commitment. Treatment may include psychotherapy (talk therapy), medications or both.
Your healthcare provider may recommend a short-term hospital stay if you’re very distressed or at risk of harming yourself or others. During your stay, your provider will work with you to develop a treatment plan. Treatment for BPD includes:
- Therapy and counseling: Many types of psychotherapy can help you manage BPD. You might have dialectical behavior therapy (DBT) or cognitive behavioral therapy (CBT). A counselor works with you during several sessions to learn to manage emotions, recognize and change unwanted behaviors and gain a new perspective. You may have group therapy or talk one-on-one with a specially trained counselor.
- Medications: Although no medication treats the disorder itself, your provider may recommend one or more drugs to treat BPD symptoms. Medications can treat anxiety and depression, regulate mood swings or help you control impulsive behavior. Anti-psychotic drugs help some people with BPD.
Can I prevent borderline personality (BPD) disorder?
There is no way to prevent borderline personality disorder (BPD). BPD is often inherited (passed through families). You have an increased risk of developing the condition if you have a family history of BPD. Ask your provider how to recognize signs of the disorder so you can get treatment as early as possible.
Outlook / Prognosis
What is the outlook for people who have borderline personality disorder (BPD)?
Most of the time, borderline personality disorder (BPD) symptoms gradually decrease with age. Some people’s symptoms disappear in their 40s. With the right treatment, many people with borderline personality disorder learn to manage their symptoms and improve their quality of life.
Without treatment, people with BPD have an increased risk of drug and alcohol abuse, depression, self-harm and suicide. Many people with BPD experience unstable or chaotic personal relationships and have trouble keeping a job. They have an increased risk of divorce, estrangement from family members and rocky friendships. Legal and financial problems are also common.
When should I see my healthcare provider about borderline personality disorder (BPD)?
If you or a loved one has symptoms of borderline personality disorder (BPD), talk to your healthcare provider right away. It’s essential to get treatment as soon as possible. If you have thoughts of suicide or think you may harm yourself, get help immediately by calling 911, the National Suicide Prevention Lifeline (800-273-8255) or going to the emergency room.
A note from Cleveland Clinic
Borderline personality disorder is a mental illness. You may feel overwhelmed, hopeless and out of control, but treatments can help. Most people with BPD improve over time and learn to manage their symptoms. Treatment for BPD takes patience and requires a long-term commitment. Talk to your provider about a plan that works for you. With treatment, many people with BPD can lead happier, healthier lives.