Borderline Personality Disorder (BPD)

What is borderline personality disorder (BPD)?

Borderline personality disorder (BPD) is a mental health condition marked by extreme mood fluctuations, instability in interpersonal relationships and impulsivity.

People with BPD have an intense fear of abandonment and have trouble regulating their emotions, especially anger. They also tend to show impulsive and dangerous behaviors, such as reckless driving and threatening self-harm. All of these behaviors make it difficult for them to maintain relationships.

Borderline personality disorder is one of a group of conditions called “Cluster B” personality disorders, which involve dramatic and erratic behaviors. Personality disorders are chronic (long-term) dysfunctional behavior patterns that are inflexible, prevalent and lead to social issues and distress.

Many people who live with borderline personality disorder don't know they have it and may not realize there’s a healthier way to behave and relate to others.

What is the difference between borderline personality disorder and bipolar disorder?

While bipolar disorder is also characterized by wide fluctuations in mood and behavior, it’s distinct from borderline personality disorder (BPD).

In BPD, mood and behavior change rapidly in response to significant stress, especially when interacting with other people, whereas in bipolar disorder, moods are more sustained and less reactive. People with bipolar disorder also have significant changes in energy and activity, unlike those with BPD.

Who does borderline personality disorder affect?

Most personality disorders begin in the teen years when your personality further develops and matures. As a result, almost all people diagnosed with borderline personality disorder are above the age of 18.

Although anyone can develop BPD, it’s more common if you have a family history of BPD. People with other mental health conditions, such as anxiety, depression or eating disorders, are also at higher risk.

Nearly 75% of people diagnosed with BPD are people assigned female at birth (AFAB). Research suggests that people assigned male at birth (AMAB) may be equally affected by BPD, but they may be misdiagnosed with post-traumatic stress disorder (PTSD) or depression.

How common is borderline personality disorder?

Borderline personality disorder is relatively rare. Approximately 1.4% of the adult U.S. population has BPD.

What are the signs and symptoms of borderline personality disorder (BPD)?

Signs and symptoms of borderline personality disorder usually appear in your 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.

Symptoms can range from manageable to very severe and can include any combination of the following:

• Fear of abandonment: It’s common for people with BPD to feel uncomfortable being alone. When people with BPD feel that they’re being abandoned or neglected, they feel intense fear or anger. 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.
• Unstable, intense relationships: People with BPD find it challenging to keep healthy personal relationships because they tend to change their views of others abruptly and dramatically. They can go from idealizing others to devaluing them quickly and vice versa. Their friendships, marriages and relationships with family members are often chaotic and unstable.
• Unstable self-image or sense of self: People with BPD often have a distorted or unclear self-image and often feel guilty or ashamed and see themselves as “bad.” They may also abruptly and dramatically change their self-image, shown by suddenly changing their goals, opinions, careers or friends. 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.
• Rapid mood changes: People with BPD may experience sudden changes in how they feel about others, themselves and the world around them. Irrational emotions — including uncontrollable anger, fear, anxiety, hatred, sadness and love — change frequently and suddenly. These swings usually only last a few hours and rarely more than a few days.
• Impulsive and dangerous behavior: Episodes of reckless driving, fighting, gambling, substance use, binge eating and/or unsafe sexual activity are common among people with BPD.
• Repeated self-harm or suicidal behavior: People with BPD may cut, burn or injure themselves (self-harm) or threaten to do so. They may also have suicidal thoughts. These self-destructive acts are usually triggered by rejection, possible abandonment or disappointment in a caregiver or lover.
• Persistent feelings of emptiness: Many people with BPD feel sad, bored, unfulfilled or “empty.” Feelings of worthlessness and self-loathing are common, too.
• Anger management issues: People with BPD have difficulty controlling their anger and often become intensely angry. They may express their anger with biting sarcasm, bitterness or angry tirades. These episodes are often followed by shame and guilt.
• Temporary paranoid thoughts: Dissociative episodes, paranoid thoughts and sometimes hallucinations may be triggered by extreme stress, usually fear of abandonment. These symptoms are temporary and usually not severe enough to be considered a separate disorder.

Not everyone with borderline personality disorder experiences all of these symptoms. The severity, frequency and duration of symptoms are unique to each person.

What causes borderline personality disorder?

Healthcare providers believe BPD results from a combination of factors, including:

• Childhood abuse and trauma: Up to 70% of people with BPD have experienced sexual, emotional or physical abuse as a child. Maternal separation, poor maternal attachment, inappropriate family boundaries and parental substance use disorder are also associated with BPD.
• Genetics: Studies show that borderline personality disorder runs in families. If you have a family history of BPD, you’re more likely — but not guaranteed — to develop the condition.
• Brain changes: In people with BPD, the parts of their brain that control emotion and behavior don’t communicate properly. These problems affect the way their brain works.

How is borderline personality disorder diagnosed?

Personality continues to evolve throughout child and adolescent development. Because of this, healthcare providers don’t typically diagnose someone with borderline personality disorder until after the age of 18. Occasionally, a person younger than 18 may be diagnosed with BPD if symptoms are significant and last at least a year.

Personality disorders, including borderline personality disorder, can be difficult to diagnose, as most people with a personality disorder lack insight into their disruptive behavior and thought patterns.

When they do seek help, it’s often due to conditions such as anxiety or depression as a result of the problems created by their personality disorder, such as divorce or lost relationships, not the disorder itself.

A licensed mental health professional — such as a psychiatrist, psychologist or clinical social worker — can diagnose borderline personality disorder based on the diagnostic criteria for BPD in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

They do so by performing a thorough interview and having conversations about symptoms. They ask questions that’ll shed light on:

• Personal medical history and family medical history, especially histories of mental health conditions.
• Previous work history.
• Impulse control.

Mental health professionals often work with the person’s family and friends to collect more insight into their behaviors and history.

How is borderline personality disorder treated?

BPD historically has been challenging to treat. But with newer, evidence-based treatment, many people with borderline personality disorder experience fewer and less severe symptoms, improved functioning and better quality of life.

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 healthcare provider will work with you to develop a treatment plan.

People with borderline personality disorder often have other mental health conditions, including:

• Mood disorders (80% to 96% of people with BPD).
• Anxiety disorders (88%).
• Substance use disorder (64%).
• Eating disorders (53%).
• Attention-deficit/hyperactivity disorder (ADHD) (10% to 30%).
• Bipolar disorder (15%).
• Somatoform disorders (10%).

If they have a co-existing condition, they’ll also need treatment for it.

Psychotherapy treatment for BPD

Psychotherapy (talk therapy) is the treatment of choice for borderline personality disorder. The goal of treatment is to help you uncover the motivations and fears associated with your thoughts and behavior and to help you learn to relate to others more positively.

Types of therapy that can help treat BPD include:

• Dialectical behavior therapy (DBT): This type of therapy was developed specifically for people with BPD. DBT focuses on helping you accept the reality of your life and your behaviors, as well as helping you learn to change your life, including unhelpful behaviors. It teaches skills to help you control intense emotions, reduce self-destructive behaviors and improve relationships.
• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. Your therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.
• Group therapy: This is a type of psychotherapy in which a group of people meets to describe and discuss their problems together under the supervision of a therapist or psychologist. Group therapy may help people with BPD to interact with others more positively and express themselves effectively.

Medications for BPD

Because the benefits of prescription medication for borderline personality disorder are unclear, healthcare providers typically don’t prescribe medications as the main treatment for BPD.

But in some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental health conditions. Medications can treat anxiety and depression, regulate mood swings or help control impulsive behavior. Antipsychotic (neuroleptic) drugs help some people with BPD.

Can borderline personality disorder be prevented?

Unfortunately, there’s no way to prevent borderline personality disorder.

BPD is often inherited (passed through families), which means you have an increased risk of developing the condition if you have a family history of BPD. Ask your healthcare provider how to recognize signs of the disorder so you can get treatment as early as possible.

What is the prognosis (outlook) for borderline personality disorder?

Most of the time, BPD symptoms gradually decrease with age. Some people’s symptoms disappear in their 40s. With the right treatment, many people with BPD learn to manage their symptoms and improve their quality of life.

Without treatment — or when treatment fails — people with borderline personality disorder have an increased risk of the following:

• Substance use disorder and alcohol use disorder.
• Depression.
• Self-harm.
• Suicide.

The risk of suicide in people with BPD is 40 times that of the general population. About 8% to 10% of people with BPD die by suicide.

Many people with untreated BPD also 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.

How can I help someone with borderline personality disorder?

If you know someone who lives with borderline personality disorder, here are some ways you can help them:

• Take time to learn about the BPD to understand what your loved one is experiencing.
• Encourage your loved one to seek treatment for BPD and ask about family therapy if they’re a relative of yours.
• Offer emotional support, understanding and patience. Change can be difficult and frightening to people with BPD, but their symptoms can improve over time with treatment.
• Seek therapy for yourself if you’re experiencing significant stress or symptoms of mental health conditions, such as anxiety or depression. Choose a different therapist from the person your loved one is seeing.

People with BPD have a significantly higher rate of self-harming and suicidal behavior than the general population.

People with BPD who are thinking of harming themselves or attempting suicide need help right away.

If you or someone you know is in immediate distress or thinking about hurting themselves, call the Suicide and Crisis Lifeline toll-free at 988.

A note from Cleveland Clinic

It’s important to remember that borderline personality disorder (BPD) is a lifelong mental health condition. But long-term, ongoing treatment — such as medication and talk therapy — can help manage your symptoms. It’s important to see your healthcare team regularly to monitor your treatment plan and symptoms. Know that your healthcare providers and loved ones are there to support you.

The family members and loved ones of people with borderline personality disorder often experience stress, depression, grief and isolation. It’s also important to take care of your mental health and seek help if you’re experiencing these symptoms.