Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is a mental health condition that affects your ability to regulate your emotions. You may experience periods of feeling intense and often uncontrollable emotions after a triggering event. As a result, it can affect the way you see yourself and cause you to act impulsively, which can disrupt relationships in your life.

Each person’s experience with BPD is different. You might not see yourself positively or hold yourself with confidence. You may self-sabotage by failing a test intentionally or not showing up to work. You may view others in extremes and quickly change your opinion of them. You may cling to others due to a strong fear of abandonment. Or you might drive recklessly or self-harm without thinking about the consequences of your actions.

Borderline personality disorder is one of a group of conditions called “Cluster B” personality disorders. These are chronic (long-term) conditions that cause unstable moods and emotions, impulsive behaviors and social dysfunction.

These behaviors may seem normal to you because it’s how part of your brain is wired. But the location of these wires isn’t permanent. A healthcare provider can help you find healthier ways to manage your emotions.

BPD affects an estimated 1 out of every 100 people in the United States.

Borderline personality disorder symptoms

Signs and symptoms of BPD can range from manageable to very severe. They include any combination of the following:

• Fear of abandonment: You might feel very strong emotions when you’re alone. This might lead you to track down loved ones or push people away to avoid rejection.
• Unstable relationships: Healthy relationships may be difficult to manage because you may quickly change your view of someone from love to hate unpredictably.
• Identity disturbances: You may have a negative view of yourself in your mind. You might suddenly change the way others see you by choosing a new friend group, hobby or opinion.
• Impulsive behaviors: You may act without thinking about the consequences, like driving well over the speed limit, overspending or overconsuming addictive substances.
• Suicidal ideation: You may openly talk about or threaten suicidal behavior to others or perform self-harm behaviors.
• Mood changes: You might feel intense emotions like uncontrollable anger, fear, anxiety, hatred, sadness and love. These moods change often and quickly. They usually only last a few hours and rarely more than a few days.
• Feeling empty: You may consistently feel sad, bored or unfulfilled. Feelings of worthlessness and self-loathing are common, too.
• Intense anger: You may have a lot of trouble controlling your temper. This could lead to physical fights or frequent outbursts. You may feel shame or guilt after.
• Stress-related dissociation: Extreme stress may cause disconnected thoughts, an out-of-body feeling and hallucinations.

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

Borderline personality disorder causes

Adverse childhood experiences may contribute to the development of borderline personality disorder. Common negative experiences may include, but aren’t limited to, the following:

• Neglect
• Physical and/or sexual abuse
• Removal, separation or loss of a caregiver, parent or loved one

In some cases, the parts of your brain responsible for emotion and behavior may have trouble communicating as expected. This could lead to BPD symptoms.

Risk factors

Although anyone can develop BPD, it’s more common if you:

• Have a biological relative diagnosed with BPD
• Have other mental health conditions (like anxiety, depression or eating disorders)

Most diagnosed cases of BPD affect females. Research suggests that males may be equally affected by BPD. Unfortunately, males may be misdiagnosed with another mental health condition like post-traumatic stress disorder (PTSD) or depression.

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

Is borderline personality disorder genetic?

You may have a higher risk of developing borderline personality disorder if it runs in your biological family. BPD is five times more common if you have a first-degree relative, like a biological parent or sibling, diagnosed with the condition.

Complications of borderline personality disorder

Borderline personality disorder can affect your emotional well-being. You may be more at risk of developing other mental health conditions like depression, anxiety, eating disorders or substance use disorder.

BPD can significantly impact your personal life, especially if it goes undiagnosed or untreated. You might have unstable or chaotic personal relationships and have trouble keeping a job. You may also have an increased risk of divorce, estrangement from family members and rocky friendships. Legal and financial problems are also common.

Your risk of death by suicide increases significantly with borderline personality disorder. You may be more likely to self-harm or to take risks without thinking about the possible outcomes, even if they could be life-threatening.

How doctors diagnose borderline personality disorder

A mental health professional, like a psychiatrist or a psychologist, can diagnose this condition. They’ll compare your symptoms with the diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

There isn’t a single BPD test to diagnose it. Instead, your provider will perform a thorough interview and discuss your symptoms. They’ll ask questions that’ll shed light on:

• Behaviors and impulse control
• Emotions, mood and stress
• Personal medical history and family medical history, especially histories of mental health conditions

Your provider will evaluate the severity of your symptoms during the initial diagnosis. This can help them create a treatment plan that best fits your needs.

Personality disorders can be difficult to diagnose, as you may not see your behavior or thought patterns as disruptive. Mental health professionals often work with your family and friends to collect more insight into your behaviors and history.

As your personality continues to evolve throughout childhood and adolescence, providers don’t typically diagnose BPD until after age 18. Occasionally, a person younger than 18 may receive a diagnosis if symptoms are significant and last at least a year.

After your provider makes a diagnosis, they’ll help you learn more about BPD and what this means for you. They’ll clear up any misconceptions about the condition because it isn’t always presented accurately in shows or movies. Then, they’ll work with you to discuss the next steps in your treatment plan.

Borderline personality disorder treatments

Your provider will recommend psychotherapy or talk therapy 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.

There are different types of therapy that may help treat BPD, including:

• Dialectical behavior therapy (DBT): DBT can teach you new skills to help you manage your emotions and behaviors and improve relationships in your life.
• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. You’ll see how your thoughts affect your actions. You can learn to adopt healthier thinking patterns.
• Group therapy: Group therapy may help you interact with others more positively and express yourself effectively.
• Mentalization-based therapy (MBT): To help improve your relationships, you’ll work on improving your ability to understand and interpret your thoughts, emotions and behaviors.
• Schema therapy (ST): You’ll address adverse childhood experiences to help you identify and change negative thoughts and behaviors into healthy ones.
• Transference-focused psychotherapy (TFP): You’ll work on improving how you see yourself and how you regulate your emotions, especially when it comes to conflicts in relationships.

Your healthcare provider may recommend a short-term hospital stay if you’re very distressed or at risk of harming yourself or others. This stay is designed to keep you safe. Your care team will help you create a treatment plan so you have the resources you need when you leave the hospital.

BPD medication

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.

If your provider recommends a medication, it’ll be time-limited to address a specific symptom you experience. It also won’t be prescribed alone. You’ll need to participate in psychotherapy while taking the medication to see its effectiveness. Your provider may review or change the medications you take every six months to make sure it’s working.

In some cases, a provider may recommend medications to treat other mental health conditions. Medications are available for anxiety, depression and bipolar disorder, among others.

When to get help for BPD

Due to the intense emotions you feel, your risk of harming yourself or attempting suicide is much higher than others.

If you’re thinking about suicide, know that there are people available 24/7 who can help you through whatever you’re dealing with at that moment. You can call or text 988. This is the Suicide & Crisis Lifeline (U.S.). You don’t have to be in a crisis to talk to someone.

If you’re in immediate danger, call 911 or your local emergency services number.

What can I expect if I have borderline personality disorder?

Borderline personality disorder is a lifelong mental health condition. Even though symptoms may gradually decrease with age, usually around 40, you shouldn’t wait for your symptoms to fade. This is because the rippling effects of your emotions and behavior may significantly impact you for more than just the length of time when you have them.

With the right treatment, you can learn skills to manage your emotions and behavior in a healthy way that can benefit you for a lifetime.

If symptoms continue without an accurate diagnosis and treatment, it may affect your life expectancy due to the risk of suicide and self-harming behaviors.

BPD historically has been challenging to treat. But with newer, person-centered treatment plans, many people with BPD experience fewer and less severe symptoms, improved functioning and better quality of life.