Borderline personality disorder (BPD) is a serious mental illness. BPD is one of four personality disorders within Cluster B, the unpredictable 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 with regard to relationships.
The instability often felt by people with this disorder can disrupt family and work life, and affect 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 in men. It usually surfaces in the teen years or early adulthood.
The exact cause of BPD is not known, but most researchers believe that it is a combination of biological (body) and psychological (mind) 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 the following possible causes of BPD:
People with BPD have extreme and long-term instability in their emotional lives, which affects their behavior and self-image. Symptoms that are common in people with BPD include the following:
If a patient has symptoms, the doctor will perform a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose personality disorders, the doctor might use various 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, healthcare 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 tell it apart from bipolar disorder (formerly manic-depressive disorder). A qualified healthcare professional will determine if the symptoms point to BPD, bipolar depression, or both.
Treatment for BPD often includes psychotherapy (a type of counseling) and medication. Medication generally is given for specific symptoms—rather than to treat the disorder itself—and might include drugs to steady the patient’s 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 to help the person:
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 improving the person's behavioral abilities and motivation to change negative behavior. DBT is usually an intensive treatment process, involving both group and individual therapy.
The person might need brief stays in the hospital during times of high stress or when symptoms are especially difficult. Many people who have BPD attempt suicide, prompting hospitalization.
Without treatment, people with BPD are at greater risk for:
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.
There is no known way to prevent BPD.
The outlook for people with BPD varies. Although BPD can be a lifelong 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 and have 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 their functioning by the time they are 35 to 40 years old.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 12/08/2017