Borderline Personality Disorder: Causes, Symptoms, and Treatment (2023)

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Borderline Personality Disorder: Causes, Symptoms, and Treatment (1)

What is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a mental illness characterized by extreme mood swings, instability in interpersonal relationships, and impulsiveness.

People with BPD have a strong fear of abandonment and have difficulty regulating their emotions, especially anger. They also tend to engage in impulsive and risky behaviors such as reckless driving and threats of self-harm. All this behavior makes it difficult for them to maintain relationships.

Borderline personality disorder is one of a group of disorders called "System B."Personality disorder, including dramatic and erratic behavior. Personality disorders are chronic (long-term) dysfunctional patterns of behavior that are rigid, pervasive, and lead to social problems and distress.

Many people with borderline personality disorder don't know they have it and may not realize there is a healthier way to behave and interact with others.

What is the difference between Borderline Personality Disorder and Bipolar Disorder?

WhileBipolar disorderalso characterized by extensive changes in mood and behavior, it is distinct from borderline personality disorder (BPD).

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

Who Is Affected by Borderline Personality Disorder?

Most personality disorders begin in adolescence, when the personality continues to develop and mature. As a result, almost all people diagnosed with borderline personality disorder are over the age of 18.

While anyone can develop borderline, it's more common if you have a family history of borderline. People with other mental illnesses, such asbeing worried about,depressionHeeating disordersThey are also at higher risk.

Nearly 75% of people diagnosed with BPD are people assigned female at birth (AFAB). Research suggests people assigned male at birth (AMAB) may be equally affected by BPD, but may be misdiagnosedpost-traumatic stress disorder (PTSD)the Depression

How common is borderline personality disorder?

Borderline personality disorder is relatively rare. About 1.4% of the US adult population has BPD.

Symptoms and causes

What Are the Signs and Symptoms of Borderline Personality Disorder (BPD)?

The signs and symptoms of borderline personality disorder usually appear in late adolescence or early adulthood. A worrying event or stressful experience can trigger or exacerbate symptoms.

Over time, the symptoms usually lessen and may disappear completely.

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

  • The fear of being abandoned: It's common for people with BPD to feel uncomfortable being alone. When people with BPD feel abandoned or neglected, they feel intense fear or anger. They can track the whereabouts of their loved ones or prevent them from leaving. Or they may push people away before they get too close to avoid rejection.
  • Unstable and intense relationships.: People with BPD find it difficult to maintain healthy personal relationships because they tend to abruptly and dramatically change their view of others. They can quickly move from idealizing others to belittling them and vice versa. Their friendships, marriages and relationships with relatives 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 suddenly and drastically change their self-image, evidenced by suddenly changing their goals, opinions, career, or friends. They also tend to sabotage their own progress. For example, they may deliberately fail a test, break off relationships, or be fired from a job.
  • rapid mood swings: 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 changes 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,Eat excessivelyand/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 from a caretaker or lover.
  • Persistent feelings of emptiness.: Many people with BPD feel sad, bored, dissatisfied, or "empty." Feelings of worthlessness and self-loathing are also common.
  • problems with anger management: People with BPD have trouble controlling their anger and often get very angry. They may express their anger with sarcasm, bitterness, or angry tirades. These episodes are often followed by shame and guilt.
  • temporary paranoid thoughts:dissociative episodesParanoid thoughts and sometimes hallucinations can be triggered by extreme stress, usually separation anxiety. These symptoms are temporary and usually not severe enough to be considered a separate condition.

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?

Health care providers believe that BPD results from a combination of factors, including:

  • Child abuse and trauma: Up to 70% of people with BPD have experienced sexual, emotional, or physical abusechild abuse. 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 are more likely, but not guaranteed, to develop the condition.
  • changes in the brain: In people with BPD, the parts of the brain that control emotions and behavior don't communicate correctly. These problems affect the way their brains work.

Diagnosis and testing

How is borderline personality disorder diagnosed?

Personality continues to develop throughout child and adolescent development. That's why health care providers generally don't diagnose someone with borderline personality disorder after age 18. Occasionally, a person under the age of 18 may be diagnosed with BPD if symptoms are significant and persist for at least a year.

Personality disorders, including borderline personality disorder, can be difficult to diagnose because most people with personality disorders are unaware of their disruptive behaviors and thinking patterns.

When they seek help, it is often for conditions such as anxiety or depression due to the problems caused by their personality disorder, such as divorce or loss of relationships, not for the disorder itself.

A licensed mental health professional, such as apsychiatrist,psychologisto Clinical social worker: can diagnose borderline personality disorder based on the American Psychiatric Association's diagnostic criteria for BPDDiagnostic and Statistical Manual of Mental Disorders.

They do this by conducting an extensive interview and discussing the symptoms. They ask questions that shed light on:

  • Personal medical history and family medical history, especially a history of mental illness.
  • Previous employment history.
  • Impulse control.

Mental health professionals often work with the person's family and friends to gather more information about their behavior and history.

Management and treatment

How is borderline personality disorder treated?

Historically, BPD has been difficult to treat. But with newer, evidence-based treatments, many people with borderline personality disorder experience fewer and less severe symptoms, better functioning, and a better quality of life.

But effective treatment requires time, patience and dedication. Treatment may include psychotherapy (talk therapy), medication, or both.

Your healthcare provider may recommend a short hospital stay if you are very distressed or at risk of harming yourself or others. During your stay, your healthcare provider will draw up a treatment plan with you.

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

  • 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 an underlying condition, they also need treatment.

Psychotherapy for BPD

Psychotherapy (talking) is the treatment of choice for borderline personality disorder. The goal of therapy is to help you discover the motivations and fears associated with your thoughts and behaviors and to help you interact with others in a more positive way.

Types of therapy that can help treat BPD include:

  • Dialectical Behavior Therapy (DBT): This type of treatment is specifically designed for people with BPD. DBT is aimed at helping you accept the reality of your life and behavior and helping you change your life, including unhelpful behavior. Teaches skills to help you manage strong emotions, reduce self-destructive behaviors, and improve relationships.
  • Cognitive Behavioral Therapy (CBT): This is a structured and targeted form of treatment. Your therapist or psychologist will help you examine your thoughts and feelings. You will 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 form of psychotherapy in which a group of people come together to describe and discuss their problems under the supervision of a therapist or psychologist. Group therapy can help people with BPD interact with others in a more positive way and express themselves more effectively.

Medications for BPD

Because the benefits of prescription medications for borderline personality disorder are not clear, health care providers generally do not prescribe medications as the main treatment for BPD.

However, 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 control impulsive behavior. Antipsychotics (antipsychotics) help some people with BPD.


Can Borderline Personality Disorder Be Prevented?

Unfortunately, there is no way to prevent borderline personality disorder.

BPD is often hereditary (passed down from parent to child), meaning you're at a higher risk of developing the condition if you have a family history of BPD. Ask your healthcare provider how to spot the signs of the condition so you can get treatment as soon as possible.

Outlook / Forecast

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

Usually, the symptoms of BPD gradually decrease with age. Some people's symptoms go away by age 40. With proper treatment, many people with BPD learn to control their symptoms and improve their quality of life.

Without treatment, people with borderline personality disorder are at increased risk for the following:

  • substance use disorder andalcohol use disorder.
  • Depression.
  • Self hurt.
  • Suicide.

The risk of suicide in people with BPD is 40 times greater than 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 struggle to hold down a job. They are at greater risk of divorce, estrangement from relatives and difficult friendships. Legal and financial problems are also common.

they live with me

How can I help someone with borderline personality disorder?

If you know someone with borderline personality disorder, you can help in the following ways:

  • Take the time to learn about borderline to understand what your loved one is going through.
  • Encourage your loved one to seek treatment for BPD and ask about family therapy if they are family members.
  • Offer emotional support, understanding, and patience. Change can be difficult and scary for people with BPD, but their symptoms may improve over time with treatment.
  • Seek self-treatment if you experience significant stress or psychological symptoms, such as anxiety or depression. Choose a therapist other than the one your loved one sees.

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

People with BPD who are thinking about harming themselves or trying to commit suicide need immediate help.

If you or someone you know is in immediate danger or is considering harming yourself, call the Suicide and Crisis Lifeline toll-free at 988.

Note from the Cleveland Clinic

It's important to remember that borderline personality disorder (BPD) is a mental illness. As with all mental illnesses, seeking help as soon as symptoms appear can help reduce disruptions in life. Mental health professionals can offer treatment plans that can help people with BPD control their thoughts and behaviors.

Family members and loved ones of people with borderline personality disorder often experience anxiety, depression, sadness, and isolation. It's also important to take care of your mental health and seek help if you experience these symptoms.


What are the root causes of borderline personality disorder? ›

These include:
  • being a victim of emotional, physical or sexual abuse.
  • being exposed to long-term fear or distress as a child.
  • being neglected by 1 or both parents.
  • growing up with another family member who had a serious mental health condition, such as bipolar disorder or a drink or drug misuse problem.

What is the main treatment for borderline personality disorder? ›

Psychotherapy (sometimes called talk therapy) is the main treatment for people with borderline personality disorder. Most psychotherapy occurs with a licensed, trained mental health professional in one-on-one sessions or with other people in group settings.

What health problems are caused by borderline personality disorder? ›

Borderline personality disorder (BPD) is associated with many negative physical health outcomes, including increased risk for serious chronic diseases such as diabetes, heart disease, and arthritis. BPD is also linked with obesity, a condition that is strongly related to many of the same physical health problems.

What kind of upbringing causes BPD? ›

Stressful or traumatic life events

If you get a BPD diagnosis you're more likely than most people to have had difficult or traumatic experiences growing up, such as: Often having felt afraid, upset, unsupported or invalidated.

Are you born with BPD or does it develop? ›

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.

What are the 4 stages of BPD? ›

The four types of BPD include impulsive, discouraged, self-destructive, and petulant. Each highlights a different aspect of BPD. For example, people with impulsive BPD tend to act without thinking about the consequences. People with self-destructive BPD struggle with self-hatred and suicidal thoughts.

Why do borderlines hurt the ones they love? ›

BPD splitting destroys relationships because the behaviour can be impulsive or reckless in order to alleviate the pain, often hurting loved ones in the process. It can feel like everyone abandons or hurts them, often causing them to look for evidence, and creating problems from nothing.

How does a BPD person think? ›

People with BPD also have a tendency to think in extremes, a phenomenon called "dichotomous" or “black-or-white” thinking. 3 People with BPD often struggle to see the complexity in people and situations and are unable to recognize that things are often not either perfect or horrible, but are something in between.

What does a BPD episode look like? ›

Recognizing a BPD Episode

Intense outbursts of anger are indicative of an episode of BPD as are bouts of depression and anxiety. Eighty percent of those suffering from BPD experience suicidal thoughts and behavior while in the throes of an episode as well.

What mood stabilizer is best for BPD? ›

Common anticonvulsants and mood stabilizers for BPD include:
  • Depakote (valproate)
  • Lamictal (lamotrigine)
  • Lithobid (lithium)
  • Tegretol or Carbatrol (carbamazepine)
Apr 10, 2023

What is the most successful treatment for BPD? ›

DBT is the most studied treatment for BPD and the one shown to be most effective. Mentalization-based therapy (MBT) is a talk therapy that helps people identify and understand what others might be thinking and feeling.

Do people with BPD have empathy? ›

People with BPD score low on cognitive empathy but high on emotional empathy. This suggests that they do not easily understand other peoples' perspectives, but their own emotions are very sensitive. This is important because it could align BPD with other neurodiverse conditions.

Is BPD inherited from mother or father? ›

Conclusions: Parental externalizing psychopathology and father's BPD traits contribute genetic risk for offspring BPD traits, but mothers' BPD traits and parents' poor parenting constitute environmental risks for the development of these offspring traits.

Does BPD get worse with age? ›

Borderline personality disorder usually begins by early adulthood. The condition seems to be worse in young adulthood and may gradually get better with age. If you have borderline personality disorder, don't get discouraged.

What is the hardest mental illness to live with? ›

Individuals with Borderline Personality Disorder (BPDs) become overwhelmed and incapacitated by the intensity of their emotions, whether it is joy and elation or depression, anxiety, and rage. They are unable to manage these intense emotions.

At what age does borderline personality disorder develop? ›

According to the DSM-5, BPD can be diagnosed as early as at 12 years old if symptoms persist for at least one year. However, most diagnoses are made during late adolescence or early adulthood.

Can a brain scan detect borderline personality disorder? ›

However: Brain scans have shown people with BPD have amygdala's that are noticeably smaller than the general population, and may even have undergone atrophy. The smaller the amygdala, the more overactive it is.

What is the best strain for borderline personality disorder? ›

The best strain for borderline personality disorder is cannabis sativa since it helps ease anxiety and boost mood. However, it's important to be aware of the health risks and side effects that follow marijuana abuse.

What not to say to someone with BPD? ›

What Not to Say to Someone With Borderline Personality Disorder
  • “You seemed fine earlier.”
  • 2. “ Stop trying to make me feel guilty” / “It's not a big deal” / “You're overreacting”
  • 3.“ Don't be upset” / “Don't be so sensitive” / “Don't worry about it”
Mar 31, 2021

Are people with BPD abusive? ›

Those diagnosed with Borderline Personality Disorder (BPD) or those with BPD who may not even know they have it, are more likely than the general population to be verbally, emotionally/psychologically, physically abusive.

What are the three C's of borderline personality disorder? ›

The 3 C's are: I didn't cause it. I can't cure it. I can't control it.

Why do borderlines punish? ›

To punish themselves: Sometimes people with BPD appear to harm themselves out of a profound feeling or belief that they deserve punishment and abuse. Sometimes this belief appears to be related to the fact that they were abused as children and believed they deserved the abuse.

What is the rage cycle of a BPD person? ›

A BPD relationship cycle often consists of some emotional highs and lows that may leave you confused and frustrated. You might also see your partner experience unexpected bouts of anger, anxiety, or depression. They may love you and then suddenly reject you or get upset.

What hurts borderline the most? ›

Separations, disagreements, and rejections—real or perceived—are the most common triggers for symptoms. A person with BPD is highly sensitive to abandonment and being alone, which brings about intense feelings of anger, fear, suicidal thoughts and self-harm, and very impulsive decisions.

Why do borderlines cut you off? ›

People with BPD often experience intense fears of abandonment and instability. To cope with these fears, they might use splitting as a defense mechanism. This means they might cleanly separate positive and negative feelings about: themselves.

Do borderlines cry a lot? ›

To evaluate crying behavior, we used a set of specially designed tools. Compared to non-patients, BPD patients showed the anticipated higher crying frequency despite a similar crying proneness and ways of dealing with tears.

What does a BPD meltdown look like? ›

For many folks with BPD, a “meltdown” will manifest as rage. For some, it might look like swinging from one intense emotion to another. For others, it might mean an instant drop into suicidal ideation. Whatever your experience is, you're not alone.

What are the strange behaviors of BPD? ›

Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving and binge eating. Recurring suicidal behaviors or threats or self-harming behavior, such as cutting. Intense and highly changeable moods, with each episode lasting from a few hours to a few days.

How do you calm down a borderline episode? ›

You could:
  1. Wrap up in a blanket and watch your favourite TV show.
  2. Write all your negative feelings on a piece of paper and tear it up.
  3. Listen to music that you find uplifting or soothing.
  4. Write a comforting letter to the part of yourself that is feeling sad or alone.
  5. Let yourself cry or sleep.
  6. Cuddle a pet or a soft toy.

Do borderlines get jealous? ›

In close relationships, a person with BPD may appear jealous, possessive, or hyper-reactive. These individuals often fear being left alone and have deep feelings of worthlessness. In many cases, this disorder is the direct result of childhood trauma, abuse, violence, or neglect.

How can you tell if someone had BPD? ›

Symptoms - Borderline personality disorder
  1. emotional instability – the psychological term for this is "affective dysregulation"
  2. disturbed patterns of thinking or perception – "cognitive distortions" or "perceptual distortions"
  3. impulsive behaviour.
  4. intense but unstable relationships with others.

What is a BPD Favourite person? ›

Another hallmark of borderline personality disorder is having a favorite person—usually a family member, romantic partner, or someone in a supportive role, such as a teacher or coach. For someone with this type of BPD relationship, a “favorite person” is someone they rely on for comfort, happiness, and validation.

What vitamins help with BPD? ›

Magnesium. Lower levels of magnesium have been observed in individuals with BPD (20). Further, supplementation of magnesium, in conjunction with vitamin B6, has been indicated to be supportive for reducing symptoms in individuals with BPD (20).

What is the best antidepressant for BPD? ›

Antidepressants for BPD

Celexa or Zoloft for borderline personality disorder have been found to help with mood instability and impulsivity. By reducing the person's mood symptoms, they can improve their overall well-being.

Do antidepressants help BPD? ›

A number of research studies have demonstrated that certain types of antidepressants are effective in treating specific symptoms of BPD. For example, SSRIs can reduce emotional instability, impulsivity, self-harm behaviors, and anger. MAOIs have also been shown to effectively treat emotional instability.

What is the gold standard treatment for borderline personality disorder? ›

The most popular and most effective form of therapy for BPD is dialectical behavioral therapy (DBT). This form of therapy was created for people with borderline personality disorder in mind. If you've been diagnosed with BPD, know that you're not alone.

What is a petulant borderline personality disorder? ›

Petulant borderline personality disorder (PBPD) is a psychiatric condition characterized by impulsive and uncontrollable behaviors, mood swings, and erratic thoughts and emotions. People with petulant BPD often have difficulty regulating their emotions, leading to anger, sadness, or anxiety outbursts.

Are borderlines more intelligent? ›

Research indicates that BPD is linked to above-average intelligence (IQ > 130) and exceptional artistic talent (Carver, 1997). Because your partner with BPD may be exceptionally bright, they digest information and discover answers to problems more quickly than the average person.

Do people with BPD feel sorry? ›

One of the experiences of interacting with individuals with Borderline Personality Disorder or Narcissistic Personality Disorder (BP/NP) is that they sometimes do not seem truly sorry. Even though a BP/NP may say he or she is sorry, there may be something lacking.

What kind of parents do borderlines have? ›

Common traits of a parent with BPD include: Seeking constant approval from their children and other family members. Presenting as overly moody or depressed if things don't go their way. Making their children feel like they can never do “good enough” for their parent.

Should people with BPD have kids? ›

The children of parents with BPD are at risk of poorer outcomes in terms of their own mental health, educational outcomes and wellbeing. The challenges of being a parent can also exacerbate the symptoms of those with BPD traits.

Are medications the best treatment for BPD? ›

Experts are divided over whether medicine is helpful. No medicine is currently licensed to treat BPD. While medicine isn't recommended by National Institute for Health and Care Excellence (NICE) guidelines, there's evidence that it may be helpful for certain problems in some people.

Can a person with BPD really love? ›

Borderline personality disorder (BPD) isn't a personal choice. It's a mental health condition, and it can be managed. Can a person with borderline personality disorder feel love? Absolutely!

Do borderlines fall in love? ›

At the end of the day, people with BPD can fall in love; it just takes some work from both sides of the relationship. Treatment is the first step — options may include: Individual and couple's therapy. Medication.

Do borderlines ever change? ›

Borderline personality disorder (BPD) is a slow moving disorder. Most patients with BPD improve over time. The reasons for this change are unclear. Both therapy as usual and the reparations that adult life offers can facilitate these changes.

What is the life expectancy of someone with BPD? ›

People with Borderline Personality Disorder have a reduced life expectancy of some 20 years, attributable largely to physical health maladies, notably cardiovascular. Risk factors include obesity, sedentary lifestyle, poor diet and smoking.

Do borderlines end up alone? ›

Loneliness may be common with BPD, but it's not impossible to overcome. There are many strategies you can use to feel less alone, such as joining a support group, taking classes, caring for an animal, and finding new ways to communicate with your loved ones. You may also want to consider engaging in therapy.


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