Borderline Personality Disorder

Borderline Personality Disorder

Borderline Personality Disorder

Borderline personality disorder (BPD), also (more accurately) known as emotionally unstable personality disorder (EUPD), is characterized by difficult social and personal relationships, a poor self-image, and difficulty managing emotions.

Prevalence

Up to 6% of the population is reported to be affected with BPD in a given year. The male to female ratio of people diagnosed with BPD is 1:3, and it appears to become less common among older people.

The behaviors that characterize BPD typically begin by early adulthood and may be triggered by events considered normal to others. BPD commonly coexists with other conditions such as substance abuse, major depressive disorder, and eating disorders.

Many people with BPD are underdiagnosed or misdiagnosed because the symptoms can be confused with those for other personality or mood disorders, especially if a person only talks about a few symptoms rather than all symptoms experienced.

Borderline Personality Disorder vs Bipolar Disorder

Both disorders have symptoms of mood instability, but a marked difference is that the different moods in bipolar disorder can last for months whereas the mood swings in BPD can change within a few hours.

Symptoms of Borderline Personality Disorder:

The symptoms of BPD include:


  • Intense feelings and emotions — such as anger, rage, depression, panic attacks — that are excessively weighty and long lasting, and they appear excessive compared to other peoples’ more regular responses to circumstances
  • Marked sensitivity to minor rejection or criticism or thoughts of having failed
  • A desperation to not feel negative emotions — or even not feeling of lack of control or perceived betrayal — leading to self-harm, social isolation, or even dissociation (detachment from reality, out-of-body state) due to the inability and fear of processing the emotions
  • Frantic efforts to avoid real or imagined abandonment
  • What feels like permanent emptiness
  • Impulsivity, lack of self-control, and reckless behaviors such as dangerous driving or substance abuse
  • A pattern of intense and unstable relationships with loved ones such as family, friends, and romantic partners
  • Splitting – switching from extreme love and treating certain people as perfect to extreme loathing and character assassination of them due to extreme sensitivity about real or imagined rejection, loss, disappointment, or loss of esteem
  • Temporary episodes of confusion or uncertainty about one’s social role, function, preferences, beliefs, or personal goals; an inaccurate picture of self and of how others see them
  • Perceptual disturbances – auditory or visual hallucinations, paranoia

Diagnosing Borderline Personality Disorder:

A full review of all medical history and a medical screening should be done first to rule out any medical issues causes symptoms. A doctor might also ask the person to fill out a questionnaire to assess current thoughts, behavior, and feelings.

The DSM-5 says that for a BPD diagnosis, five of the following must be present:

  • Panicked attempts to avoid being abandoned — whether real or imagined
  • Dysfunctional relationships where others are sometimes put on a pedestal and at other times extremely devalued
  • No stability in perspective or sense of self
  • Impulsive, often reckless behavior with harmful consequences, such as unprotected sex, a credit card splurge, or substance abuse
  • Recurrent talk or threats of suicide, self-harm
  • Intense and unstable mood swings — anger, panic, anxiety — that often only last for a few hours
  • Long-lasting feelings of emptiness
  • Uncontrolled outbursts of intense anger, physical attacks
  • Paranoia or dissociation that’s stress related

Self-harming or suicidal behavior occurs in up to 80% of those with BPD, and the most frequent method of self-harm is cutting — with the goal of expressing emotion (particularly anger), self-punishment, and distracting oneself from emotional pain rather than with thoughts of suicide.

If you are experiencing suicidal thoughts, you can call the Suicide Prevention Hotline and talk for free at 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). They can also provide you with information about low-cost clinics and therapists for your depression.

Causes of Borderline Personality Disorder:

The causes of BPD remain unclear, but genetic, biological, environmental, psychological, and social factors have all been implicated.

  • Genetic – BPD has a 20% higher chance of developing if another family member has it.
  • Biological – While brain imaging studies have revealed brain abnormalities in those with BPD — such as size reductions in regions of the brain involved in the regulation of stress responses and emotion — many people with the same findings do not have BPD.
  • Environmental – Adverse life events such as sexual abuse, bullying, and trauma are factors that sometimes increase a person’s risk of developing BPD, but also factored in are the learned coping skills related to managing emotions in childhood.

Research on BPD is focused on examining biological and environmental risk factors, with special attention on whether early symptoms may emerge at a younger age than previously thought. Scientists are also studying ways to identify the disorder earlier in adolescents.

Risk factors for Borderline Personality Disorder:

The lifetime risk of suicide among people with BPD is between 3% and 10%. Men with BPD are approximately twice as likely to die by suicide compared to women with the same condition. 

Treatment for Borderline Personality Disorder:

Psychotherapy, namely talking therapy, is the first-line of treatment for BPD in order to help them process their emotional reactions and coping skills. Many of the following types of therapy are combined, with a team of mental health professionals working together for the best outcome. This team is possibly made up of a psychologist, psychiatrist, counselor, and social worker.

Depending on the risk of personal safety or the safety of others, a person with borderline personality disorder can initially be treated at a hospital, a residential treatment center, or a day center before graduating to weekly therapy.

Types of Talk Therapy

All types of therapy require a level of trust. All therapists are human, therefore perfection is unattainable; but all have the same goal of getting a person with BPD back on his or her feet and enjoying life again. Accepting that some aspects of therapy might not be as comfortable as one would like, perseverance and follow-through are key to working through all that’s needed to recover.

  • Dialectical behavioral therapy (DBT) – is a type of individual and group therapy that teaches mindfulness regarding one’s current situation and moods. It also teaches skills to regulate intense emotions, tolerate distress, lessen episodes of self-harm, and revamp relationships. DBT recognizes the natural strain between the need for acceptance vs the need for change.
  • Schema-focused therapy – examines the person’s learned perspective of themselves, others, situations, and circumstances and presents alternative, healthier perspectives as replacement options.
  • Psychodynamic psychotherapy – helps the person to examine their feelings and behavioral choices as exclusively their own rather than what others would choose or feel. The goal is to “own” and accept them in order to help lessen the intensity of one’s physical and verbal reactions when emotionally triggered.
  • Mentalization-based therapy (MBT) – Done in an individual and group setting over a period of about 15 months, this helps the person to understand their own mental and emotional processing and find ways to improve their methods of communicating/conveying them in relationships and social settings.
  • Transference-based therapy – The therapist sits in the place of someone close to the person with BPD and discusses topics and emptions as if he/she is that person. This reveals any dysfunctionalities in each relationship, addresses them, and helps build one’s identity and sense of self.
  • Family therapy – educates supportive family members and friends on the best interaction techniques and strategies to employ when facing conflict, stress, or obstacles at home, at work, or socially.

Art therapy – helps people to express their thoughts and emotions through creative arts like dance and art.

Self-care – Exercise regularly, eat healthy foods at scheduled mealtimes, get enough scheduled sleep, spend time with friends, enjoy restful activities and hobbies, and avoid alcohol and substance abuse. Finish out all the recommended therapy. Understanding and learning new skills can help significantly in giving one more of a feeling of control in managing the disorder.

Up to half of people with BPD improve over a ten-year period.


Coping – for family members

  • Self-care is important for those living with someone with BPD. Be sure to spend time nurturing your own physical and mental health by visiting with friends, getting time outside, and enjoying hobbies.
  • Self-support can look like attending family therapy, getting personal counseling or therapy, and/or joining a support group for those living with someone with BPD. This has the added benefit of understanding more about the disorder and learning how to best support someone with BPD while keeping healthy boundaries.

Medications for Borderline Personality Disorder can include:

There is no medication recommended exclusively for borderline personality disorder, but many of the symptoms can be treated with meds, along with medications the person may be on for coexisting mood or personality disorders.

Because of the suicide risk of people with BPD, medications are prescribed with caution.

Medications that are sometimes helpful are:

  • Antidepressants for depression, panic, OCD, or anxiety, like fluoxetine or escitalopram
  • Mood stabilizers for impulsivity and aggression, like lamotrigine or lithium
  • Antipsychotics for delusional thoughts and intense anger, like quetiapine or lurasidone
  • Benzodiazepines for anxiety and panic disorder, like clonazepam or lorazepam

Some people, especially adolescents, can react badly to antidepressants and must be monitored carefully in the first few weeks for physical reactions and increased suicidal thoughts.

Some drugs interact badly when combined. Visit https://www.drugs.com/drug-interactions to check yours.

Symptoms of Borderline Personality Disorder:

The symptoms of BPD include:


  • Intense feelings and emotions — such as anger, rage, depression, panic attacks — that are excessively weighty and long lasting, and they appear excessive compared to other peoples’ more regular responses to circumstances
  • Marked sensitivity to minor rejection or criticism or thoughts of having failed
  • A desperation to not feel negative emotions — or even not feeling of lack of control or perceived betrayal — leading to self-harm, social isolation, or even dissociation (detachment from reality, out-of-body state) due to the inability and fear of processing the emotions
  • Frantic efforts to avoid real or imagined abandonment
  • What feels like permanent emptiness
  • Impulsivity, lack of self-control, and reckless behaviors such as dangerous driving or substance abuse
  • A pattern of intense and unstable relationships with loved ones such as family, friends, and romantic partners
  • Splitting – switching from extreme love and treating certain people as perfect to extreme loathing and character assassination of them due to extreme sensitivity about real or imagined rejection, loss, disappointment, or loss of esteem
  • Temporary episodes of confusion or uncertainty about one’s social role, function, preferences, beliefs, or personal goals; an inaccurate picture of self and of how others see them
  • Perceptual disturbances – auditory or visual hallucinations, paranoia

Diagnosing Borderline Personality Disorder:

A full review of all medical history and a medical screening should be done first to rule out any medical issues causes symptoms. A doctor might also ask the person to fill out a questionnaire to assess current thoughts, behavior, and feelings.

The DSM-5 says that for a BPD diagnosis, five of the following must be present:

  • Panicked attempts to avoid being abandoned — whether real or imagined
  • Dysfunctional relationships where others are sometimes put on a pedestal and at other times extremely devalued
  • No stability in perspective or sense of self
  • Impulsive, often reckless behavior with harmful consequences, such as unprotected sex, a credit card splurge, or substance abuse
  • Recurrent talk or threats of suicide, self-harm
  • Intense and unstable mood swings — anger, panic, anxiety — that often only last for a few hours
  • Long-lasting feelings of emptiness
  • Uncontrolled outbursts of intense anger, physical attacks
  • Paranoia or dissociation that’s stress related

Self-harming or suicidal behavior occurs in up to 80% of those with BPD, and the most frequent method of self-harm is cutting — with the goal of expressing emotion (particularly anger), self-punishment, and distracting oneself from emotional pain rather than with thoughts of suicide.

If you are experiencing suicidal thoughts, you can call the Suicide Prevention Hotline and talk for free at 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). They can also provide you with information about low-cost clinics and therapists for your depression.

Causes of Borderline Personality Disorder:

The causes of BPD remain unclear, but genetic, biological, environmental, psychological, and social factors have all been implicated.

  • Genetic – BPD has a 20% higher chance of developing if another family member has it.
  • Biological – While brain imaging studies have revealed brain abnormalities in those with BPD — such as size reductions in regions of the brain involved in the regulation of stress responses and emotion — many people with the same findings do not have BPD.
  • Environmental – Adverse life events such as sexual abuse, bullying, and trauma are factors that sometimes increase a person’s risk of developing BPD, but also factored in are the learned coping skills related to managing emotions in childhood.

Research on BPD is focused on examining biological and environmental risk factors, with special attention on whether early symptoms may emerge at a younger age than previously thought. Scientists are also studying ways to identify the disorder earlier in adolescents.

Risk factors for Borderline Personality Disorder:

The lifetime risk of suicide among people with BPD is between 3% and 10%. Men with BPD are approximately twice as likely to die by suicide compared to women with the same condition. 

Treatment for Borderline Personality Disorder:

Psychotherapy, namely talking therapy, is the first-line of treatment for BPD in order to help them process their emotional reactions and coping skills. Many of the following types of therapy are combined, with a team of mental health professionals working together for the best outcome. This team is possibly made up of a psychologist, psychiatrist, counselor, and social worker.

Depending on the risk of personal safety or the safety of others, a person with borderline personality disorder can initially be treated at a hospital, a residential treatment center, or a day center before graduating to weekly therapy.

Types of Talk Therapy

All types of therapy require a level of trust. All therapists are human, therefore perfection is unattainable; but all have the same goal of getting a person with BPD back on his or her feet and enjoying life again. Accepting that some aspects of therapy might not be as comfortable as one would like, perseverance and follow-through are key to working through all that’s needed to recover.

  • Dialectical behavioral therapy (DBT) – is a type of individual and group therapy that teaches mindfulness regarding one’s current situation and moods. It also teaches skills to regulate intense emotions, tolerate distress, lessen episodes of self-harm, and revamp relationships. DBT recognizes the natural strain between the need for acceptance vs the need for change.
  • Schema-focused therapy – examines the person’s learned perspective of themselves, others, situations, and circumstances and presents alternative, healthier perspectives as replacement options.
  • Psychodynamic psychotherapy – helps the person to examine their feelings and behavioral choices as exclusively their own rather than what others would choose or feel. The goal is to “own” and accept them in order to help lessen the intensity of one’s physical and verbal reactions when emotionally triggered.
  • Mentalization-based therapy (MBT) – Done in an individual and group setting over a period of about 15 months, this helps the person to understand their own mental and emotional processing and find ways to improve their methods of communicating/conveying them in relationships and social settings.
  • Transference-based therapy – The therapist sits in the place of someone close to the person with BPD and discusses topics and emptions as if he/she is that person. This reveals any dysfunctionalities in each relationship, addresses them, and helps build one’s identity and sense of self.
  • Family therapy – educates supportive family members and friends on the best interaction techniques and strategies to employ when facing conflict, stress, or obstacles at home, at work, or socially.

Art therapy – helps people to express their thoughts and emotions through creative arts like dance and art.

Self-care – Exercise regularly, eat healthy foods at scheduled mealtimes, get enough scheduled sleep, spend time with friends, enjoy restful activities and hobbies, and avoid alcohol and substance abuse. Finish out all the recommended therapy. Understanding and learning new skills can help significantly in giving one more of a feeling of control in managing the disorder.

Up to half of people with BPD improve over a ten-year period.


Coping – for family members

  • Self-care is important for those living with someone with BPD. Be sure to spend time nurturing your own physical and mental health by visiting with friends, getting time outside, and enjoying hobbies.
  • Self-support can look like attending family therapy, getting personal counseling or therapy, and/or joining a support group for those living with someone with BPD. This has the added benefit of understanding more about the disorder and learning how to best support someone with BPD while keeping healthy boundaries.

Medications for Borderline Personality Disorder can include:

There is no medication recommended exclusively for borderline personality disorder, but many of the symptoms can be treated with meds, along with medications the person may be on for coexisting mood or personality disorders.

Because of the suicide risk of people with BPD, medications are prescribed with caution.

Medications that are sometimes helpful are:

  • Antidepressants for depression, panic, OCD, or anxiety, like fluoxetine or escitalopram
  • Mood stabilizers for impulsivity and aggression, like lamotrigine or lithium
  • Antipsychotics for delusional thoughts and intense anger, like quetiapine or lurasidone
  • Benzodiazepines for anxiety and panic disorder, like clonazepam or lorazepam

Some people, especially adolescents, can react badly to antidepressants and must be monitored carefully in the first few weeks for physical reactions and increased suicidal thoughts.

Some drugs interact badly when combined. Visit https://www.drugs.com/drug-interactions to check yours.

Sources PSYCH CENTRAL – Borderline Personality Disorder Symptoms | NIH – Borderline Personality Disorder | BORDERLINE PERSONALITY DISORDER – Overview, causes and Prognosis | MAYO CLINIC – Borderline Personality Disorder Symptoms and Causes | OPTIMIST MINDS – Borderline Personality Disorder DSM 5 (A Guide) | NIH – Diagnosing borderline personality disorder | NIH – Diagnosis, Epidemiology, Aetiology, and Treatment | VERY WELL MIND – Transference-Focused Therapy for Borderline Personality Disorder | NHS – Borderline Personality Disorder Treatment | Manning S (2011). Loving Someone with Borderline Personality Disorder. The Guilford Press. | Aviram RB, Brodsky BS, Stanley B (2006). “Borderline personality disorder, stigma, and treatment implications”. Harvard Review of Psychiatry. 14 (5): 249–56. | O’Neill A, Frodl T (October 2012). “Brain structure and function in borderline personality disorder”. Brain Structure & Function. 217 (4): 767–782.