How To Recognize Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious mental health condition that can be challenging to understand—and that often accompanies various unhelpful stigmas. For that reason, it may be beneficial for those looking to understand borderline personality disorder to examine the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Below, we’re covering the characteristics of borderline personality disorder, outlining various signs and symptoms that can indicate the presence of this condition. We’re also discussing potential treatment options—such as dialectical behavior therapy (DBT)—that you can pursue if you notice symptoms in yourself or a loved one. 

Why is the word "borderline" used in BPD? 

The term "borderline" in borderline personality disorder (BPD) was an early name given to the disorder as it was understood when it was first outlined in 1938. People with borderline personalities were thought to be on the "borderline" of neurosis and schizophrenia, and the two conditions were linked. 

However, since the 1970s, further investigation into BPD has revealed that this old name may be inadequate to describe the condition. Although the label is still used in the DSM-5, a debate continues in the psychiatric community about whether a renaming would be appropriate. If you or someone you love has been diagnosed with BPD, know that the term "borderline" is purely for diagnostic purposes and does not necessarily describe your personality or who you are as a person. 

What is a personality disorder?

Borderline personality disorder is a cluster B disorder in the DSM-5. As a personality disorder, the traits and behaviors accompanying BPD are often rooted in the personality. About 30% of those seeking mental healthcare have one or more personality disorders, which can be challenging to cope with. 

Someone with a personality disorder may have problems with their self-concept and trouble relating to others healthily. Anyone could have thoughts or behaviors that typify a personality disorder. However, if these behaviors only happen once or rarely, they might not fit the diagnostic criteria. Personality disorders are long-term, persistent, and challenging conditions that might cause marked functioning difficulties in relationships. 

Symptoms of borderline personality disorder

Borderline personality disorder is one of the ten listed personality disorders in the DSM-5. Two common symptoms of borderline personality disorder are an unstable sense of self and dysfunctional interpersonal relationships. Both components of the condition may show up in thoughts and behaviors. 

Additionally, symptoms of several other mental health conditions can occur alongside borderline personality disorder. Depression, post-traumatic stress disorder, eating disorders, and bipolar disorder are potential comorbidities. Studies show, for example, that 25-58% of people with borderline personality disorder also live with post-traumatic stress disorder. These potential comorbidities may explain manifestations of the condition that differ from those discussed below.  

The following are explorations of the common symptoms of borderline personality disorder. 

Unstable sense of self 

People with BPD might not see themselves as others do, and their self-concept might be distorted and negative. They might have periods of high self-confidence followed by periods of low self-esteem, which occur within proximity to each other. These changes in opinion and esteem can also be directed at other people, which may be called "splitting."

Difficulty with self-direction  

If you are living with borderline personality disorder, you might have trouble making concrete plans and following through with them. Your career path might involve false starts and lengthy detours, or you may let others determine your life course. 

Impulsive and self-damaging behaviors 

Dangerous behaviors and risk-taking are symptoms of BPD. An individual living with this condition might drive recklessly, go on wild spending sprees, have unprotected sex, use substances, binge eat, or impulsively take part in any other dangerous behavior. They may also threaten harm, attempt suicide, or engage in self-harm.

Intense and rapidly changing moods 

Unlike some mental health conditions, borderline personality disorder can feature intense moods that can change within the hour or the same day. In addition to living with severe mood swings, many people with BPD may experience anxiety, depression, or another co-occurring mental illness (e.g., bipolar disorder, post-traumatic stress disorder). 

Feelings of emptiness or anger  

A pervasive feeling of emptiness often occurs with BPD, and secondary anger can also occur if one isn't in touch with their emotions. This type of anger may be difficult to control and impact those around them. For people with BPD, anger might arise in situations that others may see as "trivial" or "unimportant." 

Paranoid thoughts when stressed 

Paranoia might occur with BPD and often occurs when an individual is stressed. Stress can be common due to poor self-esteem, interpersonal challenges, profound emotions, and intense desires. 

Dissociation 

As borderline personality disorder is often caused by trauma in childhood, symptoms related to a prolonged fight or flight response or traumatic memories may occur. These memories or experiences can cause dissociation, which might make an individual feel that they are "out of their body" or that they or others around them are "not real." Their memories may seem "above them" instead of from their own point of view. 

Fear of abandonment 

People with borderline personality disorder may fear abandonment to such a degree that they feel desperate or panicked in trying to avoid it. Efforts to avoid abandonment may lead to abandonment, potentially perpetuating a cycle. A few behaviors that might be connected to this fear could include the following: 

• Checking a partner's phone or computer

• Sending hundreds of messages when someone doesn't respond 

• Asking for constant reassurance that someone won't leave 

• Calling someone to check up on them throughout the day 

• Breaking up with a person to see if they'll ask you to stay 

• Running away to see if someone will come to get you 

Unstable relationships

For someone with BPD, relationships with friends, family members, and romantic partners may be intense and unstable. The individual might experience extreme emotions, switching between idealizing it and criticizing the person they're with. In addition, fear of abandonment can lead to anxious attachment or pushing others away to avoid eventual rejection.

Difficulty managing anger

Since extreme, sudden, and frequent anger is often a part of borderline personality disorder, those who haven't learned how to control their anger might struggle with anger management. They may get into physical fights to the extent that their actions constitute assault or may notice that they yell at their partners or say phrases they don't mean. 

Excessive anger may not be conducive to healthy interpersonal relationships and can lead to a more intense fear of abandonment. Although those with BPD recover from anger quickly, others might not recover from their words or actions as quickly, leading to potential relationship changes. 

Misinterpreting facial expressions 

People with borderline personality disorder may misinterpret the emotions of others through their facial expressions, seeing unwanted emotions when others don't. The person they interact with may not express any emotion, but the individual with BPD might see sadness, disgust, anger, or fear in that person. Misinterpreting someone else may lead to requests for reassurance or insistence that someone is feeling what they are not feeling, which might lead to anxiety for both people. 

What to do when you recognize BPD traits in yourself

If you suspect you might have borderline personality disorder or have been told by a partner, friend, or family that your behavior is concerning, consider contacting a mental health professional. You're not alone, and speaking to someone can allow you to be heard, validated, and supported as you work through your challenges. 

Types of therapy for borderline disorder

For individuals with borderline personality disorder, therapy can provide emotional support, a better understanding of BPD symptoms, and a means of addressing a potential comorbid mental health condition (e.g., post-traumatic stress disorder). Many therapies have been tried for people with borderline personality disorder (BPD), but the two that have proven most effective are cognitive-behavioral therapy (CBT) and dialectic behavior therapy (DBT). Through cognitive-behavioral therapy (CBT), a mental health professional can examine your thoughts and help you replace faulty perceptions with reality-based ones. 

Dialectical behavior therapy (DBT) uses four modules, including mindfulness, emotional control, distress tolerance, and interpersonal effectiveness, to help you experience life at the moment, reduce your distress, manage your emotions, and keep your relationships healthy. Developed by a psychologist with BPD, dialectical behavior therapy is a modality specifically made for the symptoms many people with borderline personality disorder experience. In addition, dialectical behavior therapy can be graduated, allowing you to move forward with a unique set of skills and the knowledge that you could complete the sessions and take control of your symptoms. 

What to do when you recognize BPD symptoms in a loved one

When someone you care about seems to show signs of borderline personality disorder (BPD), support them in seeking professional help. You can talk to your loved one about potential treatment options, like dialectical behavior therapy (DBT), which can help them address the challenges they’re experiencing. However, note that someone may not reach out for help until they're ready, and many people with personality disorders feel shameful about their symptoms. Instead of shaming or blaming someone else, let them know how much you care about them and are concerned about their well-being.  

Since a diagnosis is a complex decision based on an objective evaluation, it must be done by a professional. A person must meet borderline personality disorder criteria to get a diagnosis. These criteria are outlined in detail in the DSM-5, and although anyone can read this diagnostic manual, it is used alongside the therapeutic knowledge and educational experience that psychologists and counselors have. 

If you know someone with symptoms of BPD who refuses to reach out for help, it may be up to you how to respond. Some people choose to leave relationships that have become unhealthy for them, and it is healthy and normal to break up with someone or leave a friendship if it isn't serving you. However, if you decide to stay in this individual's life, know it isn't your responsibility to treat them, "fix" their problems, or convince them they need support. Each person is responsible for their own healing, so try to focus on yourself as much as possible and ask yourself what you need as you cope. 

You might also consider counseling if you're struggling with your relationship with this individual. Talking to a therapist about your experiences and ensuring you also have support can be beneficial. Your therapist can help you learn effective ways to communicate with this individual and move forward if you struggle to do so.

Counseling options 

Many forms of counseling are effective for BPD or the loved ones of a person with this condition. However, for many people experiencing a mental health challenge, it can be difficult to leave home or seek support in an area with limited options for personality disorder care. In these cases, speaking to a specialist in personality disorders may be more convenient online. 

Studies have found that online counseling is effective in treating the symptoms of personality disorders, anxiety, and depression. Online therapy may also allow you to control your treatment, allowing you to choose between phone, video, or live chat sessions. The counselor may use one or more proven effective techniques, including DBT or CBT. One study found that online DBT was more effective than in-person DBT for many people with BPD, with more people staying in the intervention until the end of treatment. 

If you're interested in receiving support from an expert in personality disorder treatment,  consider talking to a therapist through a platform like BetterHelp for individuals or Regain for couples. Both platforms offer flexibility to thousands of therapists, and the option to specify your therapy needs when you sign up.