Possible Borderline Personality Causes

Borderline personality causes are uncertain, but studies indicate that genetic, environmental, and social factors may be influencing factors. Borderline personality disorder is characterized as a cluster B personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), presenting a pattern of instability in mood, interpersonal relationships, and self-image that can cause significant distress or interferes with functioning.

While living with borderline personality disorder can be challenging, especially in relation to managing one's emotional intensity, evidence-based treatments involving psychotherapy may significantly reduce symptoms and improve quality of life and well-being. To learn more about the possible causes of borderline personality disorder and other associated mental disorders, as well as its diagnosis and treatment options, it may be helpful to explore the availability of treatments and how they work. 

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Possible causes of borderline personality disorder (BPD) 

Various risk factors are associated with the development of BPD. However, these risk factors alone do not necessarily predict its development, as many people who meet the risk factor criteria do not have the condition.  

Research findings from the National Institute of Mental Health (NIMH) suggest that this mental health condition may develop in relation to the following risk factors:

• Family history: Having a family member with BPD or another mental illness may increase one's risk of developing BPD. 
• Changes in brain structure and function: Structural and functional changes in the brain, specifically in the areas related to impulse and emotion regulation, are linked with this personality disorder. However, findings are unclear as to whether these changes cause the disorder or whether the disorder causes these changes.
• Social, cultural, and environmental factors: Experiences of trauma, such as abandonment, abuse, neglect, and other adverse childhood occurrences, may raise one's risk of developing this mental health condition. Moreover, unstable relationships and conflicts can influence disorder development.  
• Unknown risk factors: Some people develop borderline personality disorder in the absence of any of the above risk factors. 

Borderline personality disorder diagnosed 

The American Psychological Association (APA) characterizes borderline personality disorder as "a personality disorder characterized by a long-standing pattern of instability in mood, interpersonal relationships, and self-image that is severe enough to cause extreme distress or interfere with social and occupational functioning."

Symptoms of a personality disorder can vary from person to person but may include:

• Unstable and intense relationships with friends, family, and loved ones 
• Intense emotional pain 
• Challenges coping with intense emotional pain and distress
• A tendency to experience frequent and intense emotions, taking longer to recover from experiences
• An intense fear of abandonment 
• A tendency toward extreme swings in attitudes, opinions, or values
• A tendency toward extreme changes in opinions
• Oscillating feelings toward others, ranging from intense appreciation to dislike or aversion
• A less stable or unclear self-image 
• A tendency toward impulsive behaviors, such as substance use, spending sprees, eating excessively, and unprotected or unsafe sex
• Self-harming behavior
• Recurring suicidal ideation, threats, or warnings
• Intense and variable mood swings lasting from hours to days
• A recurring sense of emptiness 
• Challenges with controlling anger
• Frequent changes in jobs, careers, and life goals
• Anger that may be inappropriate to the situation
• Dissociation, such as a sense of being an outside observer of oneself
• A sense of unreality
• Intense paranoia
• A higher risk of comorbid conditions like bipolar disorder, binge eating disorder, and anxiety disorders

When impulsivity happens in relation to an elevated mood, impulsivity may stem from a mood disorder rather than borderline personality. Often, a diagnosis is made in early adulthood or late adolescence. However, some people under 18 may be diagnosed with the disorder in rare cases. 

Borderline personality disorder treated 

Previously believed to be challenging to address, findings indicate that BPD symptoms may significantly subside with proper treatment. Treatment for borderline disorder often involves psychotherapy. Evidence-based psychotherapy modalities for this condition include the following. 

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) helps clients identify, reframe, and change beliefs and behaviors based on unhelpful or inaccurate perceptions about themselves, situations, and others. In doing so, they may address and reduce mood swings and self-harming behavior, among other behaviors. CBT for personality disorders may involve mindfulness training, restructuring core beliefs, training in emotion regulation, and interpersonal skills training, as well as other skills aimed at improving functioning and reducing symptoms. 

Dialectical behavior therapy (DBT)

Developed specifically to address borderline personality disorder, DBT employs mindfulness techniques and approaches for gaining awareness of one's emotions and present situation. The modality also teaches techniques in emotion regulation, ways to reduce self-harm behavior, and ways to improve interpersonal relationships. DBT is based on cognitive-behavioral therapy but aims to help individuals learn skills to manage intense emotions. Individual and group sessions may be offered. 

Schema therapy

Aimed at addressing personality disorders and conditions with chronic symptoms, schema therapy incorporates principles of CBT, psychodynamic perspectives, attachment theory, and gestalt therapy. This modality draws on conceptual models like early maladaptive schemas associated with dysfunctional patterns of thought and behavior often tied to childhood experiences and the schema mode model related to current states and coping styles. 

Less often, medication may also be recommended. However, the effects of medication for this condition are still being studied. When a doctor prescribes medication, they may be doing so to help a client manage co-occurring conditions, such as depression and anxiety disorders. Do not start, change, or stop a medication without consulting your doctor. Therapists, counselors, and psychologists cannot prescribe or manage medication for a client as they are not doctors.  

Post-traumatic stress disorder and BPD

BPD is often comorbid with symptoms of post-traumatic stress disorder (PTSD). As many as a fourth of people with PTSD may also meet the diagnostic criteria for BPD, and around 50% of those with BPD have also "met the criteria for lifetime PTSD."

High rates of comorbidity between post-traumatic stress disorder (PTSD) and BPD have led some researchers to speculate that BPD may be "part of a larger collection of trauma-related symptoms." This finding may be linked to the high prevalence rates of childhood maltreatment or significant interpersonal trauma in people with BPD. Some psychologists believe BPD may be related to complex PTSD (C-PTSD), a condition not listed in the DSM-5 but generally accepted as a form of PTSD that develops in people who have experienced extended trauma, especially in childhood. 

BPD and eating disorders

According to findings, eating disorders and BPD tend to co-occur, with high rates of comorbidity. When an eating disorder co-occurs with BPD, certain symptoms may be more prevalent, such as affective instability. Moreover, anorexia nervosa and the binge-eating and purging subtype are associated with more extreme symptoms of BPD. 

Some researchers have also linked impulsive, self-harming tendencies associated with BPD with increasing one's vulnerability to developing an eating disorder. As in PTSD and BPD, a history of traumatic experiences has been linked with the development of eating disorders. The prevalence of co-occurring PTSD and anorexia nervosa, for example, has been estimated to be between 10% and 47%. 

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Support options 

Living with borderline personality disorder can be challenging, as intense emotions may arise. Therapy can be a way to learn ways to manage symptoms, introducing helpful coping strategies to manage emotions. In addition, if you face barriers to in-person support, you might be able to try online therapy. 

An online therapy platform like BetterHelp enables you to connect with a licensed therapist via phone, video, or live chat. The ease of communication may allow you to speak to your therapist when seeking to control impulses, as you can message your therapist at any time and receive a response when they are available. 

A scoping review involving eleven studies evaluated the effectiveness of internet interventions for personality disorders. Its findings suggest that "internet interventions for personality disorders show promise," and online psychotherapy increases access to treatment for several mental health challenges.