Overview

Borderline personality disorder is one of 10 personality disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is a comparatively rare mental health disorder that can be difficult to manage. Individuals experiencing BPD may have unstable relationships with others, as poor emotional regulation can cause their feelings to swing from extreme affection to dislike quickly and unexpectedly. 

Due to a combination of low self-esteem and frequent loss of emotional control, people with BPD often act in ways that may be difficult for others to interpret. They also may be uncertain about their identity. 

Identifying symptoms of borderline personality disorder

BPD can be difficult to diagnose because it frequently co-occurs with other mental health disorders like PTSD, anxiety disorders, major depressive disorder, substance use disorders, or bipolar disorder.1 The overlapping symptoms of BPD and a condition like bipolar disorder can make it challenging for mental health professionals to determine if a person has one of the disorders or both concurrently. Many individuals with borderline personality disorder experience significant improvements in their symptoms and quality of life with consistent treatment. 

Symptoms

People who experience borderline personality disorder often view the world in extremes, seeing situations as all “good” or all “bad.”  Their moods often follow this extreme pattern, swinging from elation to emotional disturbance and deep sadness over short periods.

Other symptoms of borderline personality disorder

Other signs or symptoms of BPD, according to the DSM-V, include the following:  

  • A distorted and changing sense of self
  • Unstable relationships due to trying to avoid real or perceived abandonment, with the individual abruptly diving into or ending relationships without discernible cause
  • Struggling with impulse control, leading to behaviors that can vary widely from financial indiscretion to engaging in risky activities
  • Feelings of emptiness or numbness 
  • Engaging in behaviors such as self-harm to cope with distress
  • Experiencing intense anger, which they find difficult to regulate
  • Recurring threats of suicide and suicidal thoughts or behavior
  • Mood swings and periods of anxiety, depression, or irritability lasting from a few hours to a few days in duration
  • A sense of dissociation from the body, such as feeling detached or as if one is an outside observer of their own actions, which generally serves as a coping mechanism rather than a sign of psychosis

Someone experiencing borderline personality disorder may not experience all these symptoms, and the frequency, duration, and intensity of these symptoms may vary depending on the individual. They are also at greater risk for self-harm or suicidal behavior.

Causes

Researchers have not found a definitive cause for borderline personality disorder. Still, studies have identified some common risk factors2 that may make a person more susceptible to developing this mental health disorder, including but not limited to the following. 

Environmental factors

Some people who experience borderline personality disorder have a history of traumatic events in their lives, including abandonment, abuse, or hardship in their childhood years. Trauma may also include having parents or guardians with substance use disorders or who are involved in criminal activity. 

Biological factors

There are some indications that people who experience borderline personality disorder have shown structural and functional brain changes in the areas that control emotional regulation. However, researchers are unclear whether the changes cause the BPD or are the result of BPD.

Family history of borderline personality disorder

No known gene profile causes borderline personality disorder, but those who have close family members with BPD (siblings or parents, for example) are more likely to develop the disorder. However, having family members with the disorder does not mean that a person will necessarily develop it.

Treatments

Borderline personality disorder can require careful evaluation to distinguish it from other mental health conditions with similar symptoms. However, there are evidence-based treatments available that can reduce symptoms of BPD. Treating borderline personality disorder can be a long and involved process, and it may take time for symptoms to improve. However, with appropriate treatment, individuals with borderline personality disorder have the potential to reduce symptoms, build secure relationships, and develop healthy coping mechanisms.

Therapy for borderline personality disorder

The most common and effective treatment for BPD is psychotherapy.3 Sessions are conducted one-on-one with a licensed mental health professional and sometimes in an additional group setting. Group treatments can teach the individual with borderline personality disorder effective communication skills. 

One of two types of talk therapy are generally implemented with BPD: dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT). DBT was developed specifically for the treatment of borderline personality disorder and uses mindfulness and emotional awareness training to help clients learn to identify and manage intense emotions. The therapist may also teach coping skills to reduce destructive behaviors and communication skills to improve interactions with others. 

With CBT, the therapist seeks to help the person with borderline personality disorder identify and change core thoughts and behaviors that spring from inaccurate perceptions of situations and other people. CBT also offers stress management skills and tools to help the individual reduce anxiety symptoms as well as build self-esteem. 

Medication for borderline personality disorder

Certain medications may be used in the treatment of symptoms of borderline personality disorder, although there is no research-backed medication recommended for the treatment of the disorder. If used at all, medication is prescribed to assist in symptom relief for co-occurring conditions such as depression or eating disorders, or to manage mood swings. 

Some types of medication that a medical professional may prescribe in conjunction with therapy include antidepressants, mood stabilizers, or low-dose antipsychotics. Consult a doctor before starting, changing, or stopping medication for any condition. 

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Other treatment options  

For those with severe presentation of BPD, short-term hospitalization may be recommended at times to address periods of extreme stress or impulsive behaviors. Hospitalization may also be necessary if the person with borderline personality disorder shows signs of self-harm or suicidal behavior. 

Self-care

Self-care and lifestyle changes can be beneficial alongside other treatment methods, such as therapy or medication. Self-care may help not only with short-term symptoms but also with overall well-being in the long term. Self-care activities might include the following: 

  • Taking a walk in nature
  • Taking a hot bath or shower 
  • Eating nutritious foods
  • Drinking water
  • Sleeping consistently 
  • Avoiding social media pages that cause emotional distress
  • Partaking in activities you enjoy, such as hobbies 
  • Spending time with people you love 
  • Writing poetry 
  • Writing in a journal 
  • Wearing clothes that make you feel beautiful 
  • Singing or playing an instrument

Resources

The main treatment avenue for those with borderline personality disorder is therapy with a licensed mental health professional. DBT or CBT are the recommended therapeutic modalities conducted by a mental health professional like a licensed therapist, psychologist, or psychiatrist. 

Dialectical behavior therapy for borderline personality disorder

DBT offers four components to help those with BPD: individual therapy, skills training group, phone consultation, and a therapist consultation team. Together, these components retrain behavioral skills like interpersonal effectiveness, distress tolerance, and emotional regulation. They also address low self-worth, fear of abandonment, relationships, and self-harm behaviors. 

Cognitive behavioral therapy for borderline personality disorder

CBT is not specialized for addressing borderline personality disorder. However, the principles behind this type of therapy are also often helpful in treating this disorder. CBT involves reframing negative thought patterns with positive thoughts and actions. It is one of the most common forms of therapy for mental health disorders across the board. It can be effective in treating the symptoms of BPD and any concurrent disorders such as anxiety or depression. 

Online resources for borderline personality disorder

For those who may have difficulty finding therapists in their area who specialize in DBT or CBT, online therapy offers a wide range of choices. With online therapy platforms like BetterHelp, you can complete an online questionnaire to be matched with a therapist that meets your needs. Therapy sessions are held over video conferencing, messaging, or phone calls. 

Below are other resources to find out more about borderline personality disorder:

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988.

Please also see our Get Help Now page for more immediate resources.

Research

Historically, medical and mental health professionals have been reluctant to diagnose borderline personality disorder in adolescents, believing it to be an intractable disorder with a high level of stigma. A recent study, however, showed that BPD in adolescents is not as treatment-resistant as previously believed, following a similar pattern of manageability as in adult patients. 

A region of the brain called the rostro-medial prefrontal has recently been found to be less active in those diagnosed with borderline personality disorder. This inactivity could explain why those with BPD are extra sensitive to rejection and may benefit future research in the diagnosis and treatment of this disorder. 

A recent longitudinal study found that there was more evidence for stress generation than for stress-induced decompensation in those with borderline personality disorder. This research can be helpful in planning treatment interventions by allowing mental health professionals to target stress management techniques that are more personalized to the specific stress reaction.

Statistics

70% of people with BPD have a history of trauma

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Studies have examined whether borderline personality disorder (BPD) is connected to a history of trauma. A publication in the National Library of Medicine found that 70% of people with BPD have a history of trauma, showing a potential connection between the two.1

Below are more key statistics on BPD:

Associated terms

Updated on September 27, 2024.
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