Borderline Personality Disorder

People who experience BPD 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 deep sadness over short periods. 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 BPD 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.

Researchers have not found a definitive cause for BPD. 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 BPD 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 BPD 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

No known gene profile causes BPD, 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.

BPD 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 BPD 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.

Medication

Certain medications may be used in the treatment of symptoms of BPD, 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. 

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 BPD 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

The main treatment avenue for those with BPD 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. 

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. 

CBT is not specialized for addressing BDP. 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. 

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 BPD:

• National Institute of Mental Health (NIMH)
• National Alliance on Mental Illness
• National Education Alliance for Borderline Personality Disorder
• Mental Health America

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.

Historically, medical and mental health professionals have been reluctant to diagnose BPD 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 BPD. 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 BPD. 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.

70% of people with BPD have a history of trauma

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

¹National Library of Medicine

Below are more key statistics on BPD:

• Research has found that 1.6% of the population of the US has BPD.
• Approximately 20% of the inpatient psychiatric population has a diagnosis of BPD.
• The development of BPD is multifaceted but shows strong genetic and environmental factors. Studies on twins show that BPD has over 50% heritability.
• The prognosis for BPD with treatment is positive, with a 35% remission after two years, 91% remission after ten years, and 99% remission after 16 years of going to therapy.