Borderline Personality Disorder (BPD) is a disorder of emotion regulation, with 5.9% of the population displaying a characteristic at some point in their life (lifetime prevalence) and accounting for 20% of the psychiatric inpatient population. Up until a few decades ago, those diagnosed with the disorder were thought to be untreatable. Despite this shift, individuals living with BPD continue to face surplus stigma. Evidence-based treatments, however, have helped changed the narrative for people living with BPD to one of recovery and hope.
BPD can affect anyone, but it is often diagnosed in late adolescence and early adulthood. The prevalence of BPD in the general population of adolescents is around 3%. The clinical prevalence of BPD ranges from 11% of adolescents consulting at an outpatient clinic to 78% in suicidal adolescents visiting emergency departments. Up to 10% of individuals with BPD will die by suicide.
The cause of borderline personality disorder is still unclear. Studies suggest that genetics, environmental, and social factors may have an impact on developing BPD. Family history, brain structure and function, traumatic life events such as abuse, abandonment, or hardship during childhood might all contribute to the development of BDP.
Many symptoms of borderline personality disorder are similar to those found in other disorders, such as anxiety disorder, schizophrenia, and other personality disorders. Some of the most common signs or symptoms of BPD include:
- Intense mood swings, quick changes in values or interests, and impulsivity or recklessness
- A distorted self-image or sense of self, making it difficult to find a clear sense of purpose and direction
- Excessive self-criticism, including struggling to remember their own positive qualities
- A pattern of intense and unstable relationships with family, friends, and loved ones
- Impulsive and often dangerous behaviors, such as spending large amounts of money, unsafe sex practices, substance abuse, reckless driving, and binge eating
- Self-harming behaviors, such as cutting, burning, skin-picking, scratching, punching or hitting, biting, pinching, or bone-breaking
- Feelings of emptiness, intense sadness, or loneliness
- Frequent, prolonged, or intense anger that can contribute to feelings of shame, regret, or self-loathing
- Feelings of dissociation, such as feeling disconnected from oneself, observing oneself from outside one’s body, or feelings of unreality
It is important to recognize that not everyone with borderline personality disorder may experience all of these symptoms. The frequency, duration and type of symptoms can depend on the person and their condition.
The symptoms of borderline personality disorder can be summarized as instability in mood, thinking, behavior, personal relationships, and self-image.
For a diagnosis, individuals must meet at least five out of the nine criteria according to the DSM-V:
- Perceived or real fears of abandonment
- Intense mood swings, or brief periods of severe depression or anxiety
- Unstable or changing relationships
- Self-injury, suicidal ideation, or suicidal behavior
- Chronic feelings of emptiness
- Inappropriate, intense anger and rage
- Unstable self-image
- Stress-related paranoia or severe dissociative symptoms
Individuals with BPD traits can develop behaviors that can be difficult for friends and families to understand, often resulting in conflict or instability within relationships. People with personality disorders often use “defense mechanisms,” or coping strategies, that allow them to deny responsibility for their feelings and actions. One defense is called “splitting” – putting some people on a pedestal while devaluing others. Another defense is called “projective identification” – which involves denying one’s feelings, attributing them to someone else, and then behaving in a way that causes the other person to respond in kind. For example, when someone with borderline’s hostility is reciprocated, they can think and/or act as though it were not their own action.
Families of people who suffer from the disorder are often at a loss in knowing what to do and where to turn. People with BPD who stay healthily emotionally involved with their family members are more likely to have better outcomes. Obtaining help and treatment for the entire family is fundamental to individual and family well-being.
While no medication has been approved to treat BPD, mood stabilizers may be used to treat impulsive behavior and many of the comorbid conditions. Medication, though, is rarely effective without individual therapy and group or family therapy as the cornerstone. Psychotherapy in the form of dialectical behavior therapy (DBT) is considered a gold standard to treat BPD. This cognitive-based therapy combines acceptance and change strategies to help individuals recognize their behaviors and mood swings, and process negative thoughts and feelings. The treatment goal is for patients to learn better coping mechanisms, such as emotion regulation and distress tolerance skills.
Other types of therapy often used to treat BPD include:
- Mentalization-based therapy (MBT)
- Transference-focused psychotherapy (TFP)
- General/good psychiatric management (GPM)
- Schema therapy
Recovery and BPD
It is extremely important to remember that recovery is possible for those living with BPD. With the right treatment, support, and resources, individuals can live a full and successful life. Help is available.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org.
Text MHA to 741741 to connect with a trained crisis counselor from Crisis Text Line.
Call 911 or go to the nearest emergency room.
If you are in need of support, but not in crisis, consider reaching out to a warmline. Warmlines offer a place to call when you just need to talk to someone. Speaking to someone on these calls is typically free, confidential, and run by people who understand what it’s like to struggle with mental health problems.
Find a warmline at mhanational.org/warmlines.
Read stories from people living with borderline personality disorder at The Mighty.
The National Education Alliance for Borderline Personality Disorder has the largest free resource library in the world and provides free educational courses and resources for the BPD community. Learn more at www.borderlinepersonalitydisorder.com or email them at firstname.lastname@example.org.
Get additional information about borderline personality disorder at Psych Central.
Borderline Personality Disorder Resource Center
Phone: (888) 694-2273
Center for Mental Health Services
National Mental Health Information Center
PO Box 42557
Washington, DC 20015
Phone: (800) 789-2647
TTD Number: (866) 889-2647
Fax Number: (240) 747-5470
National Education Alliance for Borderline Personality Disorder
Treatment and Research for Personality Disorder (TARA)
23 Green Street
New York, NY 10013
Phone Number: (212) 966-6514
Toll-Free Hotline: (888) 4-TARA-APD
Out of the Fog
Out of the Fog provides information and resources for caregivers and loved ones of individuals living with BPD or narcissistic personality disorder. They also offer multiple online discussion forums.
What is Obsessive-Compulsive Disorder (OCD)?
People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control.