Understanding the Signs of Borderline Personality Disorder
Understanding the signs of borderline personality disorder
Borderline personality disorder (BPD) is a serious personality disorder that causes intense mood swings, severe problems with self-worth, and impulsive behaviors. The main feature of this disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and emotions. The significant emotional instability associated with this disorder can lead to a number of other stressful emotional, cognitive, and behavioral problems. Men and women with borderline personality disorder tend to have severely distorted images of themselves; they feel worthless and terribly flawed. Due to the anger, impulsiveness, and frequent mood swings exhibited, individuals with this disorder often push others away, even if they desire long-lasting relationships.
Mostly occurring in early adulthood, those with BPD will make frantic efforts to avoid any real or imagined abandonment. Any perceptions that may suggest impeding separation or rejection, or the loss of external structure, can cause an individual to have prevailing changes in self-image, affect, cognition, and behavior. Due to their intense fear of abandonment, people with BPD have a pattern of unstable and intense relationships; often idolizing caregivers or lovers, demanding to spend a lot of time with them, and sharing their most intimate details early in the relationship. However, they may quickly (and without warning) switch from idealizing that person to devaluing them, feeling that the other person doesn’t give enough or is not there for them enough.
Identity disturbances are extremely common for those who have borderline personality disorder, and are marked by an unstable self-image and sense of self. People who struggle with BPD experience sudden and dramatic changes in self-image, including rapidly shifting goals, values, and vocational ambitions. In addition to an unstable self-image, these individuals experience impulsivity in at least two different areas of their lives that put them in danger of potential harm. They may engage in a variety of risky behaviors such as substance abuse, spending recklessly, or binge eating. They may tend to display recurrent suicidal behaviors or threats and, in some cases, these may be accompanied by non-suicidal self-mutilation.
Maybe someone exhibits the signs of BPD but is not aware of the symptoms or actively decides not to seek treatment. Over the course of this person’s life, he or she might experience the following:
Relationship Troubles
People with BPD have a black-and-white view of the world: Things (and people) are either good or bad, and how someone with BPD is feeling can change almost instantly. (1) Relationships in particular can be problematic. Hooper says people with BPD commonly have a love-hate approach to others. One day, a person with BPD might view their partner, friend, or family member as the best person in the world. The next day, he or she might do a 180 and decide that that “best person in the world” is now the worst.
Some of this can be traced back to the fact that people with BPD tend to fear abandonment. For instance, they might cut off communication with a loved one if they feel they’re at risk of being left behind. (1)
This, of course, can lead to lots of interpersonal conflict and chronic difficulties with relationships, Ackerman says. Hence relationship turmoil, divorce, and trouble maintaining positive relationships with family and friends can be common among people suffering from BPD. (2)
Job Loss
These interpersonal conflicts can also affect someone’s ability to maintain a steady job, especially if they take that love-hate approach with their boss or coworkers. (2) “Their life is in disarray,” Hooper says. The symptoms of BPD can be severe and debilitating, to the point where being unable to regulate emotions can “almost certainly wreck their life,” Hooper says. “What you begin to see is a life described as instability.”
But that doesn’t mean everyone with BPD will fall into this camp. “There are some people with BPD who function quite well,” Ackerman says. “I wouldn’t say the diagnosis alone means someone might not be able to hold a job or get married if they wanted to.” (For example, Dr. Linehan, mentioned above for her pioneering work in treatment of BPD, has acknowledged having BPD herself.) But should the relationship problems be severe, job loss could be the ultimate result.
Hospitalizations Due to Self-Harm
Many people with BPD harm themselves, such as by cutting, to try to deal with their overwhelming feelings. (1) Some may even attempt to take their own lives.
Suicide attempts are so common among people with BPD that they are considered a symptom of the disorder. Up to 10 percent of the people who qualify for having BPD die by suicide, which is 50 times the rate of the population as a whole. (7)
Generally, this self-destructive behavior starts up when a person’s mood is down. “That’s where the self-mutilation comes in, the really impulsive behavior comes in,” Hooper says. Suicidal thoughts that become overwhelming may lead a person with BPD to seek help through hospitalization or by entering an inpatient treatment center, according to a study. (8)
Often, this kind of behavior serves as a wake-up call for the person suffering. “For a lot of clients, the suicide attempt scares them, and it wakes them up to how threatening this is to their life,” Hooper says.
Overview
What is borderline personality disorder (BPD)?
Borderline personality disorder (BPD) is a mental health condition marked by extreme mood fluctuations, instability in interpersonal relationships and impulsivity.
People with BPD have an intense fear of abandonment and have trouble regulating their emotions, especially anger. They also tend to show impulsive and dangerous behaviors, such as reckless driving and threatening self-harm. All of these behaviors make it difficult for them to maintain relationships.
Borderline personality disorder is one of a group of conditions called “Cluster B” personality disorders, which involve dramatic and erratic behaviors. Personality disorders are chronic (long-term) dysfunctional behavior patterns that are inflexible, prevalent and lead to social issues and distress.
Many people who live with borderline personality disorder don’t know they have it and may not realize there’s a healthier way to behave and relate to others.
What is the difference between borderline personality disorder and bipolar disorder?
While bipolar disorder is also characterized by wide fluctuations in mood and behavior, it’s distinct from borderline personality disorder (BPD).
In BPD, mood and behavior change rapidly in response to significant stress, especially when interacting with other people, whereas in bipolar disorder, moods are more sustained and less reactive. People with bipolar disorder also have significant changes in energy and activity, unlike those with BPD.
Who does borderline personality disorder affect?
Most personality disorders begin in the teen years when your personality further develops and matures. As a result, almost all people diagnosed with borderline personality disorder are above the age of 18.
Although anyone can develop BPD, it’s more common if you have a family history of BPD. People with other mental health conditions, such as anxiety, depression or eating disorders, are also at higher risk.
Nearly 75% of people diagnosed with BPD are people assigned female at birth (AFAB). Research suggests that people assigned male at birth (AMAB) may be equally affected by BPD, but they may be misdiagnosed with post-traumatic stress disorder (PTSD) or depression.
How common is borderline personality disorder?
Borderline personality disorder is relatively rare. Approximately 1.4% of the adult U.S. population has BPD.
Symptoms and Causes
What are the signs and symptoms of borderline personality disorder (BPD)?
Signs and symptoms of borderline personality disorder usually appear in your late teenage years or early adulthood. A troubling event or stressful experience can trigger symptoms or make them worse.
Over time, symptoms usually decrease and may go away completely.
Symptoms can range from manageable to very severe and can include any combination of the following:
- Fear of abandonment: It’s common for people with BPD to feel uncomfortable being alone. When people with BPD feel that they’re being abandoned or neglected, they feel intense fear or anger. They might track their loved ones’ whereabouts or stop them from leaving. Or they might push people away before getting too close to avoid rejection.
- Unstable, intense relationships: People with BPD find it challenging to keep healthy personal relationships because they tend to change their views of others abruptly and dramatically. They can go from idealizing others to devaluing them quickly and vice versa. Their friendships, marriages and relationships with family members are often chaotic and unstable.
- Unstable self-image or sense of self: People with BPD often have a distorted or unclear self-image and often feel guilty or ashamed and see themselves as “bad.” They may also abruptly and dramatically change their self-image, shown by suddenly changing their goals, opinions, careers or friends. They also tend to sabotage their own progress. For instance, they may fail a test on purpose, ruin relationships or get fired from a job.
- Rapid mood changes: People with BPD may experience sudden changes in how they feel about others, themselves and the world around them. Irrational emotions — including uncontrollable anger, fear, anxiety, hatred, sadness and love — change frequently and suddenly. These swings usually only last a few hours and rarely more than a few days.
- Impulsive and dangerous behavior: Episodes of reckless driving, fighting, gambling, substance use, binge eating and/or unsafe sexual activity are common among people with BPD.
- Repeated self-harm or suicidal behavior: People with BPD may cut, burn or injure themselves (self-injury) or threaten to do so. They may also have suicidal thoughts. These self-destructive acts are usually triggered by rejection, possible abandonment or disappointment in a caregiver or lover.
- Persistent feelings of emptiness: Many people with BPD feel sad, bored, unfulfilled or “empty.” Feelings of worthlessness and self-loathing are common, too.
- Anger management issues: People with BPD have difficulty controlling their anger and often become intensely angry. They may express their anger with biting sarcasm, bitterness or angry tirades. These episodes are often followed by shame and guilt.
- Temporary paranoid thoughts: Dissociative episodes, paranoid thoughts and sometimes hallucinations may be triggered by extreme stress, usually fear of abandonment. These symptoms are temporary and usually not severe enough to be considered a separate disorder.
Not everyone with borderline personality disorder experiences all of these symptoms. The severity, frequency and duration of symptoms are unique to each person.
What causes borderline personality disorder?
Healthcare providers believe BPD results from a combination of factors, including:
- Childhood abuse and trauma: Up to 70% of people with BPD have experienced sexual, emotional or physical abuse as a child. Maternal separation, poor maternal attachment, inappropriate family boundaries and parental substance use disorder are also associated with BPD.
- Genetics: Studies show that borderline personality disorder runs in families. If you have a family history of BPD, you’re more likely — but not guaranteed — to develop the condition.
- Brain changes: In people with BPD, the parts of their brain that control emotion and behavior don’t communicate properly. These problems affect the way their brain works.
Diagnosis and Tests
How is borderline personality disorder diagnosed?
Personality continues to evolve throughout child and adolescent development. Because of this, healthcare providers don’t typically diagnose someone with borderline personality disorder until after the age of 18. Occasionally, a person younger than 18 may be diagnosed with BPD if symptoms are significant and last at least a year.
Personality disorders, including borderline personality disorder, can be difficult to diagnose, as most people with a personality disorder lack insight into their disruptive behavior and thought patterns.
When they do seek help, it’s often due to conditions such as anxiety or depression as a result of the problems created by their personality disorder, such as divorce or lost relationships, not the disorder itself.
A licensed mental health professional — such as a psychiatrist, psychologist or clinical social worker — can diagnose borderline personality disorder based on the diagnostic criteria for BPD in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
They do so by performing a thorough interview and having conversations about symptoms. They ask questions that’ll shed light on:
- Personal medical history and family medical history, especially histories of mental health conditions.
- Previous work history.
- Impulse control.
Mental health professionals often work with the person’s family and friends to collect more insight into their behaviors and history.
Management and Treatment
How is borderline personality disorder treated?
BPD historically has been challenging to treat. But with newer, evidence-based treatment, many people with borderline personality disorder experience fewer and less severe symptoms, improved functioning and better quality of life.
But effective treatment takes time, patience and commitment. Treatment may include psychotherapy (talk therapy), medications or both.
Your healthcare provider may recommend a short-term hospital stay if you’re very distressed or at risk of harming yourself or others. During your stay, your healthcare provider will work with you to develop a treatment plan.
People with borderline personality disorder often have other mental health conditions, including:
- Mood disorders (80% to 96% of people with BPD).
- Anxiety disorders (88%).
- Substance use disorder (64%).
- Eating disorders (53%).
- Attention-deficit/hyperactivity disorder (ADHD) (10% to 30%).
- Bipolar disorder (15%).
- Somatoform disorders (10%).
If they have a co-existing condition, they’ll also need treatment for it.
Psychotherapy treatment for BPD
Psychotherapy (talk therapy) is the treatment of choice for borderline personality disorder. The goal of treatment is to help you uncover the motivations and fears associated with your thoughts and behavior and to help you learn to relate to others more positively.
Types of therapy that can help treat BPD include:
- Dialectical behavior therapy (DBT): This type of therapy was developed specifically for people with BPD. DBT focuses on helping you accept the reality of your life and your behaviors, as well as helping you learn to change your life, including unhelpful behaviors. It teaches skills to help you control intense emotions, reduce self-destructive behaviors and improve relationships.
- Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. Your therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.
- Group therapy: This is a type of psychotherapy in which a group of people meets to describe and discuss their problems together under the supervision of a therapist or psychologist. Group therapy may help people with BPD to interact with others more positively and express themselves effectively.
Medications for BPD
Because the benefits of prescription medication for borderline personality disorder are unclear, healthcare providers typically don’t prescribe medications as the main treatment for BPD.
But in some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental health conditions. Medications can treat anxiety and depression, regulate mood swings or help control impulsive behavior. Antipsychotic (neuroleptic) drugs help some people with BPD.
Prevention
Can borderline personality disorder be prevented?
Unfortunately, there’s no way to prevent borderline personality disorder.
BPD is often inherited (passed through families), which means you have an increased risk of developing the condition if you have a family history of BPD. Ask your healthcare provider how to recognize signs of the disorder so you can get treatment as early as possible.
Outlook / Prognosis
What is the prognosis (outlook) for borderline personality disorder?
Most of the time, BPD symptoms gradually decrease with age. Some people’s symptoms disappear in their 40s. With the right treatment, many people with BPD learn to manage their symptoms and improve their quality of life.
Without treatment, people with borderline personality disorder have an increased risk of the following:
- Substance use disorder and alcohol use disorder.
- Depression.
- Self-harm.
- Suicide.
The risk of suicide in people with BPD is 40 times that of the general population. About 8% to 10% of people with BPD die by suicide.
Many people with untreated BPD also experience unstable or chaotic personal relationships and have trouble keeping a job. They have an increased risk of divorce, estrangement from family members and rocky friendships. Legal and financial problems are also common.
Living With
How can I help someone with borderline personality disorder?
If you know someone who lives with borderline personality disorder, here are some ways you can help them:
- Take time to learn about the BPD to understand what your loved one is experiencing.
- Encourage your loved one to seek treatment for BPD and ask about family therapy if they’re a relative of yours.
- Offer emotional support, understanding and patience. Change can be difficult and frightening to people with BPD, but their symptoms can improve over time with treatment.
- Seek therapy for yourself if you’re experiencing significant stress or symptoms of mental health conditions, such as anxiety or depression. Choose a different therapist from the person your loved one is seeing.
People with BPD have a significantly higher rate of self-harming and suicidal behavior than the general population.
People with BPD who are thinking of harming themselves or attempting suicide need help right away.
If you or someone you know is in immediate distress or thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1.800.273.TALK (8255).
A note from Cleveland Clinic
It’s important to remember that borderline personality disorder (BPD) is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to life. Mental health professionals can offer treatment plans that can help people with BPD manage their thoughts and behaviors.
The family members and loved ones of people with borderline personality disorder often experience stress, depression, grief and isolation. It’s also important to take care of your mental health and seek help if you’re experiencing these symptoms.
