Borderline personality disorder (BPD) is a mental health condition that affects how a person thinks, feels, and behaves. People with BPD often experience intense emotions, unstable relationships, impulsivity, and a distorted sense of self. BPD can interfere with a person’s ability to function in everyday life and lead to serious complications, such as self-harm, suicide, and substance abuse.
According to the National Institute of Mental Health, about 1.4% of adults in the U.S. have BPD in a given year. BPD is more common among people assigned female at birth (AFAB), but it may affect people of any gender identity. BPD usually begins in early adulthood and may improve with age and treatment.
What are the symptoms of Borderline Personality Disorder (BPD)?
The symptoms of BPD can vary from person to person, but they generally fall into four main categories:
- Emotional instability: People with BPD have frequent and rapid mood swings, ranging from anger, anxiety, depression, shame, and happiness. They may also have difficulty controlling their emotions and coping with stress. Their emotions can be triggered by seemingly minor events, especially those involving other people. For example, they may feel angry or betrayed by a perceived slight or criticism, or they may feel euphoric or infatuated by a compliment or attention. People with BPD may also experience dissociation, which is a feeling of detachment from reality or oneself, or paranoia, which is a suspicion or mistrust of others or oneself.
- Impaired sense of self: People with BPD have a fragile and distorted self-image, which can affect their self-esteem, goals, values, and identity. They may feel empty, worthless, bad, or nonexistent. They may also have trouble knowing who they are and what they want in life. They may change their opinions, preferences, hobbies, appearance, or career frequently, depending on the situation or the person they are with. They may also try to fit in or please others by mirroring their behaviors, beliefs, or emotions, or by adopting extreme or rigid views.
- Unstable relationships: People with BPD have a fear of abandonment and rejection, which can make them clingy, needy, jealous, and possessive. They may idealize someone one moment and then devalue them the next, depending on how they perceive the person’s actions. They may also have difficulty trusting others and maintaining healthy boundaries. They may oscillate between being overly dependent or overly independent, or between being overly intimate or overly distant. They may also have frequent conflicts, arguments, breakups, or reconciliations with their partners, friends, or family members.
- Impulsive and risky behavior: People with BPD may act on impulses without considering the consequences, such as gambling, spending sprees, binge eating, unsafe sex, reckless driving, drug abuse, or self-injury. They may also sabotage their own success or happiness by quitting a job, ending a relationship, or harming themselves. These behaviors may serve as a way of escaping from negative emotions, seeking stimulation or attention, or expressing anger or frustration.
People with BPD may not have all of these symptoms, or they may have different degrees of severity. Some people with BPD may also have other mental health conditions, such as depression, anxiety, eating disorders, substance use disorders, or post-traumatic stress disorder (PTSD).
What are the causes of BPD?
The exact cause of BPD is unknown, but it is likely a combination of genetic, environmental, and social factors. Some possible causes include:
- Genetic factors: BPD may run in families, suggesting a hereditary component. Research has also found some abnormalities in the brain structure and function of people with BPD, which may affect their emotion regulation, impulsivity, and stress response.
For example, people with BPD may have reduced activity in the prefrontal cortex, which is involved in planning, reasoning, and decision-making, and increased activity in the amygdala, which is involved in fear, anger, and emotional arousal.
- Environmental factors: BPD may be influenced by the quality of the early attachment between the child and the caregiver. People with BPD often report a history of childhood abuse, neglect, trauma, or separation, which may impair their ability to form secure and stable relationships later in life. These adverse childhood experiences may also affect the development of the brain and the stress response system, making people with BPD more vulnerable to emotional dysregulation and reactivity.
- Social factors: BPD may be affected by the social and cultural context of the person. People with BPD may experience social stress, discrimination, stigma, isolation, or lack of support, which may worsen their symptoms and coping skills. They may also
have difficulty adapting to changes or transitions in their life, such as moving, graduating, getting married, or having children.
What are the types of BPD?
BPD is a complex and heterogeneous disorder, which means that not everyone with BPD has the same symptoms or severity. Some researchers have proposed different subtypes of BPD, based on the predominant features or patterns of the disorder. However, these subtypes are not officially recognized or widely accepted, and they may overlap or change over time. Some examples of the proposed subtypes are:
- Discouraged: This subtype is characterized by low self-esteem, depression, anxiety, withdrawal, and dependence. People with this subtype may appear submissive, passive, needy, and hopeless. They may also have suicidal thoughts or behaviors.
- Impulsive: This subtype is characterized by high impulsivity, thrill-seeking, aggression, irritability, and boredom. People with this subtype may appear energetic, charismatic, charming, and adventurous. They may also have antisocial tendencies or problems with the law.
- Petulant: This subtype is characterized by moodiness, anger, resentment, stubbornness, and unpredictability. People with this subtype may appear defiant, rebellious, sarcastic, and manipulative. They may also have difficulty compromising or cooperating with others.
- Self-destructive: This subtype is characterized by self-harm, self-sabotage, guilt, shame, and emptiness. People with this subtype may appear self-critical, self-loathing, masochistic, and nihilistic. They may also have a history of abuse or trauma.
How is BPD diagnosed?
The most widely used diagnostic criteria for BPD are from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is listed by the American Psychiatric Association. According to the DSM-5, a person must have at least five of the following nine symptoms to be diagnosed with BPD:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
- Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
The diagnosis of BPD may be challenging, as some of the symptoms may overlap with other mental health conditions, such as bipolar disorder, PTSD, major depressive disorder, or other personality disorders. Therefore, it is important to seek a
thorough and accurate evaluation from a qualified mental health professional.
How is BPD treated?
BPD can be treated with a combination of psychotherapy, medication, and self-care. The goals of treatment are to reduce the severity and frequency of the symptoms, improve the quality of life and functioning, and prevent or reduce the risk of self-harm, suicide, and other complications.
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Psychotherapy: Psychotherapy, also known as talk therapy or counseling, is the mainstay of treatment for BPD. Psychotherapy involves meeting with a therapist regularly to discuss the person’s thoughts, feelings, behaviors, and relationships, and to learn new skills and strategies to cope with the challenges of BPD. Different types of psychotherapy are effective for BPD, such as:
- Dialectical behavior therapy (DBT): DBT is a form of cognitive-behavioral therapy (CBT) that focuses on teaching the person how to regulate their emotions, tolerate distress, improve their interpersonal skills, and live more mindfully. DBT consists of four components: individual therapy, group skills training, phone coaching, and therapist consultation. DBT is one of the most researched and validated treatments for BPD.
- Mentalization-based therapy (MBT): MBT is a form of psychodynamic therapy that focuses on helping the person understand their own and others’ mental states, such as thoughts, feelings, beliefs, and intentions.
- Seeking support: You can seek support from people who understand and care about you, such as family members, friends, peers, or professionals. You can also join a support group, online forum, or helpline for people with BPD or similar conditions. Support can help you feel less alone, more validated, and more hopeful.
- Educating yourself: You can educate yourself about BPD, its causes, symptoms, treatments, and coping strategies. You can also learn about the experiences and perspectives of other people with BPD. Education can help you understand yourself better, reduce stigma, and increase your motivation for recovery.
- Practicing healthy habits: You can practice healthy habits that can benefit your physical and mental health, such as eating well, sleeping well, exercising regularly, avoiding drugs and alcohol, and managing stress. Healthy habits can help you boost your mood, energy, self-esteem, and resilience.
- Developing coping skills: You can develop coping skills that can help you deal with the challenges of BPD, such as regulating your emotions, tolerating distress, communicating effectively, solving problems, and setting goals. Coping skills can help you reduce your impulsivity, anger, self-harm, and suicidal thoughts, and increase your confidence, satisfaction, and happiness.
How common is BPD?
BPD is a relatively common mental health condition. According to the National Institute of Mental Health, about 1.4% of adults in the U.S. have BPD in a given year. However, the prevalence of BPD may vary depending on the population and the assessment method. Some studies have estimated that up to 5.9% of adults in the general population, 15% to 20% of adults in psychiatric settings, and 10% of adults in primary care settings may have BPD.
What are the complications of BPD?
BPD can cause significant distress and impairment in various aspects of life, such as:
- Relationships: People with BPD may have difficulty forming and maintaining healthy and satisfying relationships with their partners, friends, family members, co-workers, or others. They may experience frequent conflicts, arguments, breakups,
reconciliations, isolation, loneliness, or abuse. They may also have trouble trusting, respecting, or empathizing with others.
- Work or school: People with BPD may have difficulty performing and succeeding in their work or school. They may have low motivation, poor concentration, low productivity, low quality of work, absenteeism, tardiness, conflicts with colleagues or
teachers, or disciplinary actions. They may also have trouble finding or keeping a job or completing their education.
- Health: People with BPD may have poor physical health due to their unhealthy habits, impulsive behaviors, self-harm, or suicide attempts. They may also have other mental health conditions, such as depression, anxiety, eating disorders, substance use disorders, or post-traumatic stress disorder (PTSD). These conditions may worsen the symptoms and outcomes of BPD, and vice versa.
- Legal or financial: People with BPD may have legal or financial problems due to their impulsive and risky behaviors, such as gambling, spending sprees, reckless driving, drug abuse, or violence. They may also have debts, fines, lawsuits, arrests, convictions, or imprisonment.
Can BPD be cured?
There is no cure for BPD, but it can be treated and managed with appropriate and consistent care. Treatment can help reduce the severity and frequency of the symptoms, improve the quality of life and functioning, and prevent or reduce the risk of self-harm, suicide, and other complications. Treatment can also help people with BPD develop a more stable and positive sense of self and identity, and form more healthy and fulfilling relationships.
BPD is a chronic (long-term) condition that may require lifelong treatment and support. However, some studies have suggested that BPD may improve with age and time, as some people with BPD may experience remission (reduction or disappearance) of their symptoms or no longer meet the diagnostic criteria for BPD after several years of treatment. Remission does not mean that BPD is
cured, but rather that the person has learned to cope with the condition and live a more satisfying life.
What is the outlook for people with BPD?
The outlook for people with BPD varies depending on the individual, the severity of the condition, the availability and effectiveness of treatment, and the presence of other factors, such as co-occurring mental health conditions, social support, life events, and personal goals. Some people with BPD may experience more challenges and difficulties than others, and some may have more positive and hopeful outcomes than others.
The outlook for people with BPD may also change over time, as the condition may fluctuate in response to stress, therapy, medication, and other influences. Some people with BPD may experience periods of stability and improvement, as well as periods of relapse and deterioration. Therefore, monitoring the symptoms and progress of BPD regularly and adjusting the treatment plan accordingly is important.
People with BPD can live fulfilling and meaningful lives with proper treatment and support. They can also contribute positively to society and make a difference in the world. Some examples of famous people who have or had BPD are:
- Marilyn Monroe was an American actress, singer, and model who became a cultural icon and a symbol of beauty, glamour, and sexuality.
- Princess Diana, the first wife of Prince Charles and the mother of Prince William and Prince Harry was known for her humanitarian work and her influence on fashion and culture.
- Amy Winehouse, a British singer and songwriter who won five Grammy Awards and was praised for her distinctive voice and eclectic musical style.
- Pete Davidson is an American comedian and actor who is a cast member of Saturday Night Live and has starred in several films and TV shows.
- Halsey is an American singer and songwriter who has sold over one million albums and has received several awards and nominations.
These are just a few examples of people who have or had BPD and achieved success and recognition in their fields. There are many more people with BPD who are not famous, but who are equally valuable and worthy of respect and admiration.
Conclusion
A borderline personality disorder is a serious mental health condition that affects how a person thinks, feels, and behaves. It can cause significant distress and impairment in various aspects of life, such as mood, self-image, relationships, and impulsivity. However, with proper diagnosis, treatment, and support, many people with BPD can overcome their challenges and lead fulfilling lives.
FAQs
Q: What are the signs of borderline personality disorder?
A: The signs of borderline personality disorder (BPD) may include emotional instability, impaired self-image, relationship problems, impulsivity and risk-taking, dissociation, and paranoia. These symptoms can vary from person to person and may change over time.
Q: What causes borderline personality disorder?
A: The exact causes of borderline personality disorder are not fully understood, but they are likely to involve a combination of genetic, environmental, and social factors. Some of the possible causes are a family history of BPD, childhood trauma, brain abnormalities, and social stress.
Q: How is borderline personality disorder diagnosed?
A: Borderline personality disorder is diagnosed based on a psychological examination by a trained mental health professional. The diagnosis is based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which requires at least five of the following symptoms to be present:
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Frantic efforts to avoid real or imagined abandonment.
·
A pattern of unstable and intense interpersonal relationships.
·
Identity disturbance: markedly and persistently unstable self-image or
sense of self.
·
Impulsivity in at least two areas that are potentially self-damaging
(e.g., spending, sex, substance abuse, reckless driving, binge eating).
·
Recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior.
·
Affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours and
only rarely more than a few days).
·
Chronic feelings of emptiness.
·
Inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, and recurrent physical fights).
·
Transient, stress-related paranoid ideation or severe dissociative
symptoms.
Q: How is borderline personality disorder treated?
A: Borderline personality disorder can be treated with a combination of psychotherapy, medication, and self-care. Psychotherapy is the main treatment for BPD, and it involves talking to a therapist who can help the person understand their condition, cope with their emotions, change their behavior, and improve their relationships. Different types of psychotherapy can be effective for BPD, such as dialectical behavior therapy (DBT), mentalization-based therapy (MBT), schema therapy (ST), or transference-focused psychotherapy (TFP). Medication can help manage some of the symptoms of BPD, such as depression, anxiety, impulsivity, or psychosis.
Some of the commonly used medications are antidepressants, mood stabilizers, antipsychotics, and anti-anxiety drugs. Self-care involves taking care of one’s physical, mental, and emotional health, such as eating well, sleeping well, exercising regularly, avoiding drugs and alcohol, managing stress, practicing relaxation techniques, engaging in hobbies and interests, and seeking support from family, friends, or peers.
Q: Can borderline personality disorder be cured?
A: Borderline personality disorder is not a curable condition, but it can be managed and improved with proper treatment and support. Many people with BPD can reduce their symptoms and lead satisfying lives. Some of the factors that can help with recovery are early diagnosis, adherence to treatment, positive social support, a stable environment, coping skills, and resilience.
