Borderline personality disorder (BPD) is a mental disorder in which the person suffers from unstable relationships, a distorted sense of self and reality, and difficulty managing emotions.
What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a mental health condition that strongly affects our ability to control our emotions, distorting how we see ourselves and others. BPD can cause impulsive behavior patterns, emotion regulation issues, poor self-image, mood swings, etc.
It can also impair daily functioning and lead to unstable social and personal relationships. Surveys 1 Brüne M. (2016). Borderline Personality Disorder: Why ‘fast and furious’?. Evolution, medicine, and public health, 2016(1), 52–66. https://doi.org/10.1093/emph/eow002 estimate that BPD affects 1.6% of the world population and has a lifetime prevalence of about 6%.
People suffering from BPD often have issues with their identity and experience feelings of emptiness, thereby resorting to desperate attention-seeking behavior and dependence on others. They become impulsive and reckless, consequently going into a spiral of self-destructive behavior. Such behavior often includes self-harm and harming others around them.
Frequently, people suffering from BPD experience mood swings and violent urges that come from hypersensitivity to rejection, among other things. As a result, they unconsciously or unintentionally act out against loved ones—a phenomenon called splitting—without any sense of guilt or remorse.
Paradoxically, they suffer from commitment and trust issues and fear of abandonment because of which, they make frantic efforts to avoid real or imagined abandonment.
Research 2 Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/ also shows that people with BPD do not react positively to stressors, and this makes them spiral out of control. To “manage” such distressing incidents, they develop maladaptive and negative belief systems and unhealthy coping mechanisms like substance abuse, self-harm, abusive behavior, etc.
Case Example
Leena had been physically violent and verbally abusive to her husband numerous times in the past six months. This would invariably be followed by immediate regret and subsequent acts to “make up” for the wrong, such as cooking his favorite dish, buying him gifts, or showering him with a lot of affection and apology.
Leena’s anger was quite unpredictable and could be triggered by any small day-to-day thing, which in turn compelled her husband to remain on his tiptoes all the time.
Leena had been married for a year and had known her partner for a couple of months before that. While she declared that she loved her husband dearly, she also admitted that sometimes she hated him to the core and often felt insecure regarding his love for her. Nevertheless, she believed that her identity was intricately linked to him.
Prior to this, Leena had been in 3-4 serious relationships but none of them had lasted beyond a year.
Leena was also quite indecisive about her career goals. Her interests and hobbies frequently changed as did her mood.
Case Analysis
Leena’s anger outbursts were directed towards her loved one (her husband) but at the same time, she felt that she could not live without him.
Additionally, she seemed to be confused regarding her goals and interests and had a history of intense short term relationships. These signs may point to a possibility of borderline personality disorder.
Symptoms Of Borderline Personality Disorder
Borderline personality disorder symptoms include:
- Emotional dysfunction
- Extreme fears of abandonment
- Frantic efforts to avoid real or imagined abandonment
- Unstable social relationships
- Distorted sense of reality
- Lack of identity and morals
- Feelings of victimization
- Impulsive and reckless behavior
- Self-complexity
- Thought repression
- Lack of resilience against stressors
- Splitting, or sudden mood and behavioral changes
- Chronic feelings of emptiness
- Paranoia, or extreme feelings of suspicion and dysphoria
- Dissociating from one’s own self and reality
- Suicidal or self-harm tendencies
Read More About Self-Harm Here
Types Of Borderline Personality Disorder
There are 4 types of borderline personality disorder:
1. Discouraged Borderline Personality Disorder
Discouraged borderline is a type of BPD characterized by over-dependence 3 Duică, L., Antonescu, E., Totan, M., Boța, G., & Silișteanu, S. C. (2022). Borderline Personality Disorder “Discouraged Type”: A Case Report. Medicina (Kaunas, Lithuania), 58(2), 162. https://doi.org/10.3390/medicina58020162 on others. It is marked by:
- Extreme indecisiveness
- Clinginess
- “Passive follower” mentality
2. Impulsive Borderline Personality Disorder
People with impulsive BPD experience reckless thrill-seeking urges and have no regard for the consequences of their actions. This type of BPD is marked by:
- Recklessness
- Elusive and mercurial behavior
- Superficial charm
- Unwillingness to form meaningful relationships
- Thrill-seeking behavior
- Risk-taking behavior
3. Petulant Borderline Personality Disorder
Petulant borderline personality disorder is predominantly marked by emotional dysfunction and aggressive conduct. It is characterized by:
- Mood swings
- Irritability
- Defiance
- Passive-aggressive behavior
- Low self-esteem
- Unstable relationships
Read More About Self-Esteem Here
4. Self-destructive Borderline Personality Disorder
Self-destructive BPD is a type of BPD wherein a person takes to negative, delusional, and self-defeating thoughts and actions. Its markers include:
- Lack of self-identity and control
- Fear of abandonment
- Commitment issues
- Bitter moods and anger
Causes Of Borderline Personality Disorder
BPD can be caused by myriad factors. These include:
1. Genetics
According to a 2017 study 4 Bassir Nia, A., Eveleth, M. C., Gabbay, J. M., Hassan, Y. J., Zhang, B., & Perez-Rodriguez, M. M. (2018). Past, present, and future of genetic research in borderline personality disorder. Current opinion in psychology, 21, 60–68. https://doi.org/10.1016/j.copsyc.2017.09.002 , BPD “has moderate to high heritability based on twin and family studies”. It is found that 50% of BPD variation 5 Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/ is caused by genetics.
Read More About Genetics Here
2. Brain Abnormalities
BPD can be caused by certain functional and structural changes in the brain, including:
- Reductions in brain regions involved in the regulation of stress responses and emotion
- Smaller hippocampus
- Smaller amygdala
- Reduced activity in the prefrontal cortex
- Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis
- Disturbed cortisol levels
- Dysfunctioning stress hormones, etc.
3. Personality Traits
Certain personality traits make people more vulnerable to BPD than others. Dubbed the “borderline personality disorder traits”, these include:
- Narcissism
- Extraversion
- Neuroticism
- Masochism
- Negativism
- Avoidant personality
- Depressive personality
- Antisocial personality
Read More About Narcissism Here
4. Environmental Factors
Certain BPD risk factors are environment-related. Studies 6 Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/ show that BPD is caused by a multitude of environmental/ psychosocial factors, including:
- A history of child sexual abuse
- Dysfunctional family environment
- A history of parental abuse
- A history of domestic violence
- Experiences of bullying
- Other traumatic life events
Other conditions that co-occurr With BPD
The signs of borderline personality disorder are complex and confusing, interspersed with several comorbid conditions like:
- Depression [Read more]
- Bipolar disorder [Read more]
- Anxiety and stress-related disorders [Read more]
- Other personality disorders [Read more]
- Schizophrenia [Read more]
- Substance use
- Eating disorders [Read more]
- Attention deficit hyperactivity disorder [Read more]
- Somatic symptom disorders [Read more]
- Dissociative disorders [Read more]
Diagnosis Of Borderline Personality Disorder
The criteria for diagnosis of borderline personality disorder have been laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 7 Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World psychiatry : official journal of the World Psychiatric Association (WPA), 12(2), 92–98. https://doi.org/10.1002/wps.20050 . It states that people suffering from BPD display “a pervasive pattern of instability of interpersonal relationships, of self-image, and affects as well as marked impulsivity beginning by early adulthood and present in a variety of contexts”.
A psychiatrist/ psychologist usually conducts a mental status examination followed by a detailed interview of the patient to determine if a patient is suffering from borderline personality disorder. A number of psychometric assessments can be used in order to diagnose BPD.
Treatment For Borderline Personality Disorder
BPD is a controversial disorder, but a large number of therapies, medications, and self-help strategies are available to help people successfully address and manage the disorder.
Some of the most effective treatment approaches are mentioned below:
1. Psychotherapies
Psychotherapy is the cornerstone of borderline personality disorder treatment. It addresses behavioral and conduct disorders, self-harm and suicidal tendencies, and emotional dysfunction in BPD patients. In fact, according to a 2022 study 8 Chapman, J., Jamil, R. T., & Fleisher, C. (2022). Borderline Personality Disorder. In StatPearls. StatPearls Publishing. Available from: https://pubmed.ncbi.nlm.nih.gov/28613633/ , psychotherapies improve treatment outcomes 9 Biskin, R. S., & Paris, J. (2012). Management of borderline personality disorder. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 184(17), 1897–1902. https://doi.org/10.1503/cmaj.112055 when it comes to BPD symptom severity related to psychosocial functioning and depression.
Many long-term evidence-based psychotherapies 10 Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What Works in the Treatment of Borderline Personality Disorder. Current behavioral neuroscience reports, 4(1), 21–30. https://doi.org/10.1007/s40473-017-0103-z are used for the treatment of borderline personality disorder, comprising:
- Dialectical behavior therapy (DBT) 11 May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The mental health clinician, 6(2), 62–67. https://doi.org/10.9740/mhc.2016.03.62
- Dynamic deconstructive psychotherapy (DDP) 12 Gregory, R. J., DeLucia-Deranja, E., & Mogle, J. A. (2010). Dynamic deconstructive psychotherapy versus optimized community care for borderline personality disorder co-occurring with alcohol use disorders: a 30-month follow-up. The Journal of nervous and mental disease, 198(4), 292–298. https://doi.org/10.1097/NMD.0b013e3181d6172d
- Mentalization-based treatment (MBT) 13 Bateman, A., & Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder. World psychiatry : official journal of the World Psychiatric Association (WPA), 9(1), 11–15. https://doi.org/10.1002/j.2051-5545.2010.tb00255.x
- Transference-focused psychotherapy 14 Yeomans, F., Delaney, J. C., & Renaud, A. (2007). La psychothérapie focalisée sur le transfert [Transference focused psychotherapy]. Sante mentale au Quebec, 32(1), 17–34. https://doi.org/10.7202/016507ar
- Schema-focused therapy 15 Tan, Y. M., Lee, C. W., Averbeck, L. E., Brand-de Wilde, O., Farrell, J., Fassbinder, E., Jacob, G. A., Martius, D., Wastiaux, S., Zarbock, G., & Arntz, A. (2018). Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions. PloS one, 13(11), e0206039. https://doi.org/10.1371/journal.pone.0206039
- Systems training for emotional predictability and problem-solving (STEPPS) 16 Parker, A. L., Forsythe, L. L., & Kohlmorgen, I. K. (2019). TeamSTEPPS® : An evidence-based approach to reduce clinical errors threatening safety in outpatient settings: An integrative review. Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management, 38(4), 19–31. https://doi.org/10.1002/jhrm.21352
- General psychiatric management therapies 17 National Collaborating Centre for Mental Health (UK). Borderline Personality Disorder: Treatment and Management. Leicester (UK): British Psychological Society (UK); 2009. (NICE Clinical Guidelines, No. 78.) 7, MANAGEMENT OF CRISES. Available from: https://www.ncbi.nlm.nih.gov/books/NBK55407/
Read More About Major Depressive Disorder (Depression) Here
2. Medication
According to a 2012 study 18 Biskin, R. S., & Paris, J. (2012). Management of borderline personality disorder. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 184(17), 1897–1902. https://doi.org/10.1503/cmaj.112055 , pharmacology plays a limited role in the treatment of BPD. However, MHPs resort to short-term pharmacotherapy to treat symptoms of severe cases of BPD. They use medication including:
- Antidepressants
- Antipsychotic agents
- Mood stabilizers
Read More About Antidepressants Here
How To Cope With Borderline Personality Disorder?
There are several self-help strategies that you can employ to successfully manage borderline personality disorder symptoms. These include:
- Educating yourself about BPD
- Developing coping skills to manage anger, mood swings, violent tendencies, etc.
- Following a healthy lifestyle—with nutritious food and a good sleep hygiene regime
- Using stress-reduction techniques (like deep breathing or meditation)
- Exercising regularly
- Distracting oneself from self-destructive urges
- Grounding oneself
- Communicating honestly
- Reaching out to loved ones for support
How To Live With People Who Have BPD?
Due to the nature of people with borderline personality disorder, it might be difficult for people around them, especially their friends, partners and family members to maintain healthy relationships with them. Often, if you are living with someone who has BPD you might also need therapy.
Here are a few tips that can help you live/ sustain a relationship with a person who has borderline personality disorder:
- Read and try to learn more about the disorder so as to understand them better.
- Understand that the way they look at the relationship may be different from the way you do, and this has an impact on their behavior.
- Try to reassure them that you will be there to support them.
- Always communicate clearly with them, leaving as little ambiguity as possible.
- Do not take their outbursts personally, as they are mostly to do with their disorder, and less to do with you.
- Take care of your needs, boundaries and well-being.
- Make sure you don’t sacrifice your mental health for your loved one.
- Help them adhere to their medication and/or attend therapy sessions regularly.
In spite of these, it can sometimes still be difficult to be around someone with BPD. In such situations, a therapist or counselor can best help you figure out how to navigate the relationship.
Takeaway
Borderline personality disorder is a rare and controversial disorder that affects 1.6% of the global population. If untreated, the BPD symptoms can grow more severe and negatively impact your mental and physical health, social relationships, employment and financial prospects, and quality of life.
Thankfully, many BPD treatment methods are available that can help a person effectively manage his/her symptoms and live a normal and happy life.
At A Glance
- Borderline personality disorder (BPD) is a psychiatric disorder in which the person suffers from unstable relationships, a distorted sense of self and reality, and emotional dysfunction.
- BPD affects 1.6% of the world population and has a lifetime prevalence of about 6%.
- Borderline personality disorder symptoms include abandonment fears, impulsivity, violent conduct, self-complexity, paranoia, substance abuse, etc.
- BPD is caused by genetic factors, brain abnormalities, and environmental factors.
- BPD can be easily diagnosed with long-term therapy and medication.
Frequently Asked Questions (FAQs)
1. Can I reduce the risk of inheriting BPD?
Reducing the genetic risk of BPD is not possible, but you can regulate the environmental factors that make a person vulnerable to BPD. This involves providing yourself or your children with a safe, healthy, and emotionally reciprocative environment to grow up in.
2. Can BPD be cured with psychotherapy?
Yes. BPD is mainly treated with psychotherapy, but, in some cases, medication is also used for its treatment.
3. What is the best treatment for BPD?
Dialectical behavior therapy (DBT) is considered to be the best and first line of treatment for borderline personality disorder.
4. Is an intimate relationship possible with someone with BPD?
BPD is characterized by emotional dysfunction and unstable relationships. It takes effort to be in an intimate relationship with someone suffering from BPD, but it is not impossible.
5. Can you have borderline personality disorder and not know it?
Borderline personality disorder comprises chronic dysfunctional behavior patterns that cause emotional distress and social issues. People with borderline personality disorder do not realize that their abnormal behavior may be problematic and that they may be hurting others around them.
6. Do people with borderline personality disorder talk a lot?
Research shows that people with borderline personality disorder may show logorrhea or the tendency to use excessive wordiness and repetitiveness in any conversation. However, it’s not right to generalize and expect every individual suffering from BPD to monopolize conversations with loud and animated chatter.
7. Are intrusive thoughts a symptom of borderline personality disorder?
Yes, intrusive thoughts (particularly those related to obsessive-compulsive symptoms) are related to borderline psychopathology.
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