Borderline Personality Disorder Basics

Borderline personality disorder is characterized by instability in interpersonal relationships, self-image and moods, as well as an impairing sense of social impulsivity and fear of abandonment. It affects both adolescents and young adults, and is diagnosed predominantly in girls.

Borderline Personality Disorder: What Is It?

Borderline personality disorder, or BPD, is a pervasive pattern of emotional turmoil, instability in relationships, and self-destructive behavior, including suicide attempts. Adolescents or young adults with BPD have intense relationships characterized by sudden and dramatic shifts from idealizing to devaluing the other person. They feel chronically misunderstood and at risk of abandonment;  frantic efforts to avoid being abandoned often blow up relationships they are trying to protect.

With distorted and unstable images of themselves, people with BPD experience feelings of emptiness, worthlessness and self-hatred, which they attempt to escape through impulsive and often self-destructive behaviors, including alcohol and drug abuse, unhealthy sex, self-injury, and suicide attempts.

BPD, which develops in adolescents and young adults, can be severely disabling and dangerous, but with treatment, most people with BPD can learn to regulate extreme emotions and dramatically improve their lives.

For a more detailed explanation from BPD experts, read What Is Borderline Personality Disorder?

Borderline Personality Disorder: What to Look For

People who develop BPD are highly emotionally reactive — they feel things more intensely than other people and, once upset, take a longer time to calm down. Symptoms of the disorder you might see include extreme emotions, rapid mood swings, and what clinicians call black-and-white thinking: something (or someone) is great one minute and terrible the next. Another symptom might be expressing intense feelings of hopelessness, worthlessness and fear of abandonment. Efforts to escape those painful feelings may lead to impulsive and self-destructive behavior (risky driving, unsafe sex, alcohol and substance abuse, and self-injury like cutting). Lack of a solid sense of self might lead to being overly influenced by those around her. The most dangerous symptom of BPD is suicidal behavior, which is why getting treatment as soon as symptoms emerge, usually in adolescence, is critical.

Borderline Personality Disorder: Risk Factors

BPD is more common among those who have first-degree relatives with the disorder. Experts call it a biosocial disorder because it is the result of two distinct factors, biological and social. The biological factor in BPD is a temperament that is highly emotionally reactive, quick to get very upset and slow to return to baseline. The social factor is being raised in an environment that does not validate those intense emotions in childhood, either through neglect or ordinary parenting practices that dismiss extreme emotions as overreactions. Without that validation from adults, children may not develop effective skills in emotional regulation, and may instead resort to unhealthy ways of coping with their feelings.

 

Borderline Personality Disorder: Diagnosis

Diagnosis of borderline personality disorder requires clinical assessment by a qualified mental health professional. Diagnostic criteria include intense fear of abandonment, a persistently unstable self-image, a pattern of unstable relationships veering between extremes of idealization and devaluation, impulsive risky behavior, suicidal or self-injurious behavior, frequent mood swings, chronic feelings of emptiness, difficulty controlling anger, and paranoid thinking or dissociative symptoms.

For a diagnosis, five or more of the criteria must be present, no later than early adulthood.

Borderline Personality Disorder: Treatment

Treatment for BPD can include psychotherapy, medications and hospitalization. The gold standard treatment for BPD, with the strongest evidence base, is a form of psychotherapy called dialectical behavior therapy, or DBT. DBT is a specialized form of cognitive behavior therapy that involves validating the powerful negative feelings of the patient with BPD, and teaching her skills to manage them in healthier ways. There is no medication that treats BPD itself, but antidepressants, antipsychotics and anti-anxiety drugs may prove helpful in treating co-occurring symptoms such as depression, impulsiveness or anxiety. Hospitalization may be required for more intense treatment of adolescents or young adults who are at risk of self-injury or suicidal behaviors.

Borderline Personality Disorder: Risk For Other Disorders

Other disorders that may occur alongside borderline personality disorder include depression, substance use disorders, anxiety disorders, eating disorders and bipolar disorder. As a result of impulsive behavior, someone with BPD may also be at risk for unplanned pregnancies, sexually transmitted diseases, motor vehicle accidents, self-injury and suicidal behavior.