Borderline Personality Disorder Symptoms And How Is It Diagnosed

Updated October 4, 2022 by BetterHelp Editorial Team

Overview

Borderline personality disorder (BPD) is a personality disorder that can complicate social relationships and affect the way that an individual relates to themselves and their own feelings. The symptoms of BPD can cloud judgment and trigger behaviors that make some life situations painful and harder to navigate.

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What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a personality disorder and mental illness that is characterized by the loss of emotional regulation and control. This can lead to dangerous impulsivity, distorted self-image, and unstable relationships. People with borderline personality disorder often experience chronic feelings of intense fear, anger, and anxiety and struggle to manage or control them. Most people with BPD are diagnosed in early adulthood, but some are diagnosed as early as the age of 12.

Borderline personality disorder is one of many personality disorders that are very painful and distressing to the people who have them and are difficult to treat. According to the National Institute Of Mental Health, personality disorders often coexist with other mental disorders, such as bipolar disorder, anxiety, or depression. This can complicate the diagnosis process as there are many overlapping symptoms between borderline personality disorder and other mental health disorders. Many people with BPD are often diagnosed for other conditions before receiving their BPD diagnosis. If you believe you have a mental health condition or multiple conditions and personality disorders, seeking the help of a licensed therapist or other mental health services will provide you with an accurate diagnosis and prevent potential harm from having to diagnose yourself.

Risk Factors For Borderline Personality Disorder

Although the exact causes of BPD are not completely clear, there are recognized risk factors that appear to contribute. According to the National Institute Of Mental Health, one of the most significant risk factors consists of how someone was raised by their family. Not all families are loving or harmonious, which can result in trauma, attachment issues, and adverse childhood experiences. Some examples of this include:

  • Abandonment in childhood or early adulthood
  • Disrupted family life
  • Communication fractures
  • Hostility and unstable relationships among family

These are just a few examples of experiences that can lead to BPD. It is important to note that almost any adverse childhood experience or traumatic event puts someone at a higher risk of developing borderline personality disorder or other mental health conditions.

The next risk factor is brain structure and function. There is evidence that changes in brain function and structure in areas that control the regulation of emotions and impulses may be risk factors for BPD or a result of BPD.

As with almost any mental illness, family history is a significant risk factor. Other factors include adverse environments or social experiences.

These risk factors only contribute to the likelihood that an individual may develop the disorder. Someone with all the risk factors may never develop a problem, but awareness of risk factors can help in early intervention, as well as BPD online therapy.

Symptoms Of Borderline Personality Disorder

A diagnosis can only be given by a professional. Some symptoms of borderline personality disorder are not exclusive to this disorder. It is best to seek professional evaluation and mental health services if you suspect that you or a loved one has any health issue.

BPD is characterized by emotional extremes that can change quickly. People with BPD tend to view events and relationships as good or bad rather than in the shades of gray in the manner that others may perceive. The thought process of extreme categorizing results in emotional ups and downs. This emotional turbulence can coincide with behaviors that reflect the highs and lows. People with BPD also frequently have a fear of abandonment in their relationships, perhaps tied to their perception of extreme ends. This often prompts thoughts and feelings that create behaviors that may ultimately put a strain on those relationships, self-fulfilling that expectation.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual Of Mental Disorders, the following symptoms and behaviors are common in those with BPD:

  • A pattern of unstable and intense relationships that can move from love to paranoia, anger, and devaluation without provocation or rational reason
  • Real or imagined thoughts of abandonment can lead to behaviors such as initiating close physical or emotional relationships rapidly or ending relationships just as quickly to avoid abandonment
  • Poor self-image and sense of self that results in behaviors like self-harm and suicidal ideation (If you are experiencing thoughts of suicide, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255.)
  • Impulsive or self-destructive behaviors like over-spending, gambling, substance abuse, reckless driving, and risky sex. (If you are struggling with substance use, reach out to the Substance Abuse And Mental Health Services Administration (SAMHSA) at (800)662-4357 for help and support.)
  • Extreme and intense mood swings that can occur without provocation that can last anywhere from a few hours to days
  • Feelings of loneliness, emptiness, intense fear
  • Inappropriate outbursts of anger, out-of-control intense anger that seems irrational, self-destructive, and threatening to themselves and/or others
  • An inability to trust others or over-trusting others
  • Dissociation that causes problems feeling connected to self or others, feelings of being disconnected from reality, viewing the self as if outside themselves, difficulty being in the present moment

Furthermore, the thoughts that underlie BPD in a person can motivate behavior that sometimes does not fit with the reality of a situation. Reactions can seem exaggerated in proportion to the situation. The severity of symptoms and their frequency vary for each person.

An individual with borderline personality disorder can have any combination of the above symptoms. However, don’t simply use this list as a way to self-diagnose borderline personality disorder in yourself or your loved ones. Only, a licensed doctor or licensed clinical social worker can help someone better understand if the history of their symptoms constitutes a BPD diagnosis.

If you or someone you know is dealing with any combination of the symptoms listed here, it is a good idea to seek an appointment with a professional. A diagnosis can be helpful as a first step to understanding how a person’s symptoms can be alleviated. A trained professional can make the evaluation and provide BPD treatment options that will greatly improve symptom occurrence. Your chosen mental health care provider will help you obtain a diagnosis and provide treatment through a range of proven therapies and techniques.

Diagnosing Borderline Personality Disorder

Only a licensed professional can provide a diagnosis of borderline personality disorder. A licensed counselor, psychologist, or psychiatrist performs various evaluations to diagnose BPD.

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Interview

The first part of diagnosis includes an interview by your therapist, psychologist, or doctor. During the interview, you'll be asked to discuss symptoms and any problems in your life that you perceive are related to them. The therapist will inquire about symptom severity and prevalence. Information during the clinical interview is used to help your clinician understand why, when, and how symptoms occur.

BPD symptoms are found across a range of other potential diagnoses. The interview and discussion are important to ruling out or including other potential diagnoses. This portion can also be helpful to identify any coinciding behaviors or complications.

Medical Exam

You may be asked to have a medical examination to rule out potential health issues that may produce symptoms like what you describe to your clinician. Your therapist or psychologist may refer you to a medical provider to have testing and a medical exam done.

Family History, Social & Cultural Information

Family histories are gathered by clinicians to help in diagnosis and treatment planning. By understanding your family's medical and mental health history, as well as determining any adverse experiences you may have had early in life, clinicians can get a more complete view of the factors that play a role in your situation.

BPD has biological and environmental risk factors and contributions, and gathering information about your present living situation, your history with your family, as well as their mental health and medical history will be helpful in determining these factors. You and your doctor will try and sort out how they fit with what you are experiencing.

Proper diagnosis is the only way to ensure the best plan for treatment. The only way to receive the best possible outcome for treatment of borderline personality disorder is to find a licensed professional and receive testing and a diagnosis. With a diagnosis, these same professionals can put together a treatment plan that will provide a care plan that can ease your symptoms.

Therapy And Treatment Of Borderline Personality Disorder

Once a diagnosis is reached, treatment can begin. There are multiple options that help treat borderline personality disorder. Talking with a professional about treatment options is important to finding success. Everyone is different and may respond differently to various types of treatments.

This list of treatments and therapies is for reference only; the best plan will be one that is tailored to the specific needs of the individual by a licensed professional.

Psychotherapy

Psychotherapy with a licensed mental health professional is one of the best treatments for people with BPD. Therapy is an evidence-based treatment option that can provide people with borderline personality disorder with strategies to manage and regulate their emotions better and provide them with emotional support. Working with mental health professionals also helps a person with BPD work on the factors that worsen their mood swings, such as significant stress, traumatic life events, unstable relationships, and environmental factors, or reduce and manage the risky and harmful behavior that results, such as self-harming or attempting suicide. Furthermore, a therapist can also help with co-occurring disorders, such as eating disorders, post-traumatic stress disorder,  or anxiety disorders.

Below are two common forms of psychotherapy that are known to help people with borderline personality disorder:

  • Dialectical Behavior Therapy (DBT) is a specific form of psychotherapy that addresses the symptoms of BPD in several ways.
    • Teaching skills to control extreme emotions such as anger and/or paranoia
    • Teaching skills to reduce or eliminate self-destructive behaviors
    • Providing skills to help an individual improve relationships
  • Cognitive Behavioral Therapy (CBT) is specific psychotherapy that focuses on helping individuals with BPD learn to identify and change core beliefs that lead to the negative behaviors associated with BPD. A new way of identifying and thinking about core beliefs can help individuals learn new ways of coping with the symptoms and effects of BPD. CBT can help individuals better ascertain the reality of the situation, outside of their intense feelings about it.
  • Family therapy is another great option, especially for those who have a close family that is supportive of their healing journey. Those who have had adverse childhood experiences are at a higher risk of developing borderline personality disorder. If family is open to discussing the experiences that may have caused BPD, then family therapy can be effective.

Medication Therapies

Many people with BPD also utilize medication for the management of their symptoms. However, medications for BPD do not cure BPD. Prescription medication can help treat specific symptoms, such as mood swings, anger, and depression. Regulating these symptoms may also make it easier for people with BPD to begin and commit to talk therapy and reduce self-destructive behaviors. This talk therapy will help them learn new coping skills which can move their thinking patterns away from painful extremes.

Borderline personality disorder varies in severity and may require multiple types of treatment depending on the individual. Diagnosis and treatment are best provided by a licensed professional who can explain treatment options and tailor them for success. If you or someone you know is struggling with symptoms of BPD, talk with your healthcare provider or reach out for therapy from the comfort of your own home with BetterHelp.

Turning to an online therapist for help managing the symptoms of BPD, like depression, can be very effective. Studies have shown that internet based interventions are just as effective for treating depression as in-person therapies. Even more, long-term benefits of continued symptom management and reduction has been shown to favor online treatment plans.

Talking with a therapist online can be a more manageable, long-term solution for the regulation of your symptoms. Meeting online allows flexibility in your schedule that could help you commit more fully and long-term to talk therapy treatments. Having therapy from the comfort of your home can make it easier to “show up” to therapy as you feel more comfortable in the space and with your therapist over a video call, phone call, or even messaging.

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Some commonly asked questions on this topic include:

How do they diagnose BPD?
What are the 9 criteria for BPD?
What is BPD usually misdiagnosed as?
Is BPD still a diagnosis?
What does a BPD episode look like?
What triggers borderline personality disorder?
Do I have BPD or am I just sensitive?
Is BPD the same as bipolar?
Is BPD hard to diagnose?
How does a person with BPD act?

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