Borderline Personality Disorder Symptoms: How Is It Diagnosed?

According to the National Institutes of Health, 1.6% of people in the United States are living with borderline personality disorder (BPD). This equates to over 5 million people who have this disorder. BPD can severely affect the ability of a person to control their emotions. Without emotional control, someone with BPD may experience mood swings, act impulsively, and feel confused about their self-perception. These symptoms can complicate social relationships and affect the way that an individual relates to themselves and their own feelings. The symptoms of BPD can also cloud a person’s judgment and lead to behaviors that make some life situations painful and challenging to navigate. 

Below, we’ll discuss symptoms of borderline personality disorder (BPD), treatment options, and how this disorder is diagnosed.

What Is Borderline Personality Disorder?

Borderline personality disorder is one of several personality disorders that can be painful and distressing to the people who have them. However, treatment is available that supports people through the emotional challenges of this disorder. BPD tends to be characterized by a loss of emotional control, which can in turn lead to impulsivity, a distorted self-image, and unstable relationships. People with BPD often experience feelings of intense fear, anger, and anxiety and tend to have difficulty managing their emotions.

Personality disorders can 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. Some people with BPD are diagnosed with other conditions before receiving their BPD diagnosis.

Most people with BPD are diagnosed in early adulthood or in late adolescence, but some are diagnosed earlier if their symptoms last at least one year. If you believe you may be experiencing symptoms of borderline personality disorder or another mental health condition, a licensed therapist may be able to provide you with an accurate diagnosis and prevent potential confusion and harm.

Risk Factors For Borderline Personality Disorder

Although the exact causes of BPD are not completely clear, there are some risk factors that appear to contribute to the disorder. According to the Substance Abuse and Mental Health Services Administration, the following are some of the risk factors for borderline personality disorder: 

• Abandonment as a child or adolescent

• Disrupted family life

• Communication problems in the family

• Physical, emotional, or sexual abuse

These are just a few examples of experiences that can lead to BPD. Any adverse childhood experience (ACE) or traumatic event can put someone at a higher risk of developing borderline personality disorder or other mental health conditions.

Also, as with almost any mental illness, family history is thought to be a risk factor for BPD. Some twin studies show that there may be a genetic component to personality disorders and other mental health conditions. 

Another possible factor with BPD is related to brain structure and function. There is some evidence that changes in brain areas that control emotions may be risk factors for BPD. Also, certain brain chemicals, such as serotonin, may be altered in a person with BPD.

These risk factors don’t guarantee that an individual will develop borderline personality disorder. Someone with all these risk factors may never develop a the disorder, but awareness of risk factors may help with early intervention.

Symptoms Of Borderline Personality Disorder

A diagnosis can only be given by a licensed mental health professional. Some symptoms of borderline personality disorder are not exclusive to this disorder. For this reason, it’s recommended that you seek professional evaluation if you suspect that you or a loved one may have symptoms of BPD.

People with BPD also tend to have a fear of abandonment in their relationships, which may be related to their perception of extremes. This may lead to behaviors that ultimately put a strain on relationships and even lead to their end in a type of self-fulfilling prophecy.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual Of Mental Disorders (DSM-5), 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

• Thoughts of abandonment, which 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, which can result in behaviors like self-harm and suicidal ideation

• Impulsive or self-destructive behaviors like over-spending, gambling, substance use, reckless driving, and risky sex

• Extreme and intense mood swings that can occur without provocation that can last anywhere from a few hours to days

• Feelings of loneliness, emptiness, and intense fear

• Inappropriate outbursts of anger, including out-of-control intense anger that seems irrational, self-destructive, and threatening to themselves and/or others

• An inability to trust others

• Dissociation, which can cause problems with feeling connected to self or others, feelings of being disconnected from reality, a view of the self as if outside themselves, and difficulty being in the present moment

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

If you or someone you know is experiencing any combination of the symptoms listed above, it may help to seek an appointment with a professional. A diagnosis can be helpful as a first step to understanding the reasons behind the symptoms. A trained professional can conduct an evaluation and provide BPD treatment options that can reduce symptom occurrence. 

Diagnosing Borderline Personality Disorder

Only a licensed physician or mental health professional can provide a diagnosis of borderline personality disorder. A licensed counselor, psychologist, or psychiatrist can conduct an evaluation to diagnose BPD.

Interview

The first part of an evaluation for BPD typically includes an interview by a therapist, psychologist, or doctor. During the interview, you may be asked to discuss symptoms and any problems in your life that you perceive are related to them. The mental health professional may inquire about symptom severity and frequency. Information during the clinical interview may be used to help your clinician understand why, when, and how symptoms occur.

BPD symptoms are often found in other mental health conditions as well. The interview process may help the clinician rule out or include other potential diagnoses.

Medical Exam

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

Family History

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

BPD tends to have some biological and environmental risk factors, and gathering information about your present living situation, your history with your family, and your family’s mental health and medical history may be helpful in determining these factors. 

With a diagnosis, these same professionals can put together a treatment plan that may ease your symptoms and increase your emotional well-being.

Therapy And Treatment Of Borderline Personality Disorder

There are multiple options that can help individuals living with borderline personality disorder. Everyone is different and may respond differently to various types of treatments. 

This list of treatments and therapies below is for reference only; the best plan may be tailored to your specific needs by a licensed clinician.

Psychotherapy

Psychotherapy tends to be one of the leading treatments for people with BPD. Therapy is an evidence-based treatment option that can provide strategies for managing and controlling emotions better. Working with a mental health professional may also help 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. This, in turn, may reduce risky and harmful behaviors, such as self-harm or impulsive decisions.

Furthermore, a therapist may help with co-occurring disorders, such as eating disorders, post-traumatic stress disorder, or anxiety disorders.

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

Dialectical Behavior Therapy (DBT)

DBT was developed by Dr. Marsha Linehan specifically for borderline personality disorder.  DBT is an evidence-based approach that addresses the symptoms of BPD by: 

• 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)

Cognitive behavioral therapy (CBT) tends to focus on helping individuals with BPD learn to identify and change core beliefs that lead to the harmful behaviors associated with BPD. A new way of identifying and thinking about core beliefs may help individuals learn new ways of coping with the symptoms of BPD. CBT may help individuals better assess the reality of a situation, outside of their intense feelings about it.

Schema Therapy

According to a study published in PLoS One, another form of therapy that has been shown to be effective for BPD is schema therapy, which can take place one-on-one or in a group. Schema therapy may help a person with BPD to recognize patterns that they may have used for survival and fulfillment of unmet needs. These patterns may cause harm in the present. A therapist may be able to help someone with BPD to discover healthy ways to get their needs met.

Family Therapy

Family therapy is another potentially beneficial option for individuals with BPD, especially for those who have a close family that is supportive of their healing journey. Those who have had adverse childhood experiences (ACEs) may be at a higher risk of developing borderline personality disorder. If family is open to discussing the experiences that may have contributed to BPD, then family therapy may be effective. Even without such childhood experiences, family therapy may help an individual with BPD to feel more supported.

Medication For Individuals With BPD

While there isn’t currently a medication designed specifically for BPD, some people with BPD take medication to manage their symptoms. These medications may include antidepressants, mood stabilizers, and antipsychotic medications. Prescription medication may help treat specific symptoms, such as mood swings, anger, and depression. Controling these symptoms may also make it easier for people with BPD to begin talk therapy and reduce self-destructive behaviors. 

Reaching Out For Support

If you’re experiencing symptoms of borderline personality disorder, you may benefit from speaking to a licensed counselor. If your symptoms make you feel hesitant to visit a therapist’s office, you might consider online therapy, which numerous peer-reviewed studies have demonstrated to be effective, including for anxiety and depression, which sometimes co-occur with BPD.

Meeting online often allows for flexibility in your schedule that could help you commit more fully to talk therapy treatments. Having therapy from the comfort of your home may make you feel more comfortable, and you can communicate with your therapist via video chat, phone call, or even live messaging. 

Below are some reviews of online therapists from people who have tried online therapy at BetterHelp.

“Barbie has been my counselor for the past few months. She is AMAZING! I had never taken any therapy services before so I had my doubts on how this would be beneficial, I was wrong. Barbie has helped me not only understand why I’ve had anxiety and depression, but also create a process to keep it under control when it does occur. Crisis will happen in our lives, but that doesn’t mean we shouldn’t have a way to deal with our emotions when it does happen instead of crisis catching us by surprise. I highly recommend Barbie’s therapy services to anyone that is hesitant in trying therapy for the first time or if you want to find a new counselor. She’s an expert in her field and puts the interests of her patients first.”

Hoi Moy, MS, LPC

“Rene was assigned as my counselor, and I couldn't be happier with his support. I've been working with him for about 2 months now and he's helped me get through some really dark times. When I first signed up for BetterHelp, I was experiencing depression unlike any episode I've had before. Rene gave me the tools and advice I needed to get through those days and that I can use anytime I feel those thoughts creeping back. I look forward to our sessions and can't thank him enough for the support and motivation he's given me. I highly recommend working with Rene!”

Rene Brathwaite, LPCMH, ICCDP-D, NCC