Borderline Personality Disorder Symptoms And How Is It Diagnosed

By Sarah Fader

Updated December 17, 2018

Reviewer Whitney White, MS. CMHC, NCC., LPC

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 difficult to navigate.

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Although the exact causes for BPD are not completely clear, there are recognized risk factors that appear to contribute. There is evidence that changes in brain function and structure in areas that control regulation of emotions and impulse may be risk factors for BPD or a result of BPD. Family history of BPD is another risk factor for the development of BPD, as are social, cultural, and adverse childhood 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.

Symptoms Of Borderline Personality Disorder

Diagnosis should always be completed by a professional, as some of the symptoms of BPD are found in other issues. It is best to seek professional evaluation and treatment if you suspect that you or a loved one has any health issue.

BPD is characterized by emotional extremes that can change quickly and a tendency to view events and relationships as good or bad rather than in shades of gray that often are more realistic. The thought process of categorizing along extremes results in emotional ups and downs and behaviors that coincide with those highs and lows. People with BPD frequently have a fear of abandonment in relationships, which often prompts thoughts and feelings that create behaviors that ultimately cause relationships to end.

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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 that 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
  • Impulsive or self-destructive behaviors like over-spending, gambling, substance use, 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 and emptiness
  • 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

An individual with borderline personality disorder can have any combination of symptoms. The thoughts that underly BPD 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.

If you or someone you know is dealing with any combination of the symptoms listed here, it is a good idea to seek a diagnosis from a professional. Diagnosis is important to the quality of life. A trained professional can make the evaluation and provide 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 problems that you have related to them. The therapist will inquire about symptoms severity and prevalence. Information collected 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.

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 and 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 be sure and receive the best possible outcome for treatment of borderline personality disorder is to find a licensed professional and receive thorough testing and diagnosis. With a diagnosis, these same professionals can put together a treatment plan that will provide the very best care possible.

Therapy and Treatment of Borderline Personality Disorder

Once a diagnosis is reached, treatment can begin. Several therapeutic treatments exist for BPD. Talking with a professional about treatment options is important to finding success. Everyone is different and may respond differently to various types of treatments.

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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

  • DBT or Dialectical Behavior Therapy 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
  • CBT or Cognitive Behavioral Therapy is specific psychotherapy that works on helping individuals with BPD learn to identify and change core beliefs that lead to the negative behaviors of 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

Medication Therapies

Medications for BPD do not cure BPD; but they can help alleviate some of the severe symptoms. Mood swings, anger, and depression found in BPD can be helped by medication, which makes it easier for individuals with BPD to enter therapy and learn new ways of thinking and coping skills that are helpful in living with BPD.

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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 at BetterHelp.


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