Borderline Personality Disorder: Symptoms And Diagnosis
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 the 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, an unstable self-image, and insecure 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. Other mental health professionals, including a psychologist or clinical social worker, may also be able to help provide assistance and information that could be helpful.
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:
- Adolescent abandonment or child abuse
- Disrupted family life
- Communication problems in the family
- Physical, emotional, or sexual abuse
If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.
These are just a few examples of experiences that can lead to BPD. Any adverse childhood experiences (ACE), social factors, or traumatic events 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 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 a 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 self-harming behavior and suicidal ideation
- Impulsive self-destructive, or dangerous behaviors like overspending, 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
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
* if you or someone you love is thinking of attempting suicide or any form of suicidal thoughts, its essential to reach out for help immediately. You can reach the 24/7 988 Suicide and Crisis Lifeline by dialing 988.
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 member 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. Controlling 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.
Counselor reviews
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 about how this would be beneficial, but 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 the crisis catching us by surprise. I highly recommend Barbie’s therapy services to anyone who is hesitant to try 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
Takeaway
With BetterHelp, you can be matched with a therapist who has training and experience helping people with symptoms of BPD. Take the first step toward addressing symptoms of borderline personality disorder and reach out to BetterHelp today.
Below are some of the most frequently asked questions about borderline personality disorder symptoms and how to treat borderline personality disorder (BPD).
What are the nine symptoms of BPD?
The nine symptoms of borderline personality disorder diagnosed via the DSM-5 include the following:
- Intense and unstable relationships
- Self-harm and suicidal behavior
- Risky behavior, such as unsafe sex, substance misuse, and binge eating
- Intense emotions and anger
- Rapid changes in mood
- Chronic feelings of emptiness
- An extreme fear of abandonment or loss
- Pattern of unstable relationships with family members, friends, and partners
- A lack of understanding of one’s own identity
If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.
What triggers a person with borderline personality disorder?
People with borderline personality disorder (BPD) often have a history of trauma and severe symptoms of emotional dysregulation. They may struggle to cope with their traumatic past. Some people with BPD may also have a disorganized attachment style caused by prolonged childhood abuse or a lack of having their needs met by their caregivers.
People with this condition can have different trauma triggers, depending on their specific experiences. However, because BPD is formed around a fear of abandonment, it may be most difficult for them to practice emotion regulation skills when a partner is breaking up with them or they are worried about losing someone close to them, like family members.
What is high-functioning BPD like?
People with borderline personality disorder treated by a therapist or mental health provider may learn skills to manage many of their unhealthiest symptoms. They may be able to avoid risky behaviors like unsafe sex, binge eating, substance misuse, self-harm, or suicidal behaviors. These people may only have emotional breakdowns occasionally, experiencing more internalized behaviors, such as self-loathing. They may develop skills to cope with more challenging emotions through a modality like dialectical behavior therapy (DBT), designed to teach people with BPD emotion regulation skills.
What is the hardest mental illness to live with?
All mental illnesses can be challenging to live with, and one may not be worse than the others. In addition, each person with a mental illness may cope differently and have varying severity of symptoms. For example, some people with depression can lead a successful life, whereas others may struggle to get out of bed, groom themselves, or attend appointments. Comparing mental illnesses may not be healthy. Instead, if you are experiencing severe symptoms, you may benefit from seeking a mental health provider for support.
What is the biggest indicator of BPD?
One of the primary indicators a mental health provider may look for when treating borderline personality disorder is an extreme fear of abandonment. This symptom is unique to other mental illnesses and is characteristic of BPD. They may also examine whether clients are emotionally sensitive, have a traumatic past, partake in risky behavior, or frequently engage in self-harm and suicidal behaviors. People may also be at risk of BPD if they have a family medical history of mental illness or BPD.
Do people with BPD have empathy?
People with BPD do have empathy but may struggle to have their empathy in moments when they are emotionally dysregulated. They may seem to regress to a younger mindset or become inconsolable, which can make it difficult for them to see reason or understand what another person is feeling about their actions. However, this symptom does not give someone with BPD the right to abuse or maltreat a partner.
If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text “START” to 88788. You can also use the online chat.
Can a person with BPD really love?
People with borderline personality disorder experience love, empathy, and emotional support for others. People with this condition often have intense emotions, including positive ones. They may love deeply when they love someone. The feeling of love is separate from behaviors. People with BPD may love someone and still treat them unhealthily due to their behaviors. Working through these behaviors in a therapeutic modality like DBT can be beneficial to having healthier and longer-lasting relationships.
What are the three Cs of borderline personality disorder?
The three Cs of borderline personality are as follows:
- “I didn’t cause it.”
- “I can’t cure it.”
- “I can’t control it.”
These three Cs are meant for the loved ones of people with BPD. They are a reminder that you are not at fault for your loved one’s behavior, that you cannot cure BPD for them, and that you cannot control how they choose to act. There are treatment programs available with high success rates in treating BPD. If someone with BPD is dedicated to getting support, they can get these resources and work through them.
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