Treating Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) typically involves symptoms such as risky behavior, intense fear of abandonment, periods of paranoia, extreme mood swings, and a pattern of unstable relationships. Risk factors for borderline personality disorder may include family history, the structure and function of the brain, and various environmental, cultural, and social factors.

What is borderline personality disorder?

Borderline personality disorder (BPD) is a mental health condition that can affect the way a person thinks or feels about themselves and others. People with BPD generally experience symptoms beginning in adolescence or early adulthood. It is typically characterized by a long-term pattern of strong emotional responses, unstable relationships, a distorted self-image, and impulsive behaviors that may affect how individuals with BPD feel about themselves and how they relate with others.

Symptoms

Symptoms of BPD can vary among individuals, and it tends to manifest mostly in adults, as it is a personality disorder. Some people may experience several symptoms, but others may only experience limited signs. The severity and duration of symptoms can also vary among individuals.

The symptoms of borderline personality disorder may be incited by what some consider simple events. For example, an individual with borderline personality disorder may become distressed when separated from people with whom they feel close, such as when traveling to work or school.

Some common symptoms can include:

Risky or impulsive behaviors

People with BPD may be likely to engage in risky or dangerous behaviors, such as unprotected sex, reckless driving, alcohol or substance use, and binge eating. They may also show impulsive behaviors, such as gambling, going on spending sprees, or suddenly ending positive relationships for no apparent reason. Some people with BPD might exhibit self-harming behavior and, in severe cases, suicidal behavior. 

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

Intense fear of abandonment

A fear of abandonment is another common symptom experienced by people with BPD. This fear can be so severe that a person may engage in extreme measures, such as faking illness, to avoid perceived separation or rejection from others.

Periods of paranoia

Stress-related paranoia or loss of contact with reality can be common for those with BPD. Episodes of paranoia may be as brief as a few minutes but can last for much longer periods in some cases.

Extreme mood swings

Individuals living with BPD may also experience intense, inappropriate anger. Such anger may present as suddenly losing their temper or acting bitter or sarcastic, and some people may engage in physical fights or self-harm.

A pattern of intense, unstable relationships

People living with BPD often experience intense and unstable relationships involving extreme emotional shifts. There may be emotional patterns ranging from extreme idealization (being madly in love) and closeness to anger and intense dislike.

Potential substance use

People who live with BPD or bipolar may resort to substance misuse to cope with the symptoms they’re experiencing. The combination of a mental health condition and substance use can greatly disrupt a person’s life and well-being. As a result, such an individual may need concurrent treatment for substance abuse and their mental health condition. 

The symptoms of BPD can be similar to those of bipolar disorder. The primary difference may be that people living with bipolar symptoms typically experience longer periods of mood stability. A trained mental health provider, such as a clinical social worker or psychologist, can be helpful in determining the proper diagnosis.

What causes BPD?

The exact cause of borderline personality disorder is currently unknown, and researchers and clinicians often vary in their hypotheses. According to the National Institute of Mental Health, three risk factors may primarily contribute to BPD: family history; the structure and function of the brain; and environmental, cultural, and social factors. 

Some research suggests that the structure and function of the brains of people with BPD may differ from those without it, particularly in the areas that affect the control of emotions and impulses, primarily the prefrontal cortex. Additionally, genetics and social, cultural, and environmental factors are believed to increase a person’s risk of developing BPD.

People who have experienced neglect or abuse, post-traumatic stress disorder (PTSD), or an unstable environment, especially during the developmental stages of early childhood, may also be at increased risk of developing this disorder. Having a first-degree relative, such as a sibling or parent, with BPD has also been associated with the occurrence of BPD, as well as living with certain mental health conditions, such as eating disorders.

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.

Another hypothesis regarding the cause of BPD involves brain chemistry. A hormone compound in blood called serotonin, which is usually responsible for mood control, typically transmits signals from one area of the brain to another. Abnormalities in serotonin production and absorption may make some people more susceptible to developing BPD and other mental health problems.

Getting an accurate diagnosis

Borderline personality disorder is generally believed to have first been diagnosed in the early 20th century. Because BPD may not be as commonly known as other disorders, misdiagnoses can be common. As research advances, the process of getting BPD diagnosed accurately is improving. As a result, mental health professionals may be better prepared with the knowledge to treat these disorders effectively.

The process of diagnosing borderline personality disorder is often multilayered. A medical exam, which can help rule out underlying medical conditions that may be the cause of symptoms, is usually the first step. Diagnosis can also involve completing a clinical interview, gathering a family history, and administering assessments or tests. 

Because temperment is believed to continue developing through adolescence, diagnosing children with borderline personality disorder is an issue of debate among some mental health professionals. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) sets standards for diagnosing behavioral, personality, and mood disorders as well as other mental illnesses, and it suggests caution when evaluating and diagnosing children with any personality disorder. This is because some conditions present symptoms that mirror typical adolescent behavior.

Overall, an official diagnosis of BPD generally requires that at least five primary symptoms be present in an individual. The primary symptoms of BPD may include:

• Intense or unstable interpersonal relationships
• Impulsive behavior
• Self-destructive behavior
• Fear of abandonment
• Poor self-image
• Emotional instability
• Difficulty controlling intense anger
• Feelings of emptiness or worthlessness
• Extreme suspiciousness or feelings of being “disconnected”

Treating BPD

The treatment approach for borderline personality disorder may include a combination of medication, psychotherapy, and hospitalization. Treatment plans are generally determined by the severity of a person’s symptoms and willingness to comply with a recommended care plan. For example, those with severe symptoms or co-occurring disorders may require a more intensive plan. 

Although medication may not cure borderline personality, some medications may be useful in relieving symptoms associated with it. Each individual may respond to medication differently. Therefore, patients are encouraged to follow directions for medications, keep follow-up appointments, and report any changes in mood or behavior or any unpleasant side effects to their medical provider. Individuals with borderline personality disorder should also avoid starting or stopping medication without the guidance of a medical professional.

The most common treatment for borderline personality disorder is generally psychotherapy, often referred to as talk therapy. Psychotherapy may help individuals cope with mental health challenges, reduce self-destructive behaviors, and treat specific symptoms, such as intense emotions and an unstable self-image. It usually focuses on managing or controlling psychological symptoms so that the affected person can function more effectively. Mental health professionals may recommend individual and group therapy sessions. 

Commonly used types of face-to-face or online BPD therapy include cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), and schema-focused therapy. Dialectical behavior therapy (DBT) is often the most effective method to treat borderline personality disorder, as it was developed specifically as an offshoot of CBT for the condition. The founder of DBT, Marsha Linehan, Ph.D., was also diagnosed with BPD and used her experience with this condition to develop treatment for mental health professionals and clients worldwide.

What is CBT?

Cognitive-behavioral therapy typically helps identify and change unhealthy beliefs and inaccurate perceptions that an individual experiences regarding themselves or others. These changed perceptions and beliefs can then positively affect a person’s emotions and behaviors. CBT can teach a person healthy ways to react to feelings of anxiety, anger, and insecurity. In addition to BPD, CBT is also commonly used for eating disorders, depression, anxiety, or other disorders.

What is DBT?

Dialectical behavior therapy is generally considered to be designed specifically for people with borderline personality disorder. Developed by Dr. Marsha Linehan, it can be thought of as a special type of cognitive-behavioral treatment for borderline personality. 

DBT generally takes participants through several stages and builds core skills like mindfulness, interpersonal effectiveness, emotional control, and distress tolerance.

Dialectical behavioral therapy (DBT) usually involves focusing on individual psychotherapy and group skills training. DBT often teaches participants how to apply the skills learned in real-life situations by structuring their environment and continuing to work with a treatment team. Dialectical behavior therapy typically requires weekly appointments so that mental health professionals can monitor progress effectively.

Individual psychotherapy usually focuses on helping a person grasp an understanding of borderline personality, what symptoms may occur, and how to manage symptoms when they arise.

Group skills training often includes the following four modules:

• Practicing mindfulness or awareness in the present moment
• Tolerating distress and pain in challenging situations 
• Being more effective in interpersonal relationships by asking for what you want and saying no in appropriate ways
• Controlling emotions by increasing understanding of the function of emotions as well as the associated actions

While both medical and psychological treatment for borderline personality disorder can be effective independent of each other, many people find that a combination of medication and psychotherapy offers the best treatment results.

Online therapy may help you manage BPD symptoms

Dialectical behavioral therapy (DBT) is a common form of treatment for BPD, but it may not always be convenient to attend sessions in person. Online therapy may be a more available alternative for those with BPD who would prefer to get help from home (or anywhere they have a stable internet connection). 

According to a study in the International Journal of Mental Health Nursing, online DBT proved to be as effective as traditional in-office therapy. 

With an online therapy platform like BetterHelp, you can speak with a therapist via audio or video chat at a time that works for you. Also, if you have questions or concerns in between sessions, you can contact your therapist via in-app messaging at any time of the day or night for emotional support, and they’ll get back to you as soon as they can.