Borderline personality disorder (BPD) is a type of mental health disorder that affects the way an individual views themselves and others. Symptoms can impact moods, behavior, relationships, work and school, and other aspects of a person’s life. Personality disorders can sometimes be difficult to recognize because some symptoms can be mistaken for a person’s natural demeanor, so getting familiar with the key signs can help you be more aware of whether you or someone in your life may be exhibiting signs of one. Below, we’ll explore five common symptoms and patterns of borderline personality disorder along with key treatment options.
Borderline Personality Disorder, Defined
Borderline personality disorder (BPD) is a mental health condition characterized by mood, self-image, and behavior fluctuations. It can also impact a person’s ability to control emotions and manage impulses, which may negatively affect work and relationships and can even lead to self-harming behaviors if left untreated. An individual with BPD may have trouble separating their perception of the behavior and moods of those around them from reality, which can cause fear and conflict.
Nearly 75% of these are individuals who identify as women. Healthcare professionals usually recommend immediate treatment for those who are diagnosed with borderline personality disorder to prevent harm to themselves or the people around them.
5 Common Symptoms Of Borderline Personality Disorder
Remember, only a qualified healthcare professional can properly diagnose a clinical mental health disorder like BPD. However, gaining a better understanding of the common signs and symptoms of this condition can help you decide when you or a loved one might need to consider seeking treatment. Some of the most common signs of BPD are as follows.
1. Avoidance Of Abandonment
People living with BPD often go to extreme lengths to avoid what is typically one of their deepest fears: being abandoned by those they love. Examples of behaviors an individual with BPD might exhibit in an attempt to avoid abandonment include quickly getting close to people they care about (physically or emotionally) or creating rapid and extreme distance between themselves and others in anticipation of abandonment. These behaviors can be especially evident in the context of romantic relationships. They may also be unable to tolerate being alone, even for short periods.
2. Unstable Relationships
The way an individual with BPD typically views friends, family relatives, and romantic partners can change abruptly, leading to a pattern of unstable, “on again, off again” relationships. For example, they might view the people around them as "perfect" one day and "monstrous" the next. Someone who is in any kind of relationship with an individual with untreated BPD may get frustrated with the ups and downs and end things, leading to the abandonment that the individual so fears.
3. Impulsive Behaviors
Those experiencing borderline personality disorder also commonly demonstrate difficulty managing impulses, which can lead to reckless, dangerous behaviors. These behaviors may vary based on the individual and the severity of their symptoms, but they can include things like:
- Promiscuity and unsafe sex
- Excessive alcohol and/or substance use*
- Eating disorders**
- Reckless driving
- Suicide threats and/or attempts***
*The SAMHSA National Helpline for substance use issues is available 24/7 and can be reached by calling (800) 662-4357.
**If you or a loved one is experiencing an eating disorder, you can contact the National Eating Disorder Association Helpline for support and resources at 1-800-931-2237 (M–Th from 9AM–9PM EST and Fri 9AM–5PM EST).
***If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline can be reached 24/7 by dialing 988.
4. Severe Mood Swings
Mood swings are a common symptom of multiple mood and personality disorders, so these alone don’t necessarily signify borderline personality disorder. However, they’re almost always present in those who do go on to be diagnosed with BPD. An individual with this disorder may fluctuate between irritability, sadness, euphoria, anxiety, boredom, and/or emptiness within hours or days. That said, what often differentiates BPD mood swings from those associated with other conditions is the severity and frequency. For example, a person living with BPD may feel profoundly empty one day and ecstatically fulfilled the next, either for no apparent reason or for a reason they attribute to the actions of someone else.
5. Stress-Induced Dissociation
Some people living with borderline personality disorder may experience dissociative episodes. Dissociation usually involves feeling like you're "out of your body", like you’re lacking or losing your identity, or like the world around you isn’t real. Feelings of paranoia or suspicion about the motives of other people may also precede full dissociation. Individuals living with BPD most often experience dissociation during times of high stress.
Treatment For Borderline Personality Disorder
Borderline personality disorder is a mental health condition that generally requires immediate treatment upon diagnosis. While the causes of BPD aren't entirely clear yet (genetics, environmental factors, and impaired brain function may all play a role), various treatment methods are available to help individuals manage the disorder’s symptoms and enable them to live happy, fulfilling lives. Some of the most commonly recommended treatments for borderline personality disorder include:
Medications such as antidepressants, mood stabilizers, and antipsychotics are commonly prescribed to treat BPD.
Dialectical behavioral therapy, cognitive behavioral therapy, and psychodynamic psychotherapy are often invaluable tools for individuals living with BPD. These methods of learning techniques for emotional management and awareness are usually essential for managing the disorder, and they’re considered to be some of the most effective ways to improve symptoms over time.
Depending on symptom severity, some individuals living with BPD may be hospitalized for a short time to defend themselves and others until their symptoms are under control.
Many licensed therapists and psychiatrists specialize in working with individuals who have personality disorders. Connecting with such an expert is generally the recommended way to obtain a proper diagnosis and access effective treatment.
Online Therapy For Borderline Personality Disorder
While in-person treatment can be effective as well, research suggests that people living with BPD also show signs of improvement with virtual interventions such as online therapy. In addition, online therapy can make finding treatment more convenient and less stressful for those who are uncertain about in-person therapy or who have few provider options in their area. If you’ve already been diagnosed with BPD and were advised to see a therapist or are experiencing non-severe symptoms of a mental health condition, meeting with a provider online may be a viable option for you. With an online therapy platform like BetterHelp, you can get matched with a licensed therapist who you can meet with via phone, video call, and/or in-app messaging to address the challenges you may be facing.
What are the nine main symptoms of BPD?
Symptoms of bipolar disorder (BPD) vary in intensity and frequency. Some people may not experience all of them and some might. Despite these fluctuations between individuals, there are some primary symptoms common to BPD:
Intense fear of isolation/abandonment.
People with BPD may experience extreme fear when left alone unexpectedly. This can result in problematic behaviors such as begging, inconsolable crying, and starting fights or physically preventing the individual from leaving.
Intense and unstable relationships are common for people with BPD. They may fall in love quickly and form attachments early, but it typically doesn’t take long before their rapid mood swings affect the relationship. They may experience “all-or-nothing” feelings that oscillate between idealization and depreciation, eventually leading to resentment and anger—often from both parties.
Unstable identity/sense of self.
Dramatic fluctuations in how they feel about themselves can be a problematic symptom for people with BPD. For example, one minute, the individual feels confident and good about themselves; the next, they may experience inner disdain and worthlessness. This instability of self may cause individuals to cycle quickly through jobs, religions, goals, friendships, and romantic partners.
Self-destructive, erratic behaviors.
People with BPD may engage in risky behaviors such as binge eating, excessive substance use, theft, risky sex, or reckless driving. Often, these behaviors accompany tumultuous mood swings.
Self-harming behavior/suicidal ideation.
Suicidal behavior or deliberate self-harm is also somewhat common for people with BPD. They may think about suicide, make threats of suicide, or attempt suicide. These behaviors may include intentional self-harm, such as cutting or self-mutilation without suicidal intent.
If you or someone you know is having thoughts of suicide, reach out to the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) immediately for help.
Dramatic mood swings.
People with BPD may feel elated one minute and then depressed the next. They typically have difficulty controlling their emotions triggered by an unpleasant event (or an event perceived as unpleasant), such as a contentious conversation or social slight. These types of mood swings often pass pretty quickly and usually last for anywhere from a few minutes to a few hours.
Chronic feelings of existential emptiness.
People with BPD may have feelings of self-deprecation and emptiness as if they have a “hole” inside them. As a result, they may engage in self-destructive, sensation-driven behaviors such as drug and alcohol use, casual sex, or overeating.
Rage or intense feelings of anger and irritability.
A short temper is a common trait of someone with BPD. They may struggle with controlling their feelings of intense anger and, as a result, engage in rage-driven behaviors like shouting and destroying things. The anger can be directed outwardly at someone else or inwardly at oneself.
Paranoid delusions and dissociation.
In extreme cases of BPD, people may experience paranoia and become suspicious of other people’s motives. They may also experience dissociation characterized by sensations of disconnection from reality and feeling as if they’re outside of their bodies during times of stress.
What are the main early signs of borderline personality disorder?
Early signs of borderline personality disorder typically manifest differently depending on the individual, but many people encounter them in late adolescence or the early 20s. Borderline personality disorder diagnosed early can reduce some of the long-term symptoms associated with the condition.
One may have dramatic mood swings, including intense anxiety, happiness, irritability, and shame. Some may experience uncontrolled anger or irritation, physical fighting, and verbal altercations. Feelings of emptiness and extreme sadness may emerge as well.
Is borderline personality a mental illness?
Yes, borderline personality disorder is classified as a cluster B personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Cluster B disorders are characterized by erratic, self-destructive behaviors and intense shifts in emotional state. One with a cluster B disorder may behave dramatically and impulsively and experience paranoia and delusions.
Why do people get BPD?
BPD is likely caused by a combination of risk factors such as neurological dysfunction, chemical imbalance, abnormal brain development, or genetic predisposition. Environmental factors may also play a part-- such as severe neglect during childhood, abuse, exposure to chronic distress and fear as a child, or growing up with another family member/caregiver with a severe mental health condition or substance use disorder.
How does someone with BPD think?
People with BPD often have multiple forms of distorted thinking and perceptions of the world around them. These may include paranoia, dissociation, and intense “black-or-white” thinking. They may think they’ll be abandoned by loved ones and have difficulty coping with the intense emotions that usually accompany those beliefs.
What is a BPD favorite person?
A BPD’s favorite person is usually a close partner, friend, or family member. They can also be an advocate like a coach, teacher, or someone in mental health services like a counselor or therapist. They often rely on this individual for emotional support, comfort, and security, and they feel happiest when they’re with this person.
The relationship with the favorite person may be healthy at first but become unstable due to the problematic behaviors expressed by some with BPD. For example, they may require constant attention and validation from their favorite person to the point of “neediness” due to feelings of insecurity and fear of abandonment.
Other favorite person relationships can be toxic from the beginning if the individual already has difficulty handling stress, a tendency towards interpersonal dysfunction, an unhealthy attachment style, or a substance use disorder.
When do borderline symptoms start?
Borderline symptoms typically emerge in late adolescence or early adulthood, but there are cases when BPD appears in early childhood.
Does BPD go away?
BPD is a chronic condition without a cure. While it won’t “go away,” symptoms aren’t always lifelong and can be significantly managed with psychotherapy and medication if necessary. A combination of therapeutic techniques may be required to treat borderline personality disorder, including, but not limited to, group and individual dialectical behavior therapy (DBT), cognitive behavioral therapy (CBT), and mentalization-based therapy (MBT).
It’s prudent to note that borderline personality disorder treated through therapy and medication may take one year or longer for some individuals.
How do you get tested for BPD?
Testing for BPD typically requires a thorough assessment by a licensed mental health professional. The process may include
- An in-depth interview using the Diagnostic Interview for Borderlines (DIB) and other tools to assess the patient’s cognitive symptoms, affect, interpersonal functioning, and impulse control.
- A review of the patient’s medical history, including family medical history.
- A physiological exam to rule out potential physical causes of symptoms.
- Interviews with friends, family, and loved ones if necessary. Interviews like these are often used to obtain information about the patient’s symptoms from the perspective of someone who knows them intimately.
After the assessment period, the mental health provider will typically review the criteria set forth by the DSM-V. According to the DSM-V, the patient must experience at least five of the nine symptoms common to BPD.
People developing borderline personality disorder may also experience comorbidities such as eating disorders, other types of personality disorder, post-traumatic stress disorder, and substance use disorder. These co-occurrences are typically discovered during the testing and diagnostic process and factored into the treatment plan accordingly.
Does someone with BPD have empathy?
Despite symptoms that may indicate otherwise, people with BPD do have emotional and cognitive empathy— in fact, studies suggest that some may experience an enhanced sense of empathy. The ability to feel and express empathy differs between individuals and may fluctuate depending on symptoms.
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