Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by impulsivity and instability in mood, self-image, and personal relationships. This instability often disrupts family and work, long-term planning and the individual’s sense of self-identity. Many people with BPD also have a co-occurring disorder such as depression, anxiety, substance abuse or eating disorders. Although it’s often viewed as a disorder that’s difficult to treat, BPD can be treated effectively and quality of life can improve over time.

BPD often begins during adolescence or early adulthood. Some people experience severe symptoms that require hospitalization, while others only require outpatient treatment. People with BPD experience intense emotions for long periods of time and it’s harder for them to stabilize after an emotionally taxing event.

• Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
• A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
• Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
• Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
• Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
• Intense and highly changeable moods, with each episode lasting from a few hours to a few days
• Chronic feelings of emptiness and/or boredom
• Inappropriate, intense anger or problems controlling anger
• Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality
• Suicide threats/attempts and/or self-harming behavior, such as cutting, are common

Learn more about BPD symptoms.

Although research hasn’t yielded a cause for BPD yet, it seems that genetics, environmental and social factors play a role. Some studies show that temperament and specific personality traits, like impulsiveness and aggression, can be inherited, but environmental factors, such as a traumatic life experience, can increase the risk for BPD.

There isn’t a test to diagnose BPD. In fact, it’s often misdiagnosed and underdiagnosed. The diagnosis is even more complicated if a co-occurring disorder is present, which is why a thorough evaluation by an experienced mental health professional is needed to make the diagnosis. A person must exhibit at least five symptoms for a professional to consider a BPD diagnosis.
People with BPD don’t typically seek treatment until the disorder significantly interferes with their life. This often occurs when the person doesn’t have the coping skills to deal with stress and/or major life events.

The good news is BPD can be successfully treated and people can live full, healthy lives. To date, the most effective therapy for BPD is Dialectical Behavior Therapy (DBT). DBT was developed by Marsha Linehan, a psychologist who has BPD herself. The goal of DBT is to help a person learn to take control of their lives and emotions through self-knowledge, emotion regulation and cognitive restructuring. Even with treatment, it takes time for a person to improve because they need to learn a whole new way of dealing with emotions and life stress; a way that is opposite of what they have done their entire life. There are five core modules of DBT:

1. Mindfulness: observing thoughts and feelings in the moment and realizing there’s a choice in how to respond.
2. Emotion Regulation: learning to more effectively control one’s emotions and become less reactive to people and situations.
3. Interpersonal Effectiveness: how to maintain relationships, meet personal needs and preserve self-respect.
4. Distress Tolerance: an “acceptance strategy” to help tolerate intense emotions without engaging in problematic behaviors.
5. Middle Path: more effectively managing extreme behavior to achieve greater balance in life.
   Silver Hill offers one of the only residential DBT programs in the country. It is a highly structured, intensive program for patients who do not need close inpatient supervision but are not able to manage successfully in an outpatient setting.

If you suspect you may have BPD, you should seek help from a mental health professional. Your primary care doctor can give you a referral to a psychiatrist or psychologist near you.

• National Institute of Mental Health
• National Alliance on Mental Illness
• PsychCentral
• Dialectical Behavior Therapy Resources