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Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a disorder of emotion regulation affecting up to 5% [1] of the population. Up until a few decades ago, those diagnosed with the disorder were thought to be untreatable. Despite this shift, individuals living with BPD continue to face surplus stigma. However, evidence-based treatments, have helped changed the narrative for people with the disorder to one of recovery and hope.

BPD can affect anyone, but it is often diagnosed in adolescents and young adults. Up to 40% of teens who are hospitalized in mental health treatment facilities have the disorder, making early intervention very important.  Ten percent of patients with BPD complete suicide [2]. Females appear to be at greater risk of developing BPD than males.

The cause of Borderline Personality disorder is still unclear. Personality theorists believe BPD to be a combination of inherited biological traits and environmental conditions. From bullying to childhood trauma involving emotional and sexual abuse and neglect, a wide spectrum of environmental factors may contribute to the disorders’ development.

Many symptoms of Borderline Personality disorder are similar to those found in other disorders, such as anxiety disorder, schizophrenia, and other personality disorders like:

  • histrionic personality self-dramatizing, self-indulgent, demanding, excitable, vain
  • narcissistic personality intolerant of criticism, self-important, lacking in empathy, envious, constantly demanding special favors
  • antisocial personality callous, reckless, impulsive, irritable, deceitful, and emotionally shallow.

The symptoms of Borderline Personality Disorder can be summarized as instability in mood, thinking, behavior, personal relationships, and self-image.

For a diagnosis, individuals must meet at least five out of the nine criteria according to the DSM-V

  • Perceived or real fears of abandonment
  • Intense mood swings, brief periods of severe depression or anxiety
  • Impulsivity
  • Unstable intense relationships
  • Self-injurious and suicidal behaviors
  • Chronic feelings of emptiness
  • Inappropriate, intense anger and rage
  • Unstable sense of self
  • Dissociation and feelings of detachment

There is high co-morbidity with other disorders such as depression, substance abuse, eating disorders, and other personality disorders.  This often makes BPD more challenging to treat.

Individuals with BPD traits develop maladaptive behaviors that can be difficult for friends and families to understand, often resulting in chaotic relationships. People with personality disorders often use “defense mechanisms”, or coping strategies, that allow them to deny responsibility for their feelings and actions. One defense is called “splitting” – putting some people on a pedestal while devaluing others. Another defense is called “projective identification” - which involves denying one’s feelings, attributing them to someone else, and then behaving in a way that causes the other person to respond in kind. For example, when the borderline person’s hostility is reciprocated, they can think and/or act as though it were not their own.

Families of people who suffer from the disorder are often at a loss in knowing what to do and where to turn.  Patients who stay healthily emotionally involved with their family members are more likely to have a better outcome. Obtaining help and treatment for the entire family is fundamental to individual and family wellbeing.

While no medication has been approved to treat BPD, mood stabilizers may be used to treat impulsive behavior and many of the co-morbid conditions. Medication, though, is rarely effective without individual therapy and group or family therapy as the cornerstone. Psychotherapy in the form of Dialectical Behavior Therapy (DBT) is considered a gold standard and is nearly always chosen for treatment. This cognitive based therapy combines acceptance and change strategies to help individuals recognize their behaviors and mood swings, and process negative thoughts and feelings. The treatment goal is for patients to learn better coping mechanisms such as emotion regulation and distress tolerance skills.

Read stories from people living with Borderline Personality Disorder at The Mighty.

The National Education Alliance for Borderline Personality Disorder has the largest free resource library in the world, and provides free educational courses and resources for the BPD community. Learn more at www.borderlinepersonalitydisorder.com or email them at info@borderlinepersonalitydisorder.com.

Get additional information about Borderline Personality Disorder at Psych Central.

Center for Mental Health Services
National Mental Health Information Center
PO Box 42557
Washington, DC 20015
Phone: (800) 789-2647
TTD Number: (866) 889-2647
Fax Number: (240)747-5470
Website URL: http://mentalhealth.samhsa.gov/

Treatment and Research for Personality Disorder (TARA)
23 Green Street
New York, NY 10013
Phone Number: (212) 966-6514
Toll-Free Hotline: (888) 4-TARA-APD
Website URL: www.tara4bpd.org

What is a Personality Disorder?

Those who struggle with a personality disorder have great difficulty dealing with other people. 

What is Obsessive-Compulsive Disorder (OCD)?

People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control.

Co-Dependency

Co-dependency is a learned behavior that can be passed down from one generation to another.