Borderline Personality Disorder (BPD) is a disorder marked by emotional instability and difficulty in relationships. People with BPD have trouble regulating their moods, experience feelings of emptiness, and have trouble with impulsivity. Therapy can be effective for treating BPD, but it’s important to get a diagnosis and begin treatment as soon as possible because a meaningful reduction of symptoms may take up to two years.
What Is BPD?
Borderline personality disorder, sometimes referred to as emotional unstable personality disorder (EUPD), is a chronic condition that involves difficulty in social relationships. Those with BPD often struggle to find support systems that are consistent and secure.
People with borderline personality disorder tend to test their relationships, both romantic and platonic—consciously and unconsciously. They may see how far they can push someone before that support system “gives up on them like everyone else.” For example, signs of a borderline mother might include withholding affection to “test” the child’s love.
People with BPD oscillate between idolizing and devaluing others. In the case of the “favorite person,” the individual with BPD prefers one person and wants to spend all their time with them. Unfortunately, if that person is busy—or if conflict emerges—anger and fear of abandonment can become triggered
Some people may have more internalized or self-directed symptoms of BPD (i.e., quiet BPD or discouraged BPD), instead of outward trouble in relationships. Symptoms may vary in severity, depending on what types of BPD someone has (e.g., discouraged, impulsive, self-destructive, or petulant borderline personality disorder).
8 Signs of BPD
Adults living with BPD may experience a variety of relational and environmental stressors that significantly impact how they function. It is also common for an individual diagnosed with BPD to have a history of abuse, neglect, or sexual assault in childhood.
Here are eight common signs of borderline personality disorder:
1. Difficulty In Relationships
People with BPD are likely to have turbulent romantic relationships and can be seen as “needy” to those around them. They often engage in a relationship cycle of needing attention and then retreating. People with BPD are likely to display extreme behaviors at the thought of losing an important relationship, perhaps especially when dating someone new.
People with BPD often experience social conflict, impulsivity, self-harming behaviors, lack of self-identity, anger or borderline rage, and hopelessness.
2. Problems With Self-Identity & Self-Compassion
In addition to significant relationship issues, individuals with BPD also report not having a good relationship with themselves and lack an understanding of self-identity. An unstable sense of self and lack of positive feedback from social interactions often leaves someone with BPD feeling inadequate and insignificant, which is perpetuated by social isolation and conflict.
The self-identity that someone with BPD does have might be held tightly, leading to higher levels of defensiveness when they feel like their sense of self is threatened or misunderstood.
3. Difficulty Keeping a Job
People with BPD may experience difficulty maintaining employment as a result of conflict in social settings. Also, after testing other people’s boundaries, they may become isolated. Plus, their dysfunctional relationship patterns can inspire anger from those around them.
4. Suicidal Ideation
Suicide risk is high for those with BPD, with 60-80% displaying suicidal ideation.1 Suicide risk in those with BPD should not be overlooked, as attempts are very common with up to 10% of those diagnosed dying by suicide.1
5. Self-harm
Self-harm is very common for those with BPD. 65-80% of those with a BPD diagnosis experience self-harm behaviors. This is due in part to the way in which those with BPD process complex emotions; there is a lot of emotional dysregulation that comes with experiencing BPD, so many times people turn to self-harm behaviors and dissociation to cope.19
6. Impulsive, Risky Behaviors
People with BPD often engage in risky behaviors, especially when they are experiencing extreme emotions. Some behaviors including risky drinking, drug use, sexual behaviors, excessive spending, and criminal activities, such as theft and vandalism.
7. Mood Swings
A person with BPD will experience extreme mood swings that come and go quickly, usually lasting anywhere from a few minutes to hours. These mood swings, though short, can do a lot of damage.
8. Feeling Empty
A person with BPD will often feel like there is a piece of them missing or feel empty or numb inside. It’s common to try to fill this void with alcohol or other risky behaviors like self-harm, or engage in unhealthy activities that make them feel alive.
BPD Symptoms
Signs and symptoms of BPD usually begin in early adolescence with persistent social conflict becoming evident by early adulthood. People with BPD may seek treatment as a result of the problems with those around them without taking direct accountability. Often, someone with BPD will feel like the world is the problem vs. acknowledging that the way they interact with the world can contribute.
Symptoms of BPD can include:
- Efforts to avoid loss of significant relationships ranging from typical (i.e., begging a partner to stay) to inappropriate (i.e., threatening suicide when a relationship ends)
- Fear of abandonment
- Avoidance of rejection
- Rapid changes in self-identity or self-image
- Cyclical pattern of valuing and devaluing significant relationships to the point of frustration and anger from the other person
- Desire for intensity and attention in social relationships
- Impulsivity that can be self-destructive
- Heightened suicidality and self-harm behaviors (e.g., cutting, burning)
- Lack of self-understanding
- Lack of self-image
- Intense, frequent, and rapidly shifting emotions
- Emotionally unstable
- Anger outbursts and intense aggression
- Depersonalization or dissociation in response to abandonment
- Feelings of worthlessness and purposelessness
- Temporary paranoia
Common Co-Occurring Disorders
Those with BPD often have other, comorbid mental health disorders, the most common of which are depression and anxiety.
Co-occurring disorders with BPD include:
- Depression and other mood disorders: 96% of those with BPD experiencing a mood disorder at some point in their lives.2
- Bipolar disorder: 25% of those with BPD also have bipolar disorder, but distinguishing BPD from bipolar disorder is important because 40% of people with BPD were previously diagnosed with bipolar disorder.3
- Anxiety: anxiety is a common comorbid disorder for those with BPD, with as many as 88% of patients reporting an anxiety disorder in addition to the personality disorder.2
- Eating disorders: It can be common for an individual with BPD to display disordered eating behaviors without qualifying for a secondary diagnosis of an eating disorder. Binging, purging, and restricting can be a method of self-harm for BPD patients.
- Substance misuse: it is common for individuals with BPD to have a co-occurring addiction, with 64% experiencing alcohol use disorder, 40% opiate use disorder, and 50% prescription use disorder.4
Substance use co-occurring with BPD seems to increase impulsivity and suicide risk, therefore is an important consideration in the treatment of BPD. - Narcissism: it is not especially common to have a co-occurring narcissistic personality disorder diagnosis with BPD; however, the conditions can overlap. When it comes to NPD vs. BPD, both have a co-occuring rate of 37% over the course of a lifetime.16
- Post-traumatic stress disorder (PTSD): BPD and PTSD commonly co-occur since both of these mental health conditions stem from trauma.
BPD vs. Bipolar Disorder
There are a number of causes for both BPD and bipolar disorder which at times overlap. These causes are environmental and can also be hereditary.
Causes of BPD include:
- History of physical, mental, and/or sexual abuse
- Death of a caregiver
- Family history of BPD
- History of depression, anxiety, or bipolar disorder
- Inconsistency in childhood
- Trauma
- Attachment style dysfunction
- Low self-esteem
Bipolar disorder can be caused by:
- Family history of bipolar disorder
- Death of a caregiver
- Trauma
- Drug and alcohol abuse
- Sleep disturbances
- Overwhelming stress
It is possible to have both BPD and bipolar disorder. Given the great overlap of the symptoms of both conditions, it’s common to misconstrue one diagnosis for the other; however, some people actually have both diagnoses. Currently, about 20% of individuals with BPD also have a diagnosis of bipolar disorder. Sorting through the symptoms of both can take time, but learning about both disorders can help in understanding which symptoms are that of bipolar disorder and which are related to BPD.
What Causes Borderline Personality Disorder?
The cause of BPD is both environmental and biological, with dysfunctional family environment, genetics, and brain chemistry each playing a part.5 Individuals with abusive parents or who lost a parent in childhood tend to be more likely to develop BPD than the general public.6
In addition to environmental stressors, those having a close relative with BPD, antisocial personality disorder, bipolar disorder, or depressive disorders are five times more likely to develop BPD.7 In addition, 75% of those diagnosed with BPD are female.6
Other risk factors for developing BPD are:17,8
- High conflict environments in childhood
- Neglect or abuse, sexual and physical
- Adverse childhood experiences (ACEs)
- Disorganized attachment patterns
- Brain abnormalities
- Exploitive and manipulative relationships with important adults
- Neglecting emotional needs in childhood
- Unstable self-esteem and poor emotional regulation skills
How Is BPD Diagnosed?
BPD is diagnosed by a licensed mental health practitioner. Though there’s no medical test that can diagnose BPD, mental health providers diagnose BPD by a series of assessments over the course of one to four sessions. This process may include interviews with the person’s spouse, siblings, parents, and children where a therapist would ask about the patient’s history with relationships, mood, behaviors, and family history.
An assessment of BPD may include questions about their:
- Relationship history
- Work history
- Family history
- Mood
- Impulse control
- behaviors
While BPD can be diagnosed in adolescents and individuals under the age of 18, it’s important that it isn’t unless there is extensive history of related symptoms or thorough assessment. This is due to the fact that many adolescents can display personality disorder characteristics while they wrestle with self-identification and learning to meet needs in socially appropriate ways.
Treatment of Borderline Personality Disorder
There are several effective borderline personality disorder treatments, almost always involving therapy. The gold-standard therapy for treating BPD is dialectical behavioral therapy (DBT), which is very structured and has a focus on mindfulness.
Due to the increased levels of suicidal ideation in those with BPD, seeking treatment by a qualified professional is incredibly important. Most people who go to talk therapy for BPD report improvement within a year, with significant differences occurring closer to two years into treatment.6
Therapy
Talk therapy is the first line of treatment for BPD. The relational healing present in talk therapy is significant and highly impactful for long-term success.
Types of therapy used to treat DBT include:
- Dialectical behavioral therapy (DBT): for many years, DBT has been widely used with high success in treating BPD. DBT for BPD focuses on distortions in thoughts, emotions, and beliefs, with an added emphasis on mindfulness. DBT is structured and requires a variety of interventions, including individual therapy, worksheets, group therapy, phone support, and crisis care access.
- Cognitive behavioral therapy (CBT): CBT is particularly helpful in the treatment of BPD when combined with focus on understanding of thought distortions related to self and others.9 Other cognitive and behavioral approaches such as acceptance and commitment therapy (ACT) can be helpful at distinguishing thoughts and behaviors from self and establishing parameters around identity.
- Schema-focused therapy: schema-focused therapy focuses on helping people with BPD identify their needs and understand how they have learned to get those needs met. Those with BPD who participated in schema-focused therapy reported better self-understanding and improved emotional regulation.10
- Humanistic approaches: Humanistic therapies can be helpful in facilitating good outcomes in those with BPD, particularly due to the focus on the client-therapist relationship. Humanistic approaches can be useful in helping the client find meaning in their life, which has been shown to decrease BPD symptoms.11
- Family therapy: due to the social discord present in this disorder and the genetic/environmental causes, family therapy can be an important approach for long-term success of those living with BPD. Researchers have encouraged better use of support systems in the client’s life, and attending therapy together is one way for loved ones to become more involved.12
Medication
There are no specific borderline personality disorder medications used for treatment. However, many patients may experience relief from other symptoms with the use of mood stabilizers, antidepressants, antipsychotics, and/or anxiolytics.13 The use of psychiatric medications can be beneficial for managing comorbid disorders in addition to the symptoms of BPD. While psychotropic medications are not a first-line treatment, they can greatly improve the patient’s outcomes and functionality.
How to Cope With Borderline Personality Disorder
Through treatment and a supportive environment, individuals with BPD can experience more fulfilling relationships, a better sense of self, a renewed purpose in life, increased mindfulness, and improved ability to regulate emotions. Note that regularly attending therapy is the most important way to understand borderline personality disorder and cope with its symptoms.
Here are 11 lifestyle changes that can lead to greater occupational, relational, and psychological success:
1. Work On Mindfulness
Mindfulness is a great way to become more self-aware. Mindfulness for borderline personality disorder can help you find and embrace your inner voice, listening to it to help guide you. When you practice mindfulness, you are in the most conscious state of yourself. This is the time when you are most self-aware and more accepting of all the things in your life that truly bring you joy and peace.
2. Develop a Meditation Routine
Finding a special and sacred place to meditate may also help you reflect and “be with yourself.” Meditating can help you process emotions differently, so you can react in a way that benefits you. This can also help you be more mindful with yourself and remember to speak to yourself with kindness, offering grace on the hard days. Remind yourself to take things one day at a time and slow down your mind.17
3. Practice Yoga
Yoga allows individuals to express emotions through their body. There are a lot of benefits to moving your body and exercising; however, yoga takes that one step further, as the goal tends to be finding balance. When finding balance and an emotional equilibrium is at the center of your mind, it becomes that much easier to learn more about yourself.
4. Try Journaling
Journaling for mental health gets your thoughts out of your head. Sometimes, when you write down what you feel, it can help to read that out loud. Hearing the words can help you to realize how you really feel, as you process information differently that way. This can help identify negative thought patterns and explore where they come from. Once you’re able to sort through the origins of your feelings, you can start to do the work to heal.
5. Take Lots of Nature Walks
There is a lot of research that describes the benefits of nature on mental health. It can help to reduce feelings of anxiety, depression, stress, and other mental health issues. Nature has a way of improving the mood, as there is a strong connection between the time spent in nature and overall mental state.
6. Focus On Physical Health
Taking care of your physical health has a direct impact on mental health. Some tips to consider include getting better sleep, eating a balanced diet, exercising regularly, and minimizing stress. Physical health gives you a sense of control and agency, so remembering that you are capable of things in this way can help your other symptoms as well.
7. Practice Distress Tolerance
Learning to tolerate distress, which is part of dialectical behavioral therapy, is a great way to help you manage symptoms of BPD. This can help stop you from leaning into impulsive behaviors as a means of coping. By increasing your ability to handle difficult emotions and learning to hold two opposing feelings at the same time, it can get easier to deal with the symptoms of BPD.
8. Distract Yourself
There is a lot of healing in mindfully distracting yourself. Draw your attention away from distressing things to soothing, sensory-based practices. By stimulating other senses you may be able to better acknowledge your feelings and make better sense of them all. It can be easy to become overstimulated by your own emotions.
9. Check Your Assumptions
People with BPD are quick to assume the intentions of others. You might practice checking that in yourself and even asking the other person explicitly what their intentions are. By knowing why you do something and where it is coming from in yourself, it can help you better understand and relate to yourself so you feel more in control of yourself and can interact with others in more meaningful ways..
10. Stop Projecting
Projection is common among folks with BPD because the emotions can be too hard to bear, so they become projected onto other people instead of being felt and dealt with. However, this often leads to more conflict. It’s important to acknowledge your feelings instead and learn to sit with them and give them some time and attention, and then kindly let them leave.
11. Talk to a Therapist
Getting objective feedback and guidance from a professional is always going to be helpful in addressing any emotional distress you may be facing. Healing takes time, and having someone objective along on your journey may be the exact thing you need to change your inner critical voice.18
How to Get Help for Borderline Personality Disorder
Due to the relational nature of BPD, loved ones are often involved in finding help. Relationship conflict can be significant enough to create additional symptoms of depression and anxiety, which may prompt someone to find a therapist.
Whether for you or for a loved one, it’s important to find a therapist who has a lot of experience working with people who have BPD. A great way to find a therapist is by searching a therapist directory, where you can sort by a therapist’s specialty, location, cost, and more.
Outlook for Those With BPD
Talk therapy is a long-term solution for those living with BPD. Weekly, one-hour therapy sessions with a practitioner specializing in the treatment of personality disorders can produce lasting positive outcomes.14 Those with more severe presentations of BPD may require intensive outpatient treatment and support in addition to psychotherapy, such as group, crisis team access, psychoeducational opportunities, and case management.
Length of successful treatment for BPD can be one to three years, depending on severity of symptoms and natural supports existing in the patient’s life.15
If left untreated, the prognosis for BPD can include:
- Depression
- Substance use disorder
- Alcohol use disorder
- Self-harm
- Suicide
Can Borderline Personality Disorder Be Cured?
While there’s no known cure for BPD, it seems to remit with age. Those who seek treatment in their early to mid-adulthood tend to experience a reduction of symptoms to the point of no longer meeting criteria in later life.6 In addition, those with BPD may experience a decrease in symptoms with age as a stronger sense of self is established and more emotional regulation techniques are employed.8
Tips For Loved Ones of Those With BPD
If your loved one is diagnosed with BPD, or you believe they may have this disorder, it’s important to make sure you care for yourself while supporting your loved one. To begin, educate yourself on BPD and don’t hesitate to seek your own therapist. The best things you can do for yourself and your loved one are to encourage them to go to therapy and set firm personal boundaries.
Here are tips for loved ones of those with BPD:
- Learn more about BPD: consuming books and information related to supporting someone with this disorder is often a good place to start
- Encourage your loved one to go to (and stay in) therapy: as the therapist-client relationship can be incredibly beneficial for those with BPD, it’s important that they find a therapist they feel comfortable with
- Seek your own therapist: loving someone with BPD can be challenging, so it’s important to have someone objective who you can talk to
- Set and maintain boundaries: it’s important for you to maintain your own autonomy and make time for self-care. Practicing setting firm boundaries and sticking to them.
- Consider family therapy: if the individual with BPD is a family member, it might be worth talking about things in family therapy
BPD Statistics
Understanding outcomes, treatments, and impact of BPD is important for quality care. Research into this disorder has been occurring for many years with increased understanding and efficacy of treatment. Identifying key statistics allows for better prevention and intervention approaches.
Current key research and statistics on BPD include:
- 1.6% of the population is diagnosed with BPD, with some estimating numbers could be as high as 6%6
- 75% of those diagnosed with BPD are female6
- Up to 10% of those with BPD will die by suicide1
- Up to 75% of people with BPD have performed self-injurious behaviors3
- Individuals with BPD account for 10% of outpatients, 20% of inpatients, and 6% of patients in family medicine15
- 25% of those with BPD have comorbid bipolar disorder3
- 96% will have a mood disorder in their lifetime, and 88% an anxiety disorder
64% have an alcohol use disorder4 - After 2 years of treatment, more than 50% of people with BPD recover; after 10 years, 80% recover3
Final Thoughts on BPD
BPD can feel like a lot to deal with, but you can still live a full, meaningful life with BPD. There are many therapy options, medications and self-care practices you can use to help you cope and feel better. Together, you and your support system and therapist can come up with a plan that works for you so you are able to live your best life.
For Further Reading
Borderline Personality Disorder Infographics
Borderline Personality Disorder Infographics
