Borderline Personality Disorder: Signs, Symptoms, & Treatments

Borderline personality disorder (BPD) is marked by emotional instability, problems regulating moods, feelings of emptiness, and impulsivity. The symptoms of BPD can result in relationship challenges, poor self-image, and declines in overall functioning. Treatment for borderline personality disorder includes psychotherapy, sometimes combined with medication.

Signs of Borderline Personality Disorder

Common signs of BPD may include issues with self-identity, impulsivity, and rage outbursts – sometimes called borderline rage. Environmental stressors can also contribute to additional negative borderline personality disorder traits and various relational challenges.

Below are common signs of borderline personality disorder:

Difficulty In Relationships

People with borderline personality disorder oscillate between idolizing and devaluing others. In the case of a “BPD 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.

Borderline personality disorder in relationships often includes BPD relationship cycles of seeking attention before retreating and withdrawing socially. A typical sign of BPD is the expectation to lose relationships, which can result in extreme, unhealthy actions.BPD and lying often go together because individuals with BPD will go to great measures to try and control how others perceive them. Because of this, individuals likely have turbulent, unstable romantic relationships and may be seen as “needy” to those around them.

Problems With Self-Identity & Self-Compassion

In addition to significant relationship issues, individuals with BPD report lacking positive self-relationships and self-identity. These challenges can leave someone feeling inadequate and insignificant, and social isolation or conflict can perpetuate these emotions. Those with BPD often display higher levels of defensiveness when they believe their sense of self is threatened or misunderstood.

Suicidal Ideation & Self-Harm Behaviors

Suicide risk is high for those with BPD, with 60-80% of diagnosed individuals displaying suicidal ideation.¹ This risk should not be overlooked, as suicide attempts are common.¹ Additionally, approximately 65-80% of those with BPD experience self-harm behaviors. These are partly due to how they process complex emotions, and such emotional dysregulation can contribute to self-harm and dissociation to cope.¹⁹

Impulsive & Risky Behaviors

People with borderline personality disorder frequently engage in risky behaviors, especially when experiencing extreme emotions. Some examples include drinking, drug use, sexual behaviors, excessive spending, and criminal activities (i.e., theft and vandalism).

Mood Swings

Another characteristic of borderline personality disorder is emotional reactivity and extreme mood swings that come and go quickly, usually lasting from a few minutes to hours. This emotional instability can significantly damage one’s relationships and overall functioning.

Feelings of Emptiness

A person with BPD commonly feels empty inside or like a piece of them missing. It’s typical for them to try to fill this void with alcohol, risky behaviors, or engaging in unhealthy activities that make them feel ‘alive.’

Fears of Abandonment

Another common sign of borderline personality disorder is an intense fear of real or perceived abandonment. Those with BPD may become angry when individuals set boundaries, which can disrupt interpersonal relationships in many ways.

Anger Outbursts & Rage

Traits of borderline personality disorder often include intense anger that can occur suddenly and out of nowhere. Individuals also frequently struggle with controlling their anger, which may lead to inappropriate outbursts or borderline rage.⁶

BPD Episodes of Paranoia

Signs of BPD may include stress-related paranoid ideation or dissociative symptoms.⁶ Intense stress may trigger these symptoms and fears, and individuals may even become suspicious of people they usually trust.

Common Co-Occurring Disorders

Individuals with borderline personality disorder may experience co-occurring conditions, including depression, bipolar disorder, and anxiety. Those with BPD may also struggle with substance use, which sometimes emerges as an attempt to cope with painful emotional dysregulation, feelings of emptiness, or fears of abandonment.

Co-occurring disorders with BPD include:

• Depression: An estimated 96% of those with BPD experience a mood disorder, such as depression, at some point.²
• Bipolar disorder: 25% of those with BPD also have bipolar disorder, but distinguishing BPD from bipolar disorder is important. 40% of people with BPD were previously diagnosed with bipolar disorder before receiving an accurate diagnosis.³
• Anxiety disorders: Anxiety disorders are common comorbid conditions for those with BPD, with as many as 88% of patients reporting an anxiety disorder.²
• Eating disorders: An individual with BPD may 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 those 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 appears to increase impulsivity and suicide risk.
• 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-occurring rate of 37% over the course of a lifetime.¹⁶
• Post-traumatic stress disorder (PTSD): BPD and PTSD commonly co-occur because each condition can stem from trauma.

What Causes Borderline Personality Disorder?

Borderline personality disorder causes are both environmental and biological, with dysfunctional family environments, genetics, and brain chemistry playing a part.⁵ Individuals are more likely to develop BPD than the general public if they had abusive parents or lost a parent in childhood.⁶

Common causes of BPD include:

• Genetic factors: It is believed that BPD can be genetic as a biological predisposition to emotional sensitivity can be a risk factor for the condition.²⁰
• Childhood trauma: Early trauma can set off the development of BPD symptoms, such as mood instability, emotion dysregulation, and self-destructive behaviors.²⁴ Children who experience multiple traumas over developmental periods are at higher risk for more severe symptoms of BPD.²⁴
• Neglect or abuse: There are higher rates of childhood neglect or abuse in individuals with BPD than in other groups, with strong ties to emotional and sexual abuse.²¹
• Brain differences: There may be a difference in the brain regions relating to emotion regulation, impulsive behavior, and aggression in those with BPD.⁵
• Early relationship challenges:  Invalidating early relationships may be a cause of BPD as these can reinforce emotional dysregulation and cause an individual to mistrust their emotional states.²²
• Disorganized attachment patterns: Insecure, disorganized attachment with caregivers can lead to a negative view of self, mistrust of others, and expectation of abandonment.²⁴
• Poor emotional regulation skills: Problems with emotion regulation can put an individual at higher risk for developing BPD when faced with early life stressors like emotional abuse.²²

How Is BPD Diagnosed?

A licensed mental health practitioner can provide a BPD diagnosis. Though there are no medical tests for borderline personality disorder, a diagnosis often includes a series of assessments, such as interviews with loved ones and reviews of a patient’s relationship, mood, behaviors, and family history.

Teenagers may be diagnosed with BPD, but typically this is only the case if there is an extensive history of related symptoms or thorough assessment.  This hesitation stems from the fact that many adolescents can display BPD characteristics while they wrestle with self-identification and meeting needs in socially appropriate ways.

Borderline Personality Disorder Treatments

While several effective borderline personality disorder treatments exist, practitioners often recommend psychotherapy first, such as dialectical behavioral therapy (DBT). Due to the risks of suicidal ideation in those with BPD, seeking treatment by a qualified professional is incredibly important. Most people who seek borderline personality disorder therapies report improvement within a year.⁶

Psychotherapy

Psychotherapy is an effective intervention in the treatment of BPD and management of symptoms. Individuals with BPD who participate in therapy often begin to improve within the first year of treatment.⁶ Studies show that many gain life stability in their 30s and 40s. After ten years, about half of the individuals in outpatient treatment no longer meet the criteria for a BPD diagnosis.⁶

Therapy for BPD may include:

• Dialectical behavioral therapy (DBT): DBT for BPD uses mindfulness to address mental and emotional distortions. 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 for BPD helps distinguish thoughts and behaviors from self and establishes parameters around identity.⁹
• Schema-focused therapy: Schema-focused therapy focuses on helping people with BPD identify their needs and understand how they have learned to meet these needs. Those with BPD who participated in schema-focused therapy reported better self-understanding and improved emotional regulation.¹⁰
• Humanistic approaches: Humanistic therapies can be useful in helping clients find meaning in their lives, which is believed to decrease BPD symptoms.¹¹
• Family therapy: Family therapy can be an important approach for the long-term success of those living with BPD. Researchers encourage those with BPD to lean on their support systems, and attending therapy sessions as a combined family unit can improve communication.¹²

BPD Medications

There are no specific borderline personality disorder medications used in treatment. However, many patients may experience relief from other symptoms with mood stabilizers, antidepressants, antipsychotics, or anxiolytics.¹³ The use of psychiatric medications can be beneficial for managing comorbid disorders as well.

Outlook for Borderline Personality Disorder

Talk therapy is a long-term solution for those living with BPD. One-hour weekly therapy sessions with a practitioner specializing in 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.

Can BPD Be Cured?

There is no known cure for BPD, but the condition seems to remit with age. Individuals with BPD who seek treatment in their early to mid-adulthood tend to experience reduced symptoms and no longer meet criteria later in life.⁶ Additionally, those with BPD may experience decreased symptoms with age as they establish a stronger sense of self and employ more emotional regulation techniques.⁸

Can Borderline Personality Disorder Be Prevented?

Early identification of symptoms and intervention can lead to the prevention of BPD.²⁵ For example, therapy that focuses on improving one’s overall functioning and ability to adapt to stressful situations is especially important.²⁵  If you notice signs of borderline personality disorder in yourself or a loved one, seeking preemptive intervention will prove beneficial in the long term and possibly reduce the risk of worsening symptoms.

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 an improved ability to regulate emotions. Regularly attending therapy is the best way to understand borderline personality disorder and cope with its symptoms.

Below are 13 tips for coping with borderline personality disorder:

1. Practice Mindfulness

Mindfulness for borderline personality disorder can help you find and embrace your inner voice, allowing it to guide you. When you practice mindfulness, you are in the most conscious state of yourself and fully self-aware. Accepting your life and present circumstances can offer you joy and peace.

2. Develop a Meditation Routine

Finding a special and sacred meditation place 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. You can be more mindful of yourself and 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

There are many benefits to moving your body and exercising. However, yoga takes these benefits one step further, as the goal tends to focus on finding balance. Yoga allows individuals to express emotions through their bodies. When finding emotional equilibrium is at the center of your mind, it becomes 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 them out loud. This may help you recognize feelings, identify negative thought patterns, and explore where emotions come from. Once you can sort through the origins of your feelings, you can start to heal.

5. Take Lots of Nature Walks

Research states that there are various benefits of nature on mental health. Being outdoors can help reduce feelings of anxiety, depression, stress, and other mental health issues. Nature has a way of improving mood, as there is a strong connection between the time spent in nature and one’s overall mental state.

6. Maintain Your Physical Health

Taking care of your physical health has a direct impact on mental health and provides a sense of control and agency.. Try getting better sleep, eating a balanced diet, exercising regularly, and minimizing stress to start.

7. Practice Distress Tolerance

Learning to tolerate distress is a great way to manage symptoms of BPD and stop you from leaning into impulsive behaviors to cope. By increasing your ability to handle difficult emotions, it can become easier to deal with your symptoms.

8. Distract Yourself

Distracting yourself can be an important aspect of coping with BPD. Draw your attention away from distressing things to soothing, sensory-based practices. It can be easy to become overstimulated by your own emotions. Therefore, stimulating other senses can help you better acknowledge and understand your feelings.

9. Check Your Assumptions

Those with BPD are quick to assume the intentions of others, so consider explicitly asking people what their intentions are. This can help you feel more in control of yourself as you interact with others in more meaningful ways..

10. Stop Projecting

Projection is common among folks with BPD because their emotions can be too hard to bear. In turn, they project their feelings onto other people instead of experiencing and dealing with the emotions. However, this often leads to more conflict. Acknowledge your feelings instead and learn to sit with them. Allow yourself time to notice them as they come and go.

11. Take Responsibility for Your Actions

You can start to feel empowered and make effective choices when you take responsibility for your actions. If taking responsibility brings up difficult emotions, you can work with a therapist to learn how to tolerate them to achieve long-term goals, improve your self-respect, and enhance your relationships.

12. Focus on Improving Your Relationships

Feeling connected to others can be a powerful way to enhance your quality of life. Work on identifying what issues come up for you in relationships and how to better navigate them. This can help provide mindful awareness of your actions, allowing for the improvement of connections in your life.

13. Talk to a Therapist

Getting objective feedback and guidance from a professional is always helpful in addressing any emotional distress you may be facing. Healing takes time, and having someone objective along your journey may be the exact thing you need to change your inner critical voice.¹⁸

How to Help Someone With BPD

If your loved one is diagnosed with BPD or you believe they may have this disorder, it’s important to care for yourself. 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.

Below are tips on how to help someone with borderline personality disorder:

• Learn more about BPD: Consuming information and books on BPD is often a good starting point when supporting a loved one.
• Encourage your loved one to go to (and stay in) therapy: As the therapist-client relationship can be incredibly beneficial for those with BPD, encourage your loved one to find a therapist they feel comfortable with
• Seek your own therapist: Loving someone with BPD can be challenging, so it’s important to have an objective therapist to provide insight.
• Set and maintain boundaries: Maintain your own autonomy and make time for self-care. Set firm boundaries and stick to them.
• Consider family therapy: If the individual with BPD is a family member, it might be worth talking through things in family therapy.

Final Thoughts

Borderline personality disorder can be challenging to deal with, but you can still live a meaningful life with BPD. You can cope with symptoms and feel better by utilizing therapy, medications, or self-care practices. Together, you, your support system, and your therapist can develop a plan that works for you.

For Further Reading

• Books on BPD
• BPD Resources & BPD Support Groups Online
• BPD Podcasts
• Best BPD Blogs

Borderline Personality Disorder Infographics