Borderline personality disorder symptoms include intense emotions, unstable self-image, and a tendency to act in impulsive or self-destructive ways.1 People with this condition often struggle to form and maintain healthy, close relationships with others because of past trauma, trust issues, and a deep fear of abandonment. Symptoms can be improved with therapies like cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), especially when treated early.1,2
What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is one of ten personality disorders characterized by complex conditions that lead to abnormal patterns of thinking about self and others, emotional responses, behavioral problems and unhealthy relationship patterns.4 People with BPD are often complex trauma survivors who struggle with an intense fear of abandonment, low self-esteem, intense mood swings, and impulsive decision making.3
Most Common BPD Symptoms
The symptoms of BPD, such as fear of abandonment and intense mood swings, can mimic the symptoms of other mood disorders, impulse-control disorders, and trauma disorders. Combined, these factors often mean that BPD is missed or misdiagnosed, and clients with BPD may struggle to get the treatment they need.5
All mental health conditions are diagnosed by licensed health and mental health professionals using a standardized set of symptoms from the The Diagnostic and Statistical Manual of Mental Disorders (DSM–5). BPD presents a pervasive pattern of instability of interpersonal relationships, self-image, and mood, and marked impulsivity usually beginning by early adulthood. This instability can present in a variety of contexts – for some, symptoms may be more internalized, a subtype called quiet BPD.
The DSM 5 lists nine symptoms of BPD:4
- Frantic efforts to avoid real or imagined abandonment: Excessive calling, seeking reassurance, codependent patterns, manipulative or controlling behaviors
- A pattern of unstable interpersonal relationships that alternate between idealizing and devaluing the relationship: A cycle of love/hate relationships or stormy on/off relationships
- Identity disturbance and a markedly and persistently unstable self-image or sense of self: Alternating between pride and shame, or confidence and extreme insecurity
- Impulsivity in at least two areas that are potentially self-damaging: Spending money, sex, substance abuse, reckless driving, binge eating
- Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behavior: Self-harm behaviors such as cutting, threatening to harm oneself or commit suicide, suicide attempts
- Affective instability due to a marked reactivity of mood: Intense episodes of sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days
- Chronic feelings of emptiness: Feeling empty, numb, or as though they have no true self, worth, or purpose
- Inappropriate, intense anger or difficulty controlling anger: Frequently losing one’s temper, becoming angry or destructive, getting into frequent conflicts or fights with people
- Transient, stress-related paranoid ideation or severe dissociative symptoms: Thinking others are out to get them, intend to hurt their feelings, plan to abandon or betray them, or having out-of-body experiences or “blacking out”
In order to be diagnosed with BPD, you must present with five (or more) of these symptoms.4
How Do BPD Symptoms Present?
Knowing what symptoms clinicians use to diagnose BPD is helpful, but most people want specific examples of what these symptoms look like and how they show up in a person’s daily life.
Here are some examples of how each BPD symptom can manifest in daily life:
1. Frantic Efforts to Avoid Abandonment
Deep-seated fears of abandonment and trust issues are often what drive many of the negative thoughts, difficult emotions, and destructive actions of someone with BPD.1,3 People with this condition often feel insecure, worrying that people they’re in relationships with will betray them, leave them, or hurt them. These fears can be triggered even in secure relationships, when there is no actual evidence to support them.
These insecurities can cause them to:6,7
- Be needy and clingy in relationships
- Become manipulative, using guilt and emotional coercion
- Be overly emotional or reactive to small conflicts
- Act “hot and cold,” alternating between affection and shutting down
- Remain in unhealthy, abusive or toxic relationships
- Become jealous and controlling
- Engage in negative attention seeking behaviors
2. Instability in Relationships
People with BPD tend to have toxic, unhealthy, or codependent relationships with partners, friends, and family members. Often, these same patterns have also led to high amounts of conflict or caused people to cut ties or pull away from them. Despite being driven by a fear of abandonment, someone with BPD will often behave in ways that damage their relationships and make the other person more likely to push them away.1,4
People with BPD often report:6
- Relationships that are “on/off” again
- Several burned bridges with long-standing friends
- Alternating between describing relationships as wonderful or terrible
- High levels of conflict in relationships
- A pattern of codependent romantic relationships
- Moving quickly from one serious relationship to another
- Having few close friendships or long-lasting friendships
- Being highly sensitive to rejection cues, but not to the feelings/needs of other
3. Unstable Sense of Self
A person with BPD often does not have a strong, stable sense of who they are, and may even seem to switch personalities, moods, or interests according to how they feel or who they are around. At the core, these behaviors are often driven by their personal insecurities, lack of self-worth, and fear of being rejected or abandoned by other people.
Some of the ways that an unstable self-image can show up in people with BPD include:6,7
- Adopting personas and personality traits of others to be liked or accepted
- Going through “phases” where they have different interests, styles, or hobbies
- Alternating between states of pride and shame, often in response to their interactions
- Feeling unsure of who they are or feeling like they have no ‘true self’
- Internalizing expectations, criticisms, and praise given by others
4. Impulsive Decision Making
People with BPD have a tendency to make poor, impulsive, or destructive decisions based on their emotions or urges.1,4,7 These behaviors often lead to problems and consequences, and may trigger a lot of shame, guilt, and regret afterwards. Often, these impulsive decisions are driven by strong and intense emotions that the person does not feel they’re able to contain.
Some of the impulsive decisions commonly made by people with BPD include:
- Drinking alcohol or abusing prescribed or illicit substances
- Sexual promiscuity or high-risk sexual behaviors
- Self-sabotaging behaviors that damage the person’s relationships, work, or life
- Unhealthy patterns of behavior including binge eating
- Risky behaviors like reckless driving or driving under the influence
- Overspending or poor financial decisions
- Saying or doing things out of anger that they later regret
5. Self-harming Behaviors
Some people with BPD engage in self-harming behaviors like cutting themselves in order to feel less empty or more alive. Suicidal behaviors and attempts are also common in people with BPD.1,4,7
Others with BPD will use less obvious methods of self-harm, including:
- Abusing substances or alcohol
- Making risky decisions
- Self-sabotaging in relationships, work, or other areas of life
- Restricting food or using other methods of self-punishment
- Making frequent threats to self-harm or commit suicide
6. Mood Swings and Intense Emotions
People with BPD have a lot of trouble regulating their emotions and tend to have intense emotions that can be triggered easily. This can show up as moodiness, irritability, anxiety, or as having frequent and intense mood swings that can change at a moment’s notice.1,4 Many people with BPD also struggle with extreme anger issues, and have had times when they’ve said or done destructive things when angry or upset.
Often, the core issue in BPD is not the intensity of the emotions they experience, but the fact that they don’t have the knowledge or skills to cope with these emotions. Because of this, they will often respond to strong emotions in unhelpful ways, including:
- Making impulsive or self-destructive decisions
- Ending or damaging important relationships when upset or angry
- Ruminating on negative thoughts that intensify difficult emotions
- Trying to amplify/intensify negative emotions to “feel something”
7. Feelings of Emptiness
Many people with BPD describe frequent feelings of emptiness. They may experience this as emotional numbness or dissociating from themselves, or feeling as if they don’t have a core self.1,4,6,7 Sometimes, these feelings can intensify to the point where they begin feeling hopeless, helpless, or worthless, and may even consider ending their lives.
Some of the ways that feelings of emptiness can show up for someone with BPD include:
- Feeling unsure or unclear about who they are
- Feeling numb or apathetic most of the time
- Having no interest or enjoyment in activities
- Feeling like something inside of them is broken or missing
- Feeling as though they have no life purpose
8. Intense Anger & Anger Outbursts
People with BPD struggle with emotion regulation and acting on destructive impulses. Many also have anger issues and report not feeling able to control the things they say or do when angry.1,4,7 During times when they are upset or emotional, a person with BPD will usually begin having extreme ‘all or nothing’ thoughts about themselves, others, their lives, and their future (also called splitting), which feeds into their anger.
Some examples of anger issues and outbursts common in people with BPD include:
- Being quick to become jealous, angry, or irritable
- Anger outbursts where they may yell, make threats, or become aggressive
- Being quick to lash out, attack someone, or threaten to end a relationship
9. Paranoia & Dissociative Episodes
Some people with BPD struggle with either paranoid thoughts or dissociation. Paranoid thoughts may range from slight distrust of others to strong beliefs that others have bad intentions.1 In some cases, these paranoid thoughts can cause people with BPD to develop severe anxiety or avoid interacting with people.6
Dissociation is when a person becomes disconnected from their body, their thoughts, or their emotions. This is often a response to stress, trauma, or intense emotional or physical pain. Some studies suggest that as many as 75-80% of people with BPD experience dissociative episodes, which may include:8
- Feeling detached and disconnected from the body or current experiences
- Feeling numb or unable to access any emotions
- Saying or doing things they can’t remember (often when upset)
- Zoning or tuning out from the present moment
Do I Have BPD?
Borderline personality disorder can only be diagnosed by a licensed medical or mental health professional during a formal assessment. If you suspect that you have BPD, you should set up an appointment with a licensed therapist, counselor, psychologist, or psychiatrist in order to confirm your diagnosis and get recommendations for treatment. There is also value in using screening tools to help identify BPD traits and symptoms.
Here is a short survey that can be answered with yes or no responses, with 6-7 “yes” responses indicating a possible diagnosis of BPD:9
- Have any of your closest relationships been troubled by a lot of arguments or repeated breakups?
- Have you deliberately hurt yourself physically (e.g., punched yourself, cut yourself, burned yourself)? Have you made a suicide attempt?
- Have you had at least two other problems with impulsivity (e.g., eating binges and spending sprees, drinking too much and verbal outbursts)?
- Have you been extremely moody?
- Have you felt very angry a lot of the time? Have you often acted in an angry or sarcastic manner?
- Have you often been distrustful of other people?
- Have you frequently felt unreal or as if things around you were unreal?
- Have you chronically felt empty?
- Have you often felt that you had no idea of who you are or that you have no identity?
- Have you made desperate efforts to avoid feeling abandoned or being abandoned (e.g., repeatedly called someone to reassure yourself that he or she still cared, begged them not to leave you, clung to them physically)?
What Causes Borderline Personality Disorder?
All personality disorders are believed to be caused by a mix of both genetic and environmental factors. People who have a family history of mental illness may be more likely to develop the condition, as are people with certain neurological or psychological predispositions. Some studies have even suggested that people with BPD have abnormalities in the areas of their brain responsible for emotion regulation and impulse control which help to explain their symptoms.1
Still, there are many experts who believe that in most cases, BPD develops in response to childhood trauma, and is the direct result of lasting psychological and emotional wounds related to these experiences.3 Many of the symptoms of BPD mirror the symptoms of complex trauma, and may have even been developed as defense mechanisms the child used to protect themselves. For example, people who were neglected, abused or abandoned in childhood may have developed codependent behaviors that helped them get their needs met in childhood.
When & How to Get Help If You or a Loved One Has BPD
Borderline personality disorder is a treatable condition, and many people with BPD are able to manage their symptoms and learn better methods of coping. The therapies that have shown the most success in treating BPD are Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). In most instances, medication is not recommended to treat BPD unless there is a co-occurring disorder like a mood or anxiety disorder.1,2
When possible, seeking treatment early is recommended, as studies have shown better results when the disorder is treated in adolescence or young adulthood. However, there is still hope for older people who have been struggling with BPD for longer, and finding a therapist, couples counselor or family therapist is a great first step towards recovery. In therapy, many people with the condition report an overall improvement in their ability to function, maintain healthy relationships, and manage difficult emotions in healthy ways.
Final Thoughts
Borderline personality disorder is a common but misunderstood condition. People with this disorder have trouble regulating emotions, avoiding impulsive actions, and maintaining healthy, stable relationships. They also struggle with self-worth and identity issues, personal insecurities, and fears of abandonment that may have developed in response to past traumatic experiences.3 While debilitating, the symptoms of BPD can be treated and often improve with specific therapies like CBT and DBT.1,2
Additional Resources
- National Education Alliance for Borderline Personality Disorder
- National Alliance on Mental Illness (NAMI)
- Borderline Personality Support Group
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
Are you ready to connect with a therapist but feel a little overwhelmed by all your options? Speak with one of Choosing Therapy’s Client Navigators. Client Navigators are mental health professionals who will listen to what you’re looking for in a therapist and help pair you with the best possible fit. Getting started is free, easy, and confidential.
