Signs & Symptoms of Borderline Personality Disorder

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

9 Common BPD Symptoms

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, while other types of BPD can present more externally.

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).

The DSM-5 lists nine symptoms of BPD:⁴

1. Frantic efforts to avoid real or imagined abandonment: excessive calling, seeking reassurance, codependent patterns, manipulative or controlling behaviors
2. A pattern of unstable interpersonal relationships that alternate between idealizing and devaluing the relationship: understanding borderline personality disorder relationship cycles of love/hate or stormy on/off relationships is important
3. Identity disturbance and a markedly and persistently unstable self-image or sense of self: alternating between pride and shame, or confidence and extreme insecurity
4. Impulsivity in at least two areas that are potentially self-damaging: spending money, sex, substance abuse, reckless driving, binge eating
5. 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
6. 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
7. Chronic feelings of emptiness: feeling empty, numb, or as though they have no true self, worth, or purpose
8. Inappropriate, intense anger or difficulty controlling anger: frequently losing one’s temper, becoming angry or destructive, getting into frequent conflicts or fights with people. This can be found in most BPD subtypes, particularly in a petulant borderline.
9. 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

The signs and 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

Co-occurring Disorders

Borderline personality disorder often co-occurs with other mental health conditions, including:

• Anxiety
• Depression
• PTSD
• Eating disorders
• Substance use disorders
• Other personality disorders

When a person has a co-occurring disorder, BPD becomes more difficult to diagnose and treat. Moreover, it’s been found that people with borderline personality disorder who haven’t been provided proper treatment are at risk of developing more serious psychiatric conditions.^{1, 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. Examples of presentation include frantic efforts to avoid abandonment, insatiable relationships, unstable sense of self, impulsiveness, and self-harm.

Here are nine examples of how BPD symptoms can manifest in daily life:

1. Frantic Efforts to Avoid Abandonment

Deep-seated fears of abandonment and trust issues are often what drive 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.

These insecurities can cause them to:^{6, 7}

• Be needy and clingy in relationships
• Become manipulative, using guilt and emotional coercion – This may be especially true regarding signs of a borderline mother
• 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 borderline personality disorder and relationships tend to exhibit toxic, unhealthy, or codependent patterns with partners, friends, and family members. Often, these same patterns have led to conflict or caused people to cut ties or pull away.

Despite being driven by a fear of abandonment, your BPD partner may end the relationship or behave in ways that damage the relationships to 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 (i.e., rejection sensitive dysphoria), but not to the feelings/needs of other

3. Unstable Sense of Self

A person with BPD often doesn’t 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.

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.

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 & Intense Emotions

People with BPD have 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 upset.

Often, the core issue in BPD is not the intensity of the emotions, 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.

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 & 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} When they’re 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 BPD splitting), which feeds their anger.

Examples of anger issues and outbursts common in people with BPD include:

• Being quick to become jealous, angry, or irritable
• Borderline rage
• 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

BPD & Stigma

Like other mental health conditions, BPD has carried a negative connotation not only by the public, actual sufferers, and their families, but also by the health care community. People living with BPD have been thought of as immature, unstable, manipulative, and deemed untreatable among others. This stigma stems from lack of knowledge, misinformation, and outdated data, which unfortunately has deprived many sufferers of the appropriate care or any at all.⁹

However, due to the vast scientific research, BPD can now be better understood and given the medical attention it warrants. New developments have indicated that with the appropriate evidence-based interventions individuals with BPD can have favorable outcomes, including a reduction of symptoms and intensity, improvement in functioning, and a better quality of life. Additionally, it has been found that the severity of this disorder can greatly vary among BPD sufferers.⁹

What Causes Borderline Personality Disorder?

Is BPD genetic? In part, yes; it’s believed to be caused by genetics and environmental factors, like all personality disorders. 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 suggest that people with BPD have abnormalities in the areas of their brain responsible for emotion regulation and impulse control, which helps 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 PTSD, 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.

Getting a BPD Diagnosis

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’s 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:¹⁰

1. Have any of your closest relationships been troubled by a lot of arguments or repeated breakups?
2. Have you deliberately hurt yourself physically (e.g., punched yourself, cut yourself, burned yourself)? Have you made a suicide attempt?
3. Have you had at least two other problems with impulsivity (e.g., eating binges and spending sprees, drinking too much and verbal outbursts)?
4. Have you been extremely moody?
5. Have you felt very angry a lot of the time? Have you often acted in an angry or sarcastic manner?
6. Have you often been distrustful of other people?
7. Have you frequently felt unreal or as if things around you were unreal?
8. Have you chronically felt empty?
9. Have you often felt that you had no idea of who you are or that you have no identity?
10. 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)?

When & How to Get Help If You or a Loved One Has BPD

BPD is treatable, and many people with it are able to manage their symptoms and learn better methods of coping. The therapies that have shown the most success as borderline personality disorder treatments are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). In most instances, borderline personality disorder medication is not recommended unless there is a co-occurring disorder like a mood or anxiety disorder.^{1, 2}

When possible, seek treatment early, as studies show better results for the treatment of borderline personality disorder (BPD) in teens or young adults. However, there’s still hope for older people who’ve been struggling with BPD for longer. While there is no cure for BPD, in therapy, many people with the condition report an overall improvement in their ability to function, maintain healthy relationships, and manage difficult emotions.

How to Find a Therapist

Finding a therapist, couples counselor or family therapist is a great first step towards recovery. Start your search today in an online therapist directory.

How to Cope With BPD

Dealing with BPD can be extremely challenging. However, there are healthy methods and tools you can use to better manage your emotions, improve how you relate to others, and diminish your symptoms. This strategy includes practicing mindfulness, engaging in relaxation techniques, using distractions, doing grounding exercises, developing distress tolerance, and self-care, along with regularly attending therapy.

Below are some ways to cope with BPD:¹¹

• Practice mindfulness for BPD
• Use relaxation techniques like meditation, progressive muscle relaxation, imagery, or yoga
• Find distractions through engaging in positive activities until your negative emotions subside, like spending time in nature
• Use grounding exercises to self-soothe intense emotions
• Develop distress tolerance by finding healthier ways of thinking to effectively cope with stressful situations
• Improve social skills to healthily relate to others
• Process your emotions through journaling
• Contribute to others in a positive way, like spending time volunteering with a cause you care about
• Focus on healthy eating, proper sleep, regular exercise, maintaining good health and self-care

Final Thoughts

BPD is common but misunderstood. 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.³ While debilitating, symptoms of BPD can be treated and often improve with therapies like CBT and DBT.^{1, 2}