Borderline Personality Disorder (BPD): Symptoms & Treatment

Borderline personality disorder (BPD) is a mental health condition that causes long-term patterns of unstable moods, difficulty maintaining relationships, and turbulent emotions. Like other personality disorders, it affects how a person thinks, feels, and behaves, causing deviations from the typical norms of culture and society.

An estimated 1.4% of the adult population in the United States has borderline personality disorder, and about 75% of those diagnosed are people assigned female at birth. Assigned males may be equally affected by the condition, but they tend to be misdiagnosed with conditions like depression or PTSD.

BPD is classified under the category of cluster B personality disorders, which are disorders that cause constantly changing, dramatic, emotional thoughts or behaviors. Symptoms and traits include difficulty regulating emotions, poor self-image, and feelings of emptiness. These inner experiences, which typically begin in late adolescence or early adulthood, often result in impulsivity, chaotic relationships with others, and difficulty with daily functioning.

Scientists over the years have been trying to understand more about borderline personality disorder. As a result, several studies have offered different ways of classifying this condition. One of the most well-known breakdowns of BPD was established by Theodore Millon, who identifies four primary types of BPD:

• Petulant BPD: People with this type of BPD have persistent, unpredictable mood swings and are often unable to maintain their relationships. They also have a sense of unworthiness and experience manipulative tendencies.
• Impulsive BPD: As the name may imply, this BPD subtype causes uncontrollable impulsivity, the tendency to be aggressive, and risky behaviors. People with this condition also yearn for instant satisfaction without considering the consequences.
• Discouraged BPD: People with discouraged BPD often hide their emotions and tend to keep their symptoms internal. They hardly express anger, even though they have intense mood swings and unstable self-identity. Compared to other subtypes of BPD, people with discouraged BPD tend to be less impulsive.
• Self-destructive BPD: This type of BPD often causes a sense of bitterness and self-hatred, a negative self-image, and suicidal thoughts. People who experience this type may also get involved in harmful and risky behaviors like overdosing, walking into traffic, and cutting themselves.

Borderline personality disorder can look different from person to person. If you or a loved one have BPD, you may exhibit these traits or experience the following symptoms:

• All-or-nothing mindset (thinking in extremes)
• Rapidly changing interests, values, and views of other people
• Impulsive or harmful behaviors such as substance use, unsafe sex, or excessive spending
• Aggression
• Intense emotions like rage, panic, shame, or deep sorrow
• Upsetting thoughts, such as feeling you are unworthy or a terrible person
• Irritability or anxiety
• Depressive moods or episodes
• Intense fear of rejection, being alone, or feeling abandoned
• Experiencing boredom or emptiness
• Abnormal episodes, such as hearing voices outside your head
• Feeling misunderstood
• Suicidal thoughts

The exact causes of BPD are not fully understood. However, health researchers believe the following factors may play significant roles in the development of this condition:

• Genetics: While research has not shown that any specific gene causes BPD, research suggests it has a strong genetic basis. Studies show that people who have a family history of BPD are more likely to develop this condition than people who do not have a relative with a personality disorder. 
• Environmental factors: Certain environmental factors are associated with BPD, such as fear and distress in childhood, trauma, and neglect or separation from parents. 
• Brain function and development: People with BPD may have variations or insufficiencies in brain neurotransmitters. Neurotransmitters are chemicals that allow brain cells to transmit signals to other parts of the body. One study that looked at brain scans of people with BPD also showed that many people had unusual activity in some parts of their brains or brains unusually small in size.

Borderline personality disorder can be challenging to diagnose as there are no specific tests that confirm someone has the condition. Symptoms of BPD can also look similar to other mental health conditions, which raises the risk of receiving a misdiagnosis. However, with the right education and proper assessment, some mental health providers can diagnose BPD correctly.

If you or a loved one are experiencing BPD symptoms, seeing a mental health provider can help learn more about the condition and get the support you need. During the diagnostic process, you can expect to receive a physical and psychological examination. Your healthcare provider will ask questions about your symptoms and how you react to certain experiences. They may also speak with your friends or family members to get more information about your feelings or behaviors.

To receive a diagnosis for BPD, you will also need to meet the criteria set by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Experiencing five or more of these symptoms determines a diagnosis:

1. Desperate or strong efforts to avoid abandonment
2. A pattern of emotional instability and intense interpersonal relationships
3. Severe paranoid and dissociative symptoms
4. Impulsive behavior that can be self-damaging, (e.g., reckless driving or substance use)
5. Unstable self-image
6. Constant feelings of emptiness
7. Intense and inappropriate anger that is difficult to control
8. Frequent mood swings that typically last a few hours and rarely more than a few days
9. Suicidal thoughts or self-harming behaviors

If you have received a diagnosis of BPD, getting treatment from a mental health provider is critical for your care and overall quality of life. The primary treatment for this condition is psychotherapy. Your provider may recommend medications in conjunction with therapy to help alleviate some symptoms.

Psychotherapy

Psychotherapy, also called talk therapy, is the first line of treatment for borderline personality disorder. There are different types of psychotherapy healthcare providers adopt for treating BPD. Your mental health provider (whether that’s a psychologist, social worker, or licensed therapist) may try one of the following techniques:

• Dialectical behavioral therapy (DBT): This type of therapy targets factors that cause a person with BPD to fall into a negative cycle and aims to break that cycle using one-on-one or group talks. It uses validation (accepting that your emotions are valid) and dialectics (openness to other ideas or opinions) to encourage positive behavioral changes.
• Mentalization-based therapy (MBT): People with BPD often have impaired mentalization (social cognition), and MBT can help address this. This type of therapy is beneficial for people dealing with interpersonal challenges and intense emotions by using a holistic approach to help them function better in regular social settings. 
• Transference-focused psychotherapy (TFP): This uses a client-therapist relationship to help change how people with BPD view themselves. Studies show that this treatment is effective in enhancing reflective thinking.
• Schema therapy: This is a cognitive therapy specifically designed for people with personality disorders. It helps transform faulty patterns that people with BPD develop about themselves and their relationships with others.

Medications

The Food and Drug Administration (FDA) has not approved any medication for treating borderline personality disorder, but certain medications may help manage BPD symptoms like depression, anxiety, and sleep disturbances. If your condition is causing other mental health symptoms, your provider may prescribe one or more of the following types of medications: 

• Mood stabilizers
• Antipsychotics
• Antidepressants
• Anxiolytics (anxiety medications)

Other Treatments

Your healthcare provider may also suggest other treatments alongside therapy and medication that can help reduce symptoms, improve overall well-being, and offer additional support. These may include:

• Art therapies, such as drama, music, and dance movement therapy
• Therapeutic communities (structured communities designed to help people improve their social skills)
• Psychoeducation (teaching people with BPD and their family members about the condition)
• Short-term inpatient hospitalization

There is no known way to prevent borderline personality disorder. Some older studies indicate that early interventions, such as detecting symptoms earlier and identifying appropriate risk factors may help people get an earlier diagnosis and receive treatment sooner. 

Treatments often improve BPD symptoms. When left untreated, it can increase the risk of developing other mental health conditions or behavioral concerns. These include:

• Depression
• Substance use disorder
• Suicide attempts
• Difficulty maintaining relationships at work, home, or with friends

It can be challenging to live with mental health conditions like BPD, especially as it can cause a feeling of not being understood. To improve your functioning abilities and help you manage the condition better, consider the following tips:

• Seeking appropriate medical attention and treatment
• Educating yourself more about your condition
• Working with your healthcare team on a treatment plan and sticking with the plan
• Identifying your triggers and avoiding them or creating strategies to deal with them better
• Avoiding the use of substances like alcohol and drugs, as they can worsen your symptoms or interact with your medications
• Writing in a journal or joining support groups to help express how you feel
• Trying stress management and relaxation techniques like deep breathing exercises and meditation

It’s also important to be patient with yourself during your treatment journey. With appropriate treatment and care, symptoms of BPD often improve. Improvement is often gradual, so sticking with your care plan is important.

If you’re comfortable, consider telling your loved ones about your condition, your symptoms, and any challenges you’re experiencing. This can help them understand how you feel and offer support.