Understanding Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is a complex and often misunderstood mental health condition. It’s characterized by intense emotions, unstable relationships, and a fragile sense of self.

Those with BPD often struggle with emotional regulation, which can impact an individual’s relationship and life significantly.

In this post, we’ll explore what BPD is, its symptoms, how it is diagnosed, the potential causes, and available treatments for managing the disorder.

What is borderline personality disorder?

Borderline Personality Disorder is a type of personality disorder. Individuals with BPD often exhibit patterns of behavior, thoughts, and emotions that deviate from societal expectations and cause significant distress. BPD specifically involves a pervasive pattern of instability in interpersonal relationships, self-image, and affect, along with impulsivity.

The hallmark of BPD is emotional dysregulation. Individuals with BPD often experience intense mood swings and struggle to maintain a consistent sense of identity. Their emotions can shift rapidly from extreme joy to deep despair, often triggered by events or interactions that may seem minor to others. These emotional fluctuations lead to difficulties in personal relationships, which can be marked by idealization (putting someone on a pedestal) and devaluation (suddenly seeing that person in a negative light).

BPD typically begins in adolescence or early adulthood. It affects about 1.4% of the US population. It’s more commonly diagnosed in women, though men may be underdiagnosed due to differing presentation of symptoms.

Symptoms

The symptoms of BPD can vary widely among individuals, but there are nine key criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by mental health professionals to diagnose the disorder.

A person must display at least five of the following symptoms to be diagnosed with BPD:

1. Fear of abandonment: People with BPD often go to extreme lengths to avoid real or perceived abandonment. This fear can manifest in clingy behavior, rapid attachment, or extreme reactions to minor separations.
2. Unstable relationships: Relationships are often intense and short-lived. Individuals may quickly move from idolizing a person to viewing them as cruel or uncaring. This shift from idealization to devaluation can create a pattern of turbulent relationships.
3. Unclear or shifting self-image: A person with BPD may struggle with their sense of identity. They may feel like they don’t know who they are or what they want in life, which can lead to frequent changes in jobs, friends, goals, or values.
4. Impulsive behaviors: BPD is often associated with risky or self-destructive behaviors, such as substance abuse, binge eating, reckless driving, or promiscuous sex. These behaviors are often an attempt to cope with emotional pain or boredom.
5. Self-harm or suicidal behavior: Self-harm, such as cutting or burning, or suicidal threats and attempts, are common in individuals with BPD. These behaviors are often a way to express emotional distress or manage overwhelming emotions.
6. Emotional instability: Also known as affective instability, this symptom involves intense emotional experiences that can last for a few hours to a few days. People with BPD can shift rapidly from feelings of happiness to deep sadness, anger, or anxiety.
7. Chronic feelings of emptiness: Individuals with BPD often describe feeling empty or hollow inside, which can lead to a desperate search for external validation or engagement in risky behaviors to fill this void.
8. Inappropriate, intense anger: People with BPD may struggle to control their anger and may experience frequent outbursts or engage in physical fights. Their anger may be disproportionate to the situation.
9. Paranoia or dissociation: During periods of extreme stress, people with BPD may experience paranoia or dissociation, where they feel disconnected from reality or their own identity.

Borderline Personality Disorder vs. bipolar disorder

Borderline personality disorder and bipolar disorder are often confused because both can involve mood swings, but they are distinct conditions.

The nature of mood swings in BPD are typically short-lived (lasting hours to a day). They’re often triggered by environmental factors or interpersonal conflicts. These shifts are reactive, meaning they arise in response to external events.

In bipolar disorder, mood changes are episodic and longer-lasting, with depressive episodes typically lasting at least two weeks and manic or hypomanic episodes lasting days or weeks. These mood shifts are not necessarily linked to external events.

The types of mood swings also differ. BPD mood swings are often more intense and fast-changing, with an individual cycling through anger, anxiety, and depression within a short time frame.

But in bipolar mood swings, individuals experience distinct manic/hypomanic and depressive episodes, which are more predictable in pattern.

The core symptoms of both disorders also differ.

The primary symptoms of BPD include intense fear of abandonment, unstable relationships, identity disturbances, impulsivity, and self-harm behaviors.

The core symptoms of bipolar are significant mood shifts between manic episodes and depressive episodes. There is less of a focus on interpersonal relationship issues and identity disturbances.

How BPD is diagnosed

Diagnosing BPD can be challenging, as its symptoms overlap with those of other mental health disorders such as depression, anxiety, or post-traumatic stress disorder (PTSD). There is no specific test for BPD, so a comprehensive psychological evaluation is essential. Mental health professionals assess a person’s history, behavior patterns, and symptomatology based on the criteria outlined in the DSM-5.

The evaluation process typically involves:

• Clinical interviews: The healthcare provider will ask detailed questions about the individual’s emotional state, relationships, behaviors, and any history of trauma or abuse.
• Self-reported symptoms: Individuals may be asked to complete questionnaires that assess their mood, thoughts, and behaviors.
• Observations: In some cases, a clinician may observe interactions between the person and others to better understand their relationship dynamics and emotional responses.
• Ruling out other conditions: BPD can co-occur with other disorders such as depression, bipolar disorder, anxiety disorders, or substance use disorders. It’s essential to differentiate BPD from other mental health conditions to develop an effective treatment plan.

Causes

The exact cause of BPD is not fully understood, but it’s generally believed to be the result of a combination of the following factors:

• Genetics: Research has shown that BPD may run in families. Individuals with a close family member who has BPD, or another personality disorder, are at a higher risk of developing the disorder themselves. However, genetics alone do not account for all cases of BPD.
• Environmental factors: Many people with BPD report a history of trauma, neglect, or abuse during childhood. Emotional, physical, or sexual abuse, or the loss of a caregiver, can contribute to the development of BPD. Unstable family environments or chronic invalidation of emotions during formative years may also play a role.
• Brain structure and function: Neuroimaging studies have found differences in the brain structure of people with BPD, particularly in areas related to emotional regulation, impulse control, and aggression. The amygdala (responsible for emotions) and the prefrontal cortex (involved in decision-making and impulse control) may function differently in individuals with BPD.
• Biochemical factors: Imbalances in neurotransmitters, such as serotonin, which regulates mood, may also contribute to the emotional instability seen in BPD.

Treatment options

While BPD is a challenging disorder, it is treatable.

With the right therapeutic interventions, individuals with BPD can experience significant improvements in their symptoms and quality of life. The most effective treatments include:

Therapy

Therapy is the primary treatment for borderline personality disorder. Several types of therapy have been found to be particularly effective, such as: 

• Dialectical behavior Therapy (DBT): DBT is one of the most well-known and effective therapies for BPD. It focuses on teaching individuals’ skills to manage their emotions, tolerate distress, and improve relationships. DBT emphasizes mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. 

• Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and challenge distorted thinking patterns and replace them with healthier beliefs and behaviors. It is effective in addressing the cognitive distortions and negative thought patterns common in BPD. 

• Schema-Focused Therapy: This therapy helps individuals with BPD understand and change the deeply ingrained patterns (schemas) that affect their behavior. It focuses on identifying and addressing maladaptive coping mechanisms that originated in childhood. 

Medication

While there is no medication specifically approved to treat BPD, medications may be prescribed to manage symptoms such as depression, anxiety, or impulsivity. These may include:

• Antidepressants: To address mood disorders and emotional instability.
• Antipsychotic medications: To help with distorted thinking, anger, or dissociation.
• Mood stabilizers: To reduce impulsive behaviors and mood swings.

Medication is typically used with therapy to manage specific symptoms but is not a standalone treatment for BPD.

Support systems

Support from family, friends, or support groups can be crucial in the treatment of BPD. Family therapy may help improve communication and understanding between the person with BPD and their loved ones. Peer support groups can also provide a sense of belonging and understanding for individuals with BPD.

You’re not alone

Understanding the causes and symptoms of BPD is helps reduce any stigma around the disorder and ensures that those affected receive the care and understanding they need. With proper management, individuals with BPD can lead fulfilling and stable lives.

If diagnosed with BPD, you can improve your quality of life through appropriate treatment.

And whether you or someone you love struggles with BPD, we can help.