Borderline Personality Disorder (BPD) is a disorder characterized by difficulty regulating emotions. It’s estimated that 1.6% of the adult U.S. population has BPD, but that number may be as high as 5.9%. 75% of people that are diagnosed with BPD are women, but this is not to say that men are not susceptible to having BPD. Research suggests that men may be equally affected by BPD but are commonly misdiagnosed with PTSD or depression. BPD is also a Borderline personality disorder, like all personality disordersis not diagnosed in children or adolescents, but mostly in adults. Personalities of children and adolescents are still developing so what may appear to be signs and symptoms of borderline personality disorder may go away as children get older and become more mature.
Personality Disorder Defined
Borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, affects, and marked impulsivity that begins by early adulthood and is present in a variety of context. Individuals with borderline personality disorder have an intense fear of abandonment or instability, and may have difficulty tolerating being alone. While these individuals have this fear and seek out interpersonal relationships, their behavior more often than none pushes friends and family away. Behaviors like inappropriate anger, impulsiveness and frequent mood swings causes difficulty, even though they want to have loving and lasting relationships. BPD impacts the way an individual thinks and feels about themselves and others, causing problems functioning in everyday life. BPD frequently co-occurs with other personality disorders. The most common pattern for the course of BPD is one of chronic instability in early childhood, with episodes of serious affective and impulsive dyscontrol and high levels of use of health and mental health resources.
Different Types of Borderline Personality Disorders
There are no sub types of borderline personality disorder but it is classified under Cluster B under personality disorders in the Diagnostic and Statistical Manual of Mental Disorders. Cluster B personality disorders are characterized by dramatic, overly emotional or unpredictable thinking or behavior.
Borderline Personality Disorder Causes
The cause of borderline personality disorder is not fully understood but there is an agreement that it is caused by a combination of factors. BPD may be linked to brain abnormalities, in the part of the brain that control emotions and decision-making/judgment may not communicate optimally with one another. It may also be the case that certain brain chemicals that help regulate mood, like serotonin, may not functioning correctly. Genetics may play a role in the development of borderline personality disorder. While there is no specific gene related to BPD, some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members. BPD is about five times more common among people who have a first-degree relative with the disorder. Finally, environmental factors may also be linked to BPD. Research has shows that a history of child abuse or neglect or experience other traumatic life events, are at increased risk of developing BPD.
Borderline Personality Disorder Symptoms
To be diagnosed with borderline personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, and indicated by five (or more of the following):
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremeness of idealization and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two areas that are potentially self-damaging (e,g., sex, substance abuse, spending, binge eating, reckless driving).
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., irritability, intense episodic dysphoria, or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e,g., frequent displays of temper, recurrent physical fights, constant anger).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
How to Approach a Loved One
There is not a perfect way to approach a loved one that you assume or know has borderline personality disorder. People with borderline personality disorder struggle to understand how their loved ones experience their intense reactions, mood swings, and risky behavior. While preventing a loved one from developing BPD is not possible, providing support and being aware of what their learning in treatment can be helpful. It’s important to determine the level of care a loved one may need before engaging in (and throughout the duration of) treatment. For more information on how to approach a loved one visit:
Types of Borderline Personality Disorder Treatment
Borderline personality disorder can be a challenge to treat not only because it is complicated and stigmatized, but also because its symptoms reflect ingrained patterns of thinking and behavior. Treatment for BPD is long- term and require a comprehensive treatment plan. When considering treatment it is important to consider co-occurring conditions that may exist, which is common with individuals with BPD.
Dialectical behavior therapy (DBT)– Dialectical behavior therapy is the most common form of treatment for individuals with borderline personality disorder. DBT focuses on teaching coping skills to combat counterproductive urges, regulate emotions and improve relationships. Dialectical behavior therapy usually lasts for a year and consists of both group and individual sessions. Studies conducted by researchers at the University of Washington have concluded that dialectical behavior therapy is effective at reducing self-mutilation and suicide attempts, as well as the number of days spent in psychiatric hospitals (Harvard Health Publishing, 2010).
Schema-focused therapy- The goal of therapy is to help the individual replace old schemas (or ways of thinking) with new ones and adopt a new mode of behavior, that of the “healthy adult.” Therapy must continue for at least two years to be effective.
Transference-focused psychotherapy– In this technique of therapy, clinician and individual to together understand the dynamics of past relationships and associated emotions and how these may affect their current functioning. The goal of therapy is to help individuals better integrate their views of themselves and other people. Individuals of this therapy usually attend therapy at least twice a week.
Mentalization- based treatment– This technique of therapy helps individuals develop a mental picture of the emotions, feelings, or beliefs of themselves and others, which they are lacking. A long-term study reported that mentalization- based treatment reduced antipsychotic use and the number of suicide attempts, and increased chances of recovery five years after completing treatment (Harvard Health Publishing, 2010).
Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive or suicidal behavior to ensure safety. For most treatment used for borderline personality disorder, the goal is usually to learn coping skills while in the community; therefore it is not organized around inpatient care. Although, there are some facilities that have a DBT track in inpatient-partial hospital program.
To date there are no drugs approved by the FDA that have been specifically created to treat borderline personality disorder. Medications can be useful when treating certain symptoms that are typically associated with borderline personality disorder, such as depression and anxiety. They can also be used to help increase a person’s ability to engage in psychotherapy.
Differences Between Common Disorders
There are other disorders that may resemble borderline personality disorder, so it is important to differentiate the difference between common disorders that may get confused with BPD.
- Depressive and bipolar disorders- Borderline personality disorder often co-occurs with depressive or bipolar disorders, and if an individual meets criteria for both disorders, they can both be diagnosed. The presentation of borderline personality disorder can be mimicked by an episode of depressive or bipolar disorder.
- Other personality disorders-Other personality disorders may be confused with borderline personality disorder due to their similarities in symptoms and features. If and individual meets criteria for BPD as well as another personality disorder, both can be diagnosed. For example, although histrionic personality disorder can also be characterized by attention seeking, manipulative behavior, and rapidly shifting emotions, borderline personality disorder is distinguished by self-destructiveness, angry disruptions in close relationships, and chronic feelings of deep emptiness and loneliness.
- Personality change due to another medical condition- Borderline personality disorder must be differentiated from personality change our to another medical condition, in which traits that emerge are attributable to the effects of another medical condition on the central nervous system.
- Substance use disorders- Borderline personality disorder must be differentiated from symptoms that may develop that are associated with persistent substance use.
- Identity problems-Borderline personality disorder should be differentiated from identity problem, which is contributed to identity concerns related to developmental phases, like adolescents, which does not qualify as a mental disorder.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.
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