Borderline Personality Disorder: 9 Things to Know

Borderline personality disorder (BPD) is an illness marked by difficulty regulating emotions and behavior. According to the National Alliance of Mental Illness (NAMI), approximately 1.5% of American adults have BPD. The majority—approximately 75%—are women, though researchers are realizing that men with BPD symptoms are frequently diagnosed with post-traumatic stress disorder (PTSD) or depression instead. Learn more about this complex mental health condition, including symptoms and examples of borderline personality disorder, what causes BPD, and best practices for BPD treatment.

The symptoms of borderline personality disorder often first become apparent in the late teen/early adult years. Symptoms may include impulsive and dangerous behaviors (reckless driving, substance abuse, unsafe sex), a pattern of intense and unstable relationships, distorted self-image, intense and erratic moods, difficulty trusting others, and cutting off contact with others to prevent abandonment. Evidence suggests symptoms are usually worse in young adulthood and improve by midlife.

Because the behavior of people with BPD can be dramatic and self-destructive, friends and family members sometimes think these actions are exaggerated and purposefully initiated. But as one woman with BPD wrote in a NAMI blog post, “I did not wake up thinking, ‘I want attention.’ I woke up feeling agonizing emotional pain.” The apparently nonproductive actions of people with BPD reflect their interior emotional distress and fear. Rather than dismissing their concerns, recognize their behavior as a need for medical attention and support.

No one knows exactly what causes BPD, but genetics and the environment both play roles. Having a parent or sibling with BPD increases the likelihood that you’ll also have borderline personality disorder, but it’s not a guarantee. Many people with BPD experienced significant trauma, including physical, emotional or sexual abuse and abandonment or neglect, in the early years of their lives.

Approximately three-quarters of people with BPD commit at least one deliberate act of self-harm, such as cutting. Suicidal thinking and attempts are also more common in people with borderline personality disorder than among the general population. Statistics show that approximately 9% of people with BPD die by suicide. If you or someone you love is considering suicide, get help immediately. You can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) 24 hours a day, 7 days a week. Do not hesitate to call 911 in an emergency.

According to the National Institutes of Mental Health, about 85% of people with borderline personality disorder have another mental illness as well. More than half of BPD sufferers also have depression. Other common co-existing mental illnesses include anxiety disorders, eating disorders, attention-deficit/hyperactivity disorder, post-traumatic stress disorder, and bipolar disorder. Substance abuse, including alcohol and drug use, is also common among people with BPD.

Borderline personality disorder still has a reputation as being difficult to treat. However, evidence-based treatment from a qualified provider can improve symptoms and overall quality of life over time. Two types of psychotherapy that have been proven as BPD treatments include dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT). DBT uses mindfulness and awareness to help people with BPD learn how to control intense emotions and potentially harmful behaviors. CBT helps people recognize, challenge and replace some of the inaccurate thoughts that fuel their behavior.

Taking a daily pill may seem like the easiest treatment for borderline personality disorder, but medication isn’t the most effective treatment for BPD. Therapy is the recommended first-line treatment because it can address some of the root causes of BPD (such as fear of abandonment stemming from childhood neglect) and teach patients healthy coping skills. However, doctors sometimes prescribe medication to treat coexisting anxiety, depression or other mental health disorders.

Don’t expect immediate results. It may take weeks or even months for noticeable improvement to occur. Work with a reputable therapist with expertise treating patients with BPD. Challenging and replacing established behaviors is difficult. (If you’ve ever attempted to break a bad habit, you have some idea of how difficult it is to consistently implement healthier behaviors.) You can—and should—expect setbacks as well; they are part of the process of learning new behaviors. Don’t give up on therapy. Keep going.

The intense anger, impulsiveness, and volatile moods, which can swing from “I love you” one day to “I hate you” the next, can make living with or loving someone with BPD difficult. Their moods affect your mood and well-being as well. Even if you understand that their actions are part of a mental health disorder, you might find yourself frequently frustrated, angry, stressed and scared. Attending therapy on your own can help you figure out how to effectively interact with your loved one.