A Closer Look at Borderline Personality Disorder: Symptoms, Risk Factors, and Treatments

Borderline personality disorder (BPD) is a mental health condition in which a person experiences long-term mood instability. These unstable emotions can disrupt relationships and lead to frequent changes in goals, values, and self-identity. People who have BPD tend to see things as all bad or all good, and their views about specific people and conditions can fluctuate from one extreme to the other.

The Office on Women’s Health estimates that about 2% Trusted Source Office on Women's Health Governmental authority Go to source of adults in the United States have BPD. According to the National Alliance on Mental Illness (NAMI), nearly 75% of people who receive a BPD diagnosis are female (assigned at birth).

This article will provide an overview of BPD, including common symptoms. It will also discuss how doctors diagnose BPD and available treatment options.

People with BPD experience mood fluctuations and persistent uncertainty about their individual identity.

As a result, a person with BPD may suddenly and drastically change their opinions and values about people, relationships, or goals. They may feel deep love for a person one day, then rapidly shift to anger and distrust the next.

These symptoms and unpredictable mood shifts can lead to impulsive and, in some cases, dangerous actions. It can become difficult for someone with BPD to build and maintain strong relationships.

The National Institute of Mental Health (NIMH) Trusted Source National Institute of Neurological Disorders and Stroke Governmental authority Go to source lists the symptoms of BPD as including:

• a pattern of problems in relationships with friends, family members, and other close contacts
• fear of abandonment, including quickly building intimacy or cutting off relationships in anticipation of abandonment
• extreme mood shifts, particularly in feelings about people
• episodes of mood changes that last hours or even days
• persistent feelings of emptiness
• intense anger or difficulty controlling anger
• difficulty trusting other people
• dissociation Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , or feeling separate from oneself
• recurring thoughts or episodes of self-harm, such as cutting
• experiencing frequent suicidal thoughts or displaying suicidal behavior
• dangerous or risky behavior, including binge eating, substance misuse, or unprotected sex

NIMH notes that each case of BPD is different, and not everyone with BPD will experience the same symptoms.

In some cases, BPD can be life threatening. Seek immediate medical care (call 911) for life threatening symptoms, including:

• being a danger to oneself or others, including threatening, irrational, or suicidal behavior
• trauma, such as bone fracture, burns, lacerations, eye injuries, and other injuries

Experts do not know the exact cause of borderline personality disorder. NAMI reports that researchers believe a combination of factors may play a role in BPD, including genetics, differences in brain structure and function, and environmental factors such as trauma.

The American Association for Marriage and Family Therapy (AAMFT) reports that an imbalance of serotonin may play a key role. Serotonin is a neurotransmitter that helps a person regulate their mood and manage their emotions.

AAMFT goes on to say that certain risk factors may also contribute to the development of BPD.

A number of factors increase the risk of developing BPD. However, not all people with risk factors will get BPD.

The NIMH Trusted Source National Institute of Neurological Disorders and Stroke Governmental authority Go to source lists risk factors including:

• family history of BPD
• abandonment or neglect as a child or adolescent
• family separations or disruptions as a child or adolescent, including the death of a parent
• exposure to unstable or hostile relationships
• physical or sexual abuse as a child or adolescent

Statistics from AAMFT say that about 50–70% of people who have BPD report a history of sexual abuse during childhood.

If you are at increased risk for BPD, you may benefit from mental health screening or talk therapy. Discuss your risk factors with your primary care doctor or schedule an appointment with a licensed mental health professional. 

NAMI reports that many people with BPD have one or more additional conditions. This can complicate receiving an accurate diagnosis and finding effective treatment.

Conditions that commonly occur with BPD include:

• depression
• anxiety
• bipolar disorder
• substance use disorder
• attention deficit hyperactivity disorder
• post-traumatic stress disorder
• eating disorders, particularly bulimia nervosa

Your doctor or mental health professional will develop a treatment plan to address all of your conditions and find effective options to manage symptoms.

There are no blood, laboratory, or imaging tests that can accurately detect or diagnose BPD. Your doctor and mental health professional will use a series of examinations to evaluate your symptoms.

Your care team will likely perform a physical exam and discuss your family history. They may also perform a psychological evaluation and ask you about your symptoms.

Questions your doctor might ask may include: 

• Do you experience mood fluctuations?
• How have your moods affected your relationships and employment?
• Have you ever considered or attempted self-harm or suicide?
• How have anger or fear affected your personal relationships?
• Do you currently or have you ever used substances to cope with your emotions? 
• Do you have a family history of abuse, mental illness, or substance use? 

The Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5) lists several indicators of BPD. A doctor or mental health specialist will diagnose BPD in someone who exhibits five or more of the following symptoms:

• frantic efforts to avoid abandonment, either real or imagined
• a pattern of intense and unstable relationships, marked by alternating extremes of idealization and devaluation
• a markedly and persistently unstable sense of self
• impulsive behavior in at least two self-damaging areas, including substance misuse, unprotected sex, and reckless driving
• recurring thoughts of suicide, suicidal behavior, or self-mutilation
• extended periods of intense moods that last hours up to a few days
• chronic feelings of emptiness
• intense or inappropriate anger that is difficult to control
• paranoia or dissociation from reality

Although it may be difficult to talk about your experiences, providing honest, accurate information can help your doctor reach an accurate diagnosis and begin treatment. 

There is no cure for BPD, and the condition can be difficult to treat. However, effective treatments and therapies are available.

NAMI explains that the goal of BPD treatment is to help the person become more in control of their symptoms and self-manage their care as they learn what works best for them.

Psychotherapy forms the foundation of treatment for BPD. Medications may be used to treat mood instability, depression, or disordered thinking.

Although treatment for BPD can take time, many people improve with therapy.

A type of psychotherapy designed specifically Trusted Source National Institute of Neurological Disorders and Stroke Governmental authority Go to source for the treatment of BPD, called dialectical behavior therapy (DBT), has shown promise in clinical trials.

Doctors may recommend hospitalization as part of treatment if someone expresses suicidal thinking or takes suicidal action. A person also may require hospitalization if they experience substance misuse, psychosis, or significant stress.

Doctors may recommend several types of psychotherapy to treat BPD, including:

• cognitive behavioral therapy to work on thought patterns and behavior
• DBT to work on acceptance, problem-solving, skill development, thought patterns, and behavior
• family therapy to help develop familial support and understanding
• group therapy to speak with others who have BPD and other mental health conditions
• individual therapy to work on personal mental health goals
• psychodynamic therapy to discover and understand past issues and their relationships to current behaviors and actions

If there are coexisting psychiatric conditions or symptoms, such as depressed mood, unstable mood, or psychosis, doctors may prescribe medications for BPD in addition to psychotherapy. Common medications for BPD include:

• antidepressants to treat depression or depressed mood
• antipsychotics to treat psychoses or disordered thinking
• mood stabilizers to treat bipolar disorder or unstable moods

In addition to engaging in psychotherapy and taking medications if your doctor recommends them, you may be able to improve the likelihood of success of your treatment by:

• avoiding alcohol or illicit drugs
• avoiding making decisions based on emotions
• getting enough sleep
• getting regular exercise
• seeking help immediately if you want to hurt yourself or others

Complications of untreated or poorly controlled BPD can be serious and even life threatening in some cases.

You can minimize your risk of serious complications by following the treatment plan your healthcare professional designs specifically for you. Complications of BPD include:

• abuse of drugs or alcohol
• depression
• difficulties maintaining relationships
• eating disorders
• legal or financial problems
• problems at work
• self-harm
• social isolation
• strained familial relationships
• suicide

BPD is a mental health condition in which a person experiences chronic and recurrent mood instability. A person with BPD may have rapidly changing feelings, thoughts, and values that lead to impulsive actions.

Someone with BPD may alternate between extremes of intense closeness and sudden distrust. This mood instability makes it difficult to build and maintain close relationships. It can also lead to impulsive and dangerous behavior such as substance misuse and reckless driving.

There is no specific cause of BPD, but researchers have identified factors that increase the risk of developing it. These include a family history of BPD, exposure to physical or sexual abuse in childhood, and separation or neglect from a parent at a young age.

Treatment is available for BPD and focuses on helping someone become independent in managing their symptoms. With successful treatment, someone with BPD can stabilize their mood, reduce their risk of complications, and build healthy relationships.