Borderline personality disorder is a distressing mental health issue that is often poorly understood by the average person. It often starts when a person is very young, so they may not even realize they have a problem until it starts to significantly interfere with their life and their ability to function.
Borderline personality can be difficult to live with. It can make you feel isolated from others and terrified that your friends and loved ones will abandon you. The disorder can be complex, but it can be diagnosed and effectively treated. Learn more about borderline personality disorder, its nine symptoms, and how it can be treated.
What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a mental health disorder that’s characterized by instability in a person’s mood, behaviors, and self-image. It’s often identified by problems in interpersonal relationships and periods of impulsivity. BPD is one of 10 currently recognized personality disorders, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
A personality disorder is a way of thinking or behaving that’s different from others in a way that hinders or disrupts your life. Personality disorders will affect two of the following:
- The way you think about yourself or others
- Your emotional responses
- The way you relate to others
- The control of your own behavior
BPD can make it difficult to maintain relationships or make lasting interpersonal connections. One of the most common traits of BPD is a fear of abandonment, which can cause the person to make extreme efforts to avoid both real and imagined abandonment. BPD can cause chronic feelings of anxiety or dread that the people in their lives will leave them. Even small incidents can trigger a feeling of panic that the person with BPD will be abandoned, like a delay in answering a text.
In interpersonal relationships, a person with BPD may oscillate between idealizing and devaluing others. They often build up an unattainable ideal of friends and loved ones and then lash out when a person fails to live up to those ideals. Difficulty controlling anger and having inappropriate angry outbursts are also common.
People with BPD may also experience severely unstable moods. Borderline can cause a person to experience intense anger, happiness, and sadness within the same day and sometimes within a few hours. This is different from the unstable mood that’s caused by bipolar disorder, which is characterized by extreme highs and lows that last for several weeks before switching.
What Are the 9 Signs of Borderline Personality Disorder?
Like most mental health issues, there are no lab tests or medical assessments that can effectively identify borderline personality disorder. Instead, BPD is diagnosed through a clinical and psychological evaluation. Since BPD shares some traits with dissociative and mood disorders, diagnosing it can be difficult. If you’re struggling with a mental health issue, it’s important to work with your doctor or therapist to get the best diagnosis for your needs. It may take several visits with a therapist to identify complex issues like BPD.
To help identify BPD, the DSM-5 outlines nine signs that are common in the disorder. In order to definitely qualify as having BPD, you need to have experienced five of the nine traits. Personality disorder symptoms are usually present for long periods of time and may occur from childhood. They don’t usually start for the first time after a recent event.
- Avoiding abandonment. BPD can cause an extreme fear of abandonment that causes people with the disorder to experience anxiety and take extreme steps to avoid abandonment.
- Unstable and intense personal relationships. With this disorder, you may experience a string of unstable relationships. You may idealize and devalue the people around you and switch between the two quickly. Relationships often feel like rollercoasters of intense passion and anger.
- Unstable self-image. This can affect your self-worth or your sense of who you are. You may alter your image by changing your style of dress or hair. This is referred to as an identity disturbance.
- Impulsivity. You may act quickly without thinking about what you’re doing or the potential consequences. This can cause dangerous consequences like overspending, substance misuse, binge eating, and risky sexual behavior.
- Suicidal or self-harm behavior. Self-harm and suicidal behavior are common in BPD. It often manifests as a cry for help or as an extreme measure to avoid abandonment. Even when self-harm is meant to get the attention of someone else, it may unintentionally lead to a fatality.
- Unstable moods. Moods may shift from intense sadness to anger or another emotion very quickly and intensely.
- A lasting feeling of emptiness. Emptiness is characterized by feelings of sadness, boredom, or a lack of fulfillment. It may contribute to impulsive attempts to fill up the feeling of emptiness.
- Inappropriate emotional expression. BPD can cause extreme expressions of mood and emotions that are inappropriate to the situation. For instance, small problems can cause an angry outburst or bitter tears.
- Stress-induced paranoia. High-stress situations can cause brief periods of paranoid delusions. Paranoia is often centered on the fear of abandonment. It can also cause dissociative episodes.
Can Borderline Personality Disorder Be Treated?
While borderline personality can be a difficult and distressing problem in your life, it can be effectively treated. The first step in getting the right treatment for BPD is to get an accurate diagnosis. BPD shares traits with other mental health issues and can often be misdiagnosed. Getting the right diagnosis is important because your treatment course may be very different depending on the disorder you have.
Borderline personality disorder is usually treated with psychotherapy. Psychotherapy involves regular meetings with a therapist and working through a treatment plan. You may address some of the ways BPD is currently interfering with your life and how you could learn better ways to manage emotions, fears, and impulsive feelings. You may go through cognitive-behavioral therapy (CBT) to identify common triggers that cause some of the symptoms of BPD. CBT is also helpful in developing effective coping strategies and building up your sense of self-efficacy.
You may also go through dialectical behavior therapy (DBT), which was specifically designed to treat BPD. It’s designed to help you manage emotions, increase your tolerance to distress, and improve your relationships.
Another common therapy used to treat BPD is schema-focused therapy. This is used to identify needs that weren’t met and lead to coping mechanisms that are now detrimental to your relationships. This therapy can help you meet these needs in a healthier way. Other therapies that could be helpful include mentalization-based therapy, systems training for emotional predictability and problem-solving, and Transference-focused psychotherapy.
BPD can sometimes be treated with medications, especially when it comes to other problems like depression or anxiety. In many cases, a combination of medication and psychotherapy is more effective than medication by itself.
As with any mental health treatment, it’s important to work with your therapist to find the right treatment for your needs. There is no therapy that is effective for every person, and finding what works for you may be a trial and error process that takes time. However, a lack of process doesn’t mean your case is untreatable. Instead, it could mean that you need to keep going or your treatment plan needs to be adjusted.