Borderline personality disorder (BPD) is an uncommon type of personality disorder characterized by challenges in processing and managing emotions. Individuals with BPD may experience issues with compulsivity, self-image, fluctuating moods, and changes in behavior. ¹

Unfortunately, most aren’t aware of what BPD is. More so, there’s a stigmatization against those with the condition, both within society and the medical field. ² For these reasons, we’ll take a deeper dive into BPD.

BPD Defined

Borderline personality disorder (BPD) is marked by the struggle to process and manage emotions. It commonly involves self-image issues, mood swings, and behavioral changes, often leading to a sense of instability and insecurity.

BPD symptoms often lead to impulsive behaviors and difficult relationships with loved ones. For this reason, it’s also met with low tolerance compared to other mental health conditions.

It’s estimated that 1.4% of the U.S. population struggles with BPD. About 75% of these cases involve women. However, some experts believe it’s equally common among men.

Sometimes, BPD is misdiagnosed with other mental illnesses, including bipolar disorder or depression. ³

Signs and Symptoms of BPD

Not everyone experiences BPD the same. However, there are commonalities among signs and symptoms. These include:

• Acts of self-harm, such as cutting
• Anger issues, including intense, irrational anger or difficulty controlling anger
• Attempts to avoid abandonment, which might involve leaving someone first or rushing into emotional or physical relationships with others
• Distorted and unstable self-image
• Episodes of impulsivity, such as reckless spending, unsafe sexual activities, binge eating or drinking, reckless driving, and more
• Feeling disconnected from your body
• Feelings of emptiness that persist
• Intense and rapidly changing moods
• Irrational fear of others’ intentions and difficulty trusting people
• Pattern of intense and unstable relationships with family, friends, romantic partners, and other loved ones
• Suicidal ideation or threats

If you are now or have in the past considered suicide, we recommend the following:

• Call 911 or go to the emergency room as soon as possible.
• Consult your doctor or mental health provider.
• Reach out to the 988 Suicide & Crisis Lifeline.
• Engage with your faith community.
• Contact your family, friends, and/or trusted peer groups.

What Causes BPD?

Mental health professionals still don’t entirely understand what causes BPD. However, they do believe the following play a role:

Brain Irregularities

Research has found that changes in brain function and structure may increase your risk of BPD. These changes can lead to impulsive behaviors and difficulties in regulating emotions. Still, it’s not clear if these changes are a cause of BPD rather than a result of living with the condition. ⁴

Environment

Your environment can increase the chances of developing BPD. More specifically, research confirms that different types of trauma often lead to BPD symptoms. ⁵

More specifically, a 2021 review found that “the dysfunctional familial environment that produces traumas interacts with the child’s innate temperamental traits or specific polymorphisms.” ⁶

Simply put, if you live in a prolonged stressful environment and have experienced traumas from abuse, bullying, sexual assault, or other stressors in childhood, you’re at an increased risk of BPD.

Genetics

According to research, if you have a close family member living with BPD, you’re more likely to develop the condition. However, research has not found a specific gene or profile connected to BPD development. ⁷

What Are the Risk Factors?

While researchers still can’t pinpoint the exact risks of BPD, there are two risks closely linked to people with the condition: ⁸

• Difficult Childhood – When it comes to BPD, numerous people report traumatic experiences as a child. These include:
  • Being neglected
  • Experience physical or sexual abuse
  • Had a parent or caregiver who abused drugs
  • Had a parent or caregiver who struggled with another mental illness
  • Losing someone close to you (either through death or separation)
  • Unstable family

• Hereditary – If a close relative (such as your parents or siblings) has BPD, your risk of having it increases.

Complications of BPD

People with BPD will face multiple complications daily that most of the population doesn’t face. These include:

• Consistent losing jobs or relationships
• Difficulty in relationships (can sometimes lead to abusive relationships)
• Inability to finish school
• Legal complications that may result in jail time
• Suicidal ideation and self-injury
• Unexpected accidents (i.e. pregnancy, sexually transmitted disease, car crash, fight, etc.)

Can BPD Lead to Other Mental Disorders?

If you have BPD, you’re at risk of developing other mental health conditions. These include: ⁹

• Attention-deficit/hyperactivity disorder (ADHD)
• Bipolar disorder
• Eating disorder
• Generalized anxiety disorder (GAD)
• Major depressive disorder (depression)
• Other personality disorders
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder (SAD)
• Substance use disorder (SUD)

BPD Diagnosis

There are a few ways a medical professional will diagnose you with a BPD (or another personality disorder), including:

• An evaluation of your psychology
• An in-depth analysis of your medical history
• An interview with both you and your doctor about your current medical condition

It’s less common for a medical professional to diagnose a child or teenager with BPD. Children or teenagers may show signs of the condition but will grow out of them. If these symptoms continue into adulthood, then they’ll receive a proper diagnosis. ¹⁰

BPD Treatment

BPD treatment usually involves a combination of the following two interventions:

Medication

Currently, the Food and Drug Administration (FDA) has not approved any drugs for the treatment of BPD. However, there are a few medications believed to help with specific symptoms.

For example, a patient may be prescribed antidepressants if they’re showing symptoms of depression and anxiety. They may also be prescribed either antipsychotics or mood stabilizers if they’re showing symptoms of compulsiveness and anger. ¹¹

Psychotherapy

Psychotherapies (also known as talk therapies) are the most important aspect of treating BPD. They allow you to pinpoint where your symptoms affect you and how to gain better control over them. ¹² Common psychotherapies for BDP include:

• Dialectical Behavior Therapy (DBT) – Among all the psychotherapies listed, DBT may be the most effective, as it was specifically designed for BPD. Through both group and individual sessions, you can expect to learn how to regulate your emotions, better manage stress, and enhance your relationships. ¹³

• Mentalization-Based Therapy (MBT) – This is to help you become aware of your thoughts and emotions. By gaining this understanding, the aim is for you to take control of your thoughts and emotions at any moment and steer them in a new direction. ¹⁴

• Schema-Focused Therapy – If BPD has hindered you from achieving your life goals, schema-focused therapy can assist in transforming harmful habits into positive patterns that support your aspirations. Additionally, this therapy helps individuals who engage in self-harm to better understand and redirect negative thought patterns into positive ones. ¹⁵

• Systems Training for Emotional Predictability and Problem-Solving (STEPPS) – Through this 20-week training, you’ll involve your family, friends, and other significant people in your treatment, working together as a team. ¹⁶

• Transference-Focused Psychotherapy (TFP) – Sometimes referred to as psychodynamic psychotherapy, this psychotherapy aims to help you better understand your feelings and BPD symptoms by fostering a strong relationship between you and your therapist. The goal is for you to apply what you learn to real-life situations. ¹⁷

References

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² Aviram RB, Brodsky BS, Stanley B. Borderline personality disorder, stigma, and treatment implications. Harv Rev Psychiatry. 2006 Sep-Oct;14(5):249-56. doi: 10.1080/10673220600975121. PMID: 16990170.

³ Ruggero CJ, Zimmerman M, Chelminski I, Young D. Borderline personality disorder and the misdiagnosis of bipolar disorder. J Psychiatr Res. 2010 Apr;44(6):405-8. doi: 10.1016/j.jpsychires.2009.09.011. Epub 2009 Nov 3. PMID: 19889426; PMCID: PMC2849890.

⁴ Soloff P, Nutche J, Goradia D, Diwadkar V. Structural brain abnormalities in borderline personality disorder: a voxel-based morphometry study. Psychiatry Res. 2008 Dec 30;164(3):223-36. doi: 10.1016/j.pscychresns.2008.02.003. PMID: 19019636; PMCID: PMC3286221.

⁵ van der Kolk BA, Hostetler A, Herron N, Fisler RE. Trauma and the development of borderline personality disorder. Psychiatr Clin North Am. 1994 Dec;17(4):715-30. PMID: 7533284.

⁶ Bozzatello P, Rocca P, Baldassarri L, Bosia M, Bellino S. The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective. Front Psychiatry. 2021 Sep 23;12:721361. doi: 10.3389/fpsyt.2021.721361. PMID: 34630181; PMCID: PMC8495240.

⁷ Amad A, Ramoz N, Thomas P, Jardri R, Gorwood P. Genetics of borderline personality disorder: systematic review and proposal of an integrative model. Neurosci Biobehav Rev. 2014 Mar;40:6-19. doi: 10.1016/j.neubiorev.2014.01.003. Epub 2014 Jan 20. PMID: 24456942.

⁸ Wapp M, van de Glind G, van Emmerik-van Oortmerssen K, Dom G, Verspreet S, Carpentier PJ, Ramos-Quiroga JA, Skutle A, Bu ET, Franck J, Konstenius M, Kaye S, Demetrovics Z, Barta C, Fatséas M, Auriacombe M, Johnson B, Faraone SV, Levin FR, Allsop S, Carruthers S, Schoevers RA, Koeter MW, van den Brink W, Moggi F; IASP Research Group. Risk Factors for Borderline Personality Disorder in Treatment Seeking Patients with a Substance Use Disorder: An International Multicenter Study. Eur Addict Res. 2015;21(4):188-94. doi: 10.1159/000371724. Epub 2015 Apr 1. PMID: 25832736; PMCID: PMC4869722.

⁹ Fyer MR, Frances AJ, Sullivan T, Hurt SW, Clarkin J. Comorbidity of borderline personality disorder. Arch Gen Psychiatry. 1988 Apr;45(4):348-52. doi: 10.1001/archpsyc.1988.01800280060008. PMID: 3355321.

¹⁰ Zanarini MC, Horwood J, Wolke D, Waylen A, Fitzmaurice G, Grant BF. Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year-olds and 34,653 American adults. J Pers Disord. 2011 Oct;25(5):607-19. doi: 10.1521/pedi.2011.25.5.607. PMID: 22023298; PMCID: PMC4678770.

¹¹ Pascual JC, Arias L, Soler J. Pharmacological Management of Borderline Personality Disorder and Common Comorbidities. CNS Drugs. 2023 Jun;37(6):489-497. doi: 10.1007/s40263-023-01015-6. Epub 2023 May 31. PMID: 37256484; PMCID: PMC10276775.

¹² Crotty K, Viswanathan M, Kennedy S, Edlund MJ, Ali R, Siddiqui M, Wines R, Ratajczak P, Gartlehner G. Psychotherapies for the treatment of borderline personality disorder: A systematic review. J Consult Clin Psychol. 2023 Oct 30. doi: 10.1037/ccp0000833. Epub ahead of print. PMID: 37902689.

¹³ Smith A, MacDougall D. Dialectical Behaviour Therapy for People with Borderline Personality Disorder: A Rapid Qualitative Review [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Nov 6. PMID: 33534449.

¹⁴ Bateman A, Fonagy P. Mentalization based treatment for borderline personality disorder. World Psychiatry. 2010 Feb;9(1):11-5. doi: 10.1002/j.2051-5545.2010.tb00255.x. PMID: 20148147; PMCID: PMC2816926.

¹⁵ Tan YM, Lee CW, Averbeck LE, Brand-de Wilde O, Farrell J, Fassbinder E, Jacob GA, Martius D, Wastiaux S, Zarbock G, Arntz A. Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions. PLoS One. 2018 Nov 21;13(11):e0206039. doi: 10.1371/journal.pone.0206039. PMID: 30462650; PMCID: PMC6248917.

¹⁶ Ekiz E, van Alphen SPJ, Ouwens MA, Van de Paar J, Videler AC. Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder: A systematic review. Personal Ment Health. 2023 Feb;17(1):20-39. doi: 10.1002/pmh.1558. Epub 2022 Jun 21. PMID: 35729869.

¹⁷ Fischer-Kern M, Doering S, Taubner S, Hörz S, Zimmermann J, Rentrop M, Schuster P, Buchheim P, Buchheim A. Transference-focused psychotherapy for borderline personality disorder: change in reflective function. Br J Psychiatry. 2015 Aug;207(2):173-4. doi: 10.1192/bjp.bp.113.143842. Epub 2015 May 21. PMID: 25999334.