Living in a constant state of instability is common for people with borderline personality disorder (BPD), a chronic mental illness characterized by intense mood swings, impulsive behavior, and ongoing struggles with self-image, relationships, and more. Per a report from Verywell Mind, data from one report shows that 1.6% of U.S. adults have BPD, which translates to more than 4 million people in the country who have the disorder.
As the National Institute of Mental Health (NIMH) notes, people with BPD may have intense episodes of anger, depression, and anxiety that can last anywhere from a few hours to a few days. Because their self-image shifts rapidly, how they see themselves and their place in the world can prompt them to change their interests, values, behaviors, and more, often without warning.
All of this and more can lead to unfulfilling, strained relationships and cause a person with BPD to isolate themselves from everyone they know. In the past, treating the illness was viewed as difficult, but according to NIMH, evidence-based treatment can help people suffer fewer symptoms or symptoms that are less severe. Before a person with BPD can get help for the disorder, it is important for them and their loved ones to understand what it is.
If you or someone you know suspects that concerning behavior could mean a person has borderline personality disorder but aren’t sure, there are several symptoms that can help you decide that you should get some answers. Borderline personality is officially recognized as a personality disorder. It can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Because it is a personality disorder, BPD can affect how you think about yourself, how you think about other people, how you relate to others, and how you conduct yourself. BPD is characterized by nearly a dozen symptoms. People who have BPD may have any of the following:
- Fear of abandonment. Per Mayo Clinic, the fear of being left alone is intense. A person with BPD could go to extreme lengths to avoid being rejected or separated from someone else.
- Unstable ties to other people. A pattern of unstable relationships is characteristic of BPD. A person with the disorder could think someone cares deeply for them and then switch out, thinking the person does not care for them at all. Instability in relationships could also involve being in an abusive relationship.
- Quickly changing up one’s identity. Fast changes in self-identity could mean a person may view themselves as a bad person or not view themselves at all. A person with BPD may also switch out their values or goals.
- Extreme paranoia. BPD can make a person paranoid due to extreme stress, making them lose touch with reality for a certain amount of time. This could last a few minutes or a few hours.
- Extreme mood swings. A person with BPD can have emotional highs and lows that can cause them to experience happiness, shame, anxiety, or irritability. These shifts in mood can last a few hours to a few days, depending on the person.
- Engagement in reckless behavior. A lack of self-control is also an issue with BPD. This includes any activity that presents a danger to a person. It could be risky drug use, sex, binge eating, shopping sprees, or gambling. Mayo Clinic notes that a person with BPD could also sabotage themselves by quitting a job suddenly or ending a positive relationship. All of these examples suggest a lack of self-control. Acting first without thinking about what they are doing or the kinds of problems it could bring is problematic for people with BPD.
Borderline personality disorder can cause a person to detach from themselves and feel empty on an ongoing basis. They can also struggle with bouts of intense anger that do not fit the context of the situation. Inappropriate outbursts of anger, biting sarcasm, and picking physical fights are some things that can happen when a person has BPD. Not everyone will experience all of these symptoms. It is also important to note, however, that any event could trigger any of these symptoms. According to NIMH, the severity and frequency of any symptoms experienced depend on the person and their illness.
Kinds of Borderline Personality Disorder
Not everyone’s borderline personality disorder is the same. Out of all the various combinations there are, they can be broken into five types, as explained by The Mighty. According to the site, a person could identify with one type or three types.
The five types are:
Affective: This kind of BPD involves having a hard time controlling one’s emotions. A person with this type of BPD could struggle with intense changes in mood.
Impulsive: This type of BPD involves losing control over one’s behavior, which could lead to decisions made on the fly that could come back to hurt a person later.
Aggressive: A person with this type of BPD has angry outbursts that are out of proportion with the situation that got them angry. The aggression is rage that can be dangerous if left unchecked.
Dependent: This person exhibits clinginess and does not want to be left alone. A person who struggles with personal independence may have trouble with boundary setting and put up with poor treatment because they fear being abandoned. They also may take on the traits from someone else’s personality.
Empty: This form of BPD involves struggling with identity issues, trusting others, and deciding on which direction to take when it comes to personal goals.
Harming One’s Self Signal Time to Get Help
Suicidal fantasies or mental images of harming oneself are common among people with this illness. This includes cutting or burning oneself or other behaviors that cause physical harm. If you (or someone you know) are entertaining thoughts of dying by suicide or harming yourself, call 911 for emergency help or call 1-800-273-TALK (1-800-273-8255), the phone number of the National Suicide Prevention Lifeline. You can also reach out to a trusted family member, friend, colleague, or medical or mental health provider.
As with other mental illnesses, the factors that cause borderline personality disorder are not understood entirely. Each person with the illness is different, so the factors that come into play for each person varies.
BPD could run in the family. According to Mayo Clinic, some research suggests that BPD could be inherited from other family members. Per NIMH, people who have a parent or sibling with BPD may be at a higher risk of developing the illness.
Functioning in the brain. Brain abnormalities, particularly in the areas of the brain that control emotional regulation, aggression, and impulsivity, could cause it. An imbalance of brain chemicals that help regulate mood could also be a reason BPD happens.
Factors that shape one’s environmental, cultural, or social experience. According to NIMH, some people with BPD are victims of traumatic experiences, particularly those involving abandonment, abuse, or other kinds of hardships. Environmental influences can also bring on the illness. Examples of this include a person who has a history of being abused or neglected during their childhood.
Men and women can have borderline personality disorder. Per Verywell Mind, women are more likely to be diagnosed with the disorder than men since about 75% of diagnoses issued are for women. According to the site, researchers do not know why more women than men are diagnosed with BPD, but it says that women are more likely to seek treatment since they are prone to it.
Verywell Mind also says there could be gender biases as men tend to be diagnosed with post-traumatic stress disorder (PTSD) or major depressive disorder (MDD) instead of BPD.
Getting help for borderline personality disorder is possible and important. Mental disorders rarely improve on their own without professional treatment, especially if they are in the severe stages. Leaving mental illness untreated puts the person and everyone around them at a disadvantage. Many people struggle daily with trying to live a normal life while managing a disorder that can derail their ability to care for themselves and relate to others.
Borderline personality disorder is treatable. As noted earlier, if you suspect that you or a loved one may have BPD, it is essential to first seek an official diagnosis from a mental health professional. Doing so can bring peace of mind. Also, when an official diagnosis is given, it confirms that your symptoms are indeed BPD. The disorder can mirror or share commonalities or similarities with other disorders, such as schizoaffective disorder.
This mental health disorder presents as a combination of schizophrenia symptoms, which include hallucinations and delusions, and a mood disorder, such as depression. A mental health professional can examine patients’ symptoms and more to tell them apart. A person without proper training may have a hard time distinguishing one from the other.
Properly identifying the disorder can ensure you get the proper treatment for it.
There is no one test that can confirm if a person has BPD. Instead, a series of steps can be taken to evaluate individuals for symptoms that typically indicate the condition is present. Usually, the following happens:
- A medical or mental health professional will meet with a person for an interview where they will be asked questions about their symptoms, including how long they have been managing them.
- A psychological evaluation will take place that could include filling out a questionnaire.
- The medical or mental health professional may conduct a medical exam or review one’s medical history.
- It could take more than one evaluation or meeting with a professional to determine if a person has BPD.
Age Can Make BPD Diagnosis Challenging
VeryWell Mind writes that the symptoms for BPD can differ according to who is being diagnosed. It can be more challenging to determine if adolescents have the disorder. That’s because adolescence is a period of change for young people. For that reason, some say a BPD diagnosis should not be made for young people under age 18 because their personalities have not yet fully developed. Plus, normal or typical teenage behavior can be hard to tell apart from BPD symptoms.
However, as Verywell Mind notes, medical and mental health professionals will assess the young person’s behavior and motivation for their behavior to determine if they have BPD. Engaging in certain behaviors to avoid certain problems or mask their emotions can be clues as to whether they have the condition.
“Research suggests that children as young as 11 are able to describe their behaviors and motivations enough for an accurate diagnosis,” it writes.
Can a Person ‘Age Out’ of BPD?
A person who is older, perhaps in their late 30s and 40s, may have BPD symptoms that are not as frequent or severe. The reasons for this aren’t clear, but some say some people may “age out” and outgrow the symptoms as they get older. Impulsivity may decline as a result of older age, which is the case for many people who do not have BPD. Some observers say that older people with BPD have learned to manage their symptoms over time and throughout their lives.
Regardless of age, one should get an official diagnosis about their condition. If BPD is present, treatment could involve psychotherapy, medication, or both, depending on the person being treated.
Psychotherapy can help people with BPD learn how to effectively manage their symptoms so that they can improve their lives. If a person also has other conditions linked to their BPD, such as substance abuse, an eating disorder, or depression, psychotherapy can address those issues as well.
NIMH encourages everyone with a confirmed diagnosis of BPD to get proper treatment. Without it, they risk developing other chronic medical or mental illnesses. They are also less likely to lead healthy lifestyles and make choices that promote health and wellness.
Plus, there is an increased risk of self-harm that could end in permanent injury or death, two undesired outcomes.
Psychotherapy has several benefits, including helping people learn how to focus on themselves and managing uncomfortable feelings. They also can help them learn how to reach out to others and improve how they relate to others.
Common psychotherapy used to help people with borderline personality disorder include:
Dialectical Behavior Therapy (DBT). This therapy helps people with BPD manage their emotions, increase their ability to handle distress, and improve their relationships. It can be given in a group setting or individual therapy session. DBT is credited with helping people with BPD control the intense emotions they feel and lower their chances of engaging in harmful, self-destructive behaviors.
Cognitive Behavioral Therapy (CBT). This widely used therapy approach helps patients assess and identify self-defeating thoughts that lead to behavior that derails healthy decisions. It also helps to correct inaccurate perceptions they have of themselves. CBT helps individuals recognize these patterns and gives them tools they can use to pursue coping strategies that lead to a better outcome for themselves.
Schema-Focused Therapy. This therapy, which can also be done alone or with others in a group, can help people identify negative life patterns that have helped them cope and survive difficult situations but recognize that these patterns are not helping them now. Per Mayo Clinic, schema-focused therapy helps a person focus on meeting their needs with positive life patterns.
Mentalization-Based Therapy (MBT). This therapy aims to help people identify what they are thinking and how they are feeling and then create a different outlook on the situation they are facing. The emphasis is on thinking first before reacting and then acting on those feelings.
There are many more therapies available to help people manage their BPD diagnosis. Your therapist or another mental health professional can recommend which one is best for you based on the assessment of your needs.
Treating Borderline Personality Disorder with Medication
Sometimes, medications will be prescribed in addition to psychotherapy to help a person living with borderline personality disorder. These medications are designed to help a person improve their ability to focus on therapy and other areas of their life, as BPD can be disruptive to the point where it’s nearly impossible to concentrate.
If you do receive medication, it will be prescribed based on your specific needs. If you have depression, you could be prescribed an antidepressant medication to lift your mood. You could be given a mood-stabilizing medication to help you manage your mood swings.
If you have a substance use disorder involving alcohol or opioid pain medication misuse, you could receive medication-assisted treatment (MAT) to help you manage or overcome your dependence while you receive therapy and counseling. People who have both mental illness and a substance abuse issue are usually recommended to attend a dual diagnosis program that addresses both types of disorders.
You are strongly advised to tell your doctor or mental health professional if you have a history of substance abuse before you start taking medications. This information is critical to your success in overcoming BPD and any other conditions you may have.
Your doctor may decide to forgo medications, reduce your dosage, or change the kind of medication you’re prescribed based on knowing your substance use history.
Living with borderline personality disorder is not only challenging for the person who has it; it’s also challenging for their loved ones, too. Family, friends, and colleagues may want to be supportive but may not know how. Whichever side you’re on, it is important to educate yourself about the illness, including what the symptoms are and how treatment works. Knowing what to look for and the proper way it should be handled can demystify the condition and come up with healthy and effective ways to handle it.
As noted, seek professional help to make dealing with BPD as manageable as possible. Once a treatment plan is in place, follow it. Attend all therapy sessions, take all medications as prescribed, and keep communication open so that everyone is on the same page. Putting a crisis plan in place can keep everyone aligned on what to do in case you feel like you need extra support.
If you are supporting a person with BPD, you can reach out to the person and let them know you are there for them. Speak with them, and when you do, take time to listen, ask questions, and offer reassurances. You can also help your loved one stay on schedule to attend their therapy sessions and take their medications.
You may be able to attend therapy sessions with them or attend other therapy sessions on your own to learn how you can help them and rebuild your relationship with them. You may also want to join a support group for people with loved ones living with BPD to have a support network of your own. You will need self-care as well. Borderline personality disorder can be hard on everyone, so take a time-out for yourself so that you can regroup.