Borderline Personality Disorder

May 31, 2021

3 min read

Borderline personality disorder (BPD) is a psychological condition in which people are unable to regulate their emotions. The feelings of their emotions are extremely intense and long-lasting. BPD can greatly impact a person’s ability to control their behaviors and to maintain relationships with others. In the US, an estimated 1.4% of people have BPD. Some research suggests it may be under diagnosed, especially in men who are commonly misdiagnosed with depression or post-traumatic stress disorder.

The cause of BPD is not completely understood, but scientists believe a combination of factors may contribute to a person developing BPD.

Experiencing a traumatic event
Genetics (having a family member with BPD increases a person’s risk of developing the disorder)
Abnormal brain structure and functioning, particularly in the parts that are responsible for decision making

Symptoms and Diagnosis

A mental health professional is needed to make the diagnosis. The criteria for diagnosis are specified in the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association. Key symptoms include:

Impulsive behavior, including actions that risk safety (substance abuse, unsafe sex, dangerous driving)
Self-image is unstable and distorted
Extreme efforts to avoid being abandoned by family or friends
Difficulty maintaining stable relationships, which may swing from periods of idealization (intense love) and devaluation (intense hate)
Threats or attempts to self-harm
Intense negative feelings (depression, irritability, anxiety) that can last a long time (few hours to several days)
Anger that is inappropriate for the triggering action, followed by feelings of guilt and shame or resulting actions
Consistently feeling bored or empty
Difficulty trusting other people
Paranoid thoughts
Dissociative feelings (feeling disconnected from a person’s thoughts or body)

A psychiatrist diagnoses BPD through a combination of the assessing the symptoms listed above and reviewing previous medical records. Friends and family may be interviewed by the psychiatrist to gain larger insight into the spectrum and severity of symptoms experienced by the person.

The symptoms of BPD can be experienced on a spectrum. Some individuals may have only a few of them, while other people experience every symptom. Symptoms are usually triggered by events that most people would view as normal, but people with BPD react with much stronger emotions.

Treatment

There are several treatment options, and what works for one person may not work for others. A central goal of treatment is to support the person until they can self-direct what treatments work best for them.

Medications: A combination of medications may be used to treat the various symptoms a person is experiencing. For example, mood stabilizers can help minimize severe mood swings; anti-psychotics can limit disorganized thinking; and antidepressants can help manage feelings of extreme sadness.
Psychotherapy: This is often the preferred treatment, because people can be taught to learn how to cope with their emotional swings. Approaches include:
Cognitive behavioral therapy: Patients learn how to identify core behaviors and false beliefs they have about themselves and others. This can reduce the range of severe mood swings and impulsive behaviors.
Dialectical behavioral therapy: Patients are taught to be mindful and accepting of their current emotional state and situation. This training can help them control their emotions and actions.
Hospitalization: During times of extreme stress, impulsive behavior, or feelings of self-harm, a person may be hospitalized to ensure their safety.
Family or group support: Classes and support groups are available that teach family members how to cope with BPD and how to support them in their recovery. Group support can be extremely helpful for the patient, because they realize they are not alone and can discuss treatment strategies.

With dedication to a comprehensive treatment plan, people living with BPD are able to greatly reduce their symptoms and improve their overall quality of life. Most people can be treated as outpatients for the majority of their care, but periods of hospitalization may be needed during times when the person is unable to cope with their symptoms or poses a risk to themselves or others.

The National Alliance of Mental Illness (NAMI) provides information and emergency support for people struggling with mental illness, such as BPD.