David Baxter PhD
Late Founder
Borderline Personality Disorder
By Mayo Clinic Staff
May 14, 2008
Borderline personality disorder can be a distressing medical condition, both for the people who have it and for those around them. When you have borderline personality disorder (BPD), you have difficulty controlling your emotions and are often in a state of upheaval ? perhaps as a result of harmful childhood experiences or brain dysfunction.
With borderline personality disorder your image of yourself is distorted, making you feel worthless and fundamentally flawed. Your anger, impulsivity and frequent mood swings may push others away, even though you yearn for loving relationships.
Increasing awareness and research are helping improve the treatment and understanding of borderline personality disorder. Emerging evidence indicates that people with borderline personality disorder often get better over time and that they can live happy, peaceful lives.
Signs and symptoms
Borderline personality disorder affects how you feel about yourself, how you relate to others and how you behave.
When you have BPD, you often have an insecure sense of who you are. That is, your self-image or sense of self often rapidly changes. You may view yourself as evil or bad, and sometimes may feel as if you don't exist at all. An unstable self-image often leads to frequent changes in jobs, friendships, goals, values and gender identity.
Your relationships are usually in turmoil. You often experience a love-hate relationship with others. You may idealize someone one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even minor misunderstandings. This is because people with the disorder have difficulty accepting gray areas ? things are either black or white. For instance, in the eyes of a person with BPD, someone is either good or evil. And that same person may seem good one day and evil the next.
Other signs and symptoms of borderline personality disorder may include:
Although definitive data are lacking, it's estimated that 1 percent to 3 percent of American adults have borderline personality disorder. As with other mental disorders, the causes of borderline personality disorder are complex. The name arose because of theories in the 1940s and 1950s that the disorder was on the border between neurosis and psychosis. But that view doesn't reflect current thinking. In fact, some advocacy groups have pressed for changing the name, such as calling it emotional regulation disorder.
Meanwhile, the cause of borderline personality disorder remains under investigation, and there's no known way to prevent it. Possible causes include:
Most likely, a combination of these issues results in borderline personality disorder.
Risk factors
Personality forms during childhood. It's shaped by both inherited tendencies and environmental factors, or your experiences during childhood. Some factors related to personality development can increase your risk of developing borderline personality disorder. These include:
When to seek medical advice
People with borderline personality disorder often feel misunderstood, alone, empty and hopeless. They're typically full of self-hate and self-loathing. They may be fully aware that their behavior is destructive and be distressed about it. Impulsivity may cause problems with gambling, driving or even the law. They may find that many areas of their lives are affected, including social relationships, work or school.
If you notice these things about yourself, talk to your doctor or a mental health provider. The right treatment can help you feel better about yourself and help you live a more stable, rewarding life.
If you notice these things in a family member or friend, talk to him or her about seeing a doctor or mental health provider. But keep in mind that you can't force someone to seek help. If the relationship has you unduly distressed, you may find it helpful to see a therapist yourself.
Screening and diagnosis
Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with borderline personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published and updated by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
For borderline personality disorder to be diagnosed, at least five of the following signs and symptoms must be present:
Complications
Borderline personality disorder can damage many areas of your life. Interpersonal relationships, jobs, school, social activities and self-image all can be negatively affected. Repeated job losses and broken marriages are common. Self-injury, such as cutting or burning, can result in scarring and frequent hospitalizations. Suicide rates among people with BPD are very high, reaching 10 percent to 15 percent.
In addition, you may have other mental health problems, including:
Treatment
Treatment for borderline personality disorder has improved in recent years with the adoption of techniques specifically aimed at people with this disorder. Treatment may include psychotherapy, medications or hospitalization.
Psychotherapy
Psychotherapy is the core treatment for BPD. The two primary psychotherapy treatments for BPD are:
Medications can't cure BPD, but they can help associated problems, such as depression, impulsivity and anxiety. Medications may include antidepressant, antipsychotic and anti-anxiety medications.
Hospitalization
At times, you may need more intense treatment in a psychiatric hospital or clinic. Hospitalization can also keep you safe from self-injury.
Because treatment can be intense and long term, you face the best chance for success when you consult mental health providers with experience treating BPD.
Self-care
Living with borderline personality disorder can be difficult. You may realize your behaviors and thoughts are self-destructive or damaging yet feel unable to control them. Treatment can help you learn skills to manage and cope with your condition.
Other things you can do to help manage your condition and feel better about yourself include:
By Mayo Clinic Staff
May 14, 2008
Borderline personality disorder can be a distressing medical condition, both for the people who have it and for those around them. When you have borderline personality disorder (BPD), you have difficulty controlling your emotions and are often in a state of upheaval ? perhaps as a result of harmful childhood experiences or brain dysfunction.
With borderline personality disorder your image of yourself is distorted, making you feel worthless and fundamentally flawed. Your anger, impulsivity and frequent mood swings may push others away, even though you yearn for loving relationships.
Increasing awareness and research are helping improve the treatment and understanding of borderline personality disorder. Emerging evidence indicates that people with borderline personality disorder often get better over time and that they can live happy, peaceful lives.
Signs and symptoms
Borderline personality disorder affects how you feel about yourself, how you relate to others and how you behave.
When you have BPD, you often have an insecure sense of who you are. That is, your self-image or sense of self often rapidly changes. You may view yourself as evil or bad, and sometimes may feel as if you don't exist at all. An unstable self-image often leads to frequent changes in jobs, friendships, goals, values and gender identity.
Your relationships are usually in turmoil. You often experience a love-hate relationship with others. You may idealize someone one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even minor misunderstandings. This is because people with the disorder have difficulty accepting gray areas ? things are either black or white. For instance, in the eyes of a person with BPD, someone is either good or evil. And that same person may seem good one day and evil the next.
Other signs and symptoms of borderline personality disorder may include:
- Impulsive and risky behavior, such as risky driving, unsafe sex, gambling sprees or taking illicit drugs
- Strong emotions that wax and wane frequently
- Intense but short episodes of anxiety or depression
- Inappropriate anger, sometimes escalating into physical confrontations
- Difficulty controlling emotions or impulses
- Suicidal behavior
- Fear of being alone
Although definitive data are lacking, it's estimated that 1 percent to 3 percent of American adults have borderline personality disorder. As with other mental disorders, the causes of borderline personality disorder are complex. The name arose because of theories in the 1940s and 1950s that the disorder was on the border between neurosis and psychosis. But that view doesn't reflect current thinking. In fact, some advocacy groups have pressed for changing the name, such as calling it emotional regulation disorder.
Meanwhile, the cause of borderline personality disorder remains under investigation, and there's no known way to prevent it. Possible causes include:
- Genetics. Some studies of twins and families suggest that personality disorders may be inherited.
- Environmental factors. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.
- Brain abnormalities. Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly
Most likely, a combination of these issues results in borderline personality disorder.
Risk factors
Personality forms during childhood. It's shaped by both inherited tendencies and environmental factors, or your experiences during childhood. Some factors related to personality development can increase your risk of developing borderline personality disorder. These include:
- Hereditary predisposition. You may be at a higher risk if a close family member ? a mother, father or sibling ? has the disorder.
- Childhood abuse. Many people with the disorder report being sexually or physically abused during childhood.
- Neglect. Some people with the disorder describe severe deprivation, neglect and abandonment during childhood.
When to seek medical advice
People with borderline personality disorder often feel misunderstood, alone, empty and hopeless. They're typically full of self-hate and self-loathing. They may be fully aware that their behavior is destructive and be distressed about it. Impulsivity may cause problems with gambling, driving or even the law. They may find that many areas of their lives are affected, including social relationships, work or school.
If you notice these things about yourself, talk to your doctor or a mental health provider. The right treatment can help you feel better about yourself and help you live a more stable, rewarding life.
If you notice these things in a family member or friend, talk to him or her about seeing a doctor or mental health provider. But keep in mind that you can't force someone to seek help. If the relationship has you unduly distressed, you may find it helpful to see a therapist yourself.
Screening and diagnosis
Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with borderline personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published and updated by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
For borderline personality disorder to be diagnosed, at least five of the following signs and symptoms must be present:
- Intense fears of abandonment
- A pattern of unstable relationships
- Unstable self-image
- Impulsive and self-destructive behaviors
- Suicidal behavior or self-injury
- Wide mood swings
- Chronic feelings of emptiness
- Inappropriate anger
- Periods of paranoia and loss of contact with reality
Complications
Borderline personality disorder can damage many areas of your life. Interpersonal relationships, jobs, school, social activities and self-image all can be negatively affected. Repeated job losses and broken marriages are common. Self-injury, such as cutting or burning, can result in scarring and frequent hospitalizations. Suicide rates among people with BPD are very high, reaching 10 percent to 15 percent.
In addition, you may have other mental health problems, including:
- Depression
- Substance abuse
- Anxiety disorders
- Eating disorders
- Bipolar disorder
- Other personality disorders
Treatment
Treatment for borderline personality disorder has improved in recent years with the adoption of techniques specifically aimed at people with this disorder. Treatment may include psychotherapy, medications or hospitalization.
Psychotherapy
Psychotherapy is the core treatment for BPD. The two primary psychotherapy treatments for BPD are:
- Dialectical behavior therapy (DBT). DBT was designed specifically to treat the disorder. Generally conducted through individual, group and phone counseling, DBT uses a skills-based approach to teach you how to regulate your emotions, tolerate distress and improve relationships.
- Transference-focused psychotherapy (TFP). TFP centers on the relationship between you and your therapist - helping you understand the emotions and difficulties inevitably arising in the relationship. You can then use what you have learned in other relationships.
Medications can't cure BPD, but they can help associated problems, such as depression, impulsivity and anxiety. Medications may include antidepressant, antipsychotic and anti-anxiety medications.
Hospitalization
At times, you may need more intense treatment in a psychiatric hospital or clinic. Hospitalization can also keep you safe from self-injury.
Because treatment can be intense and long term, you face the best chance for success when you consult mental health providers with experience treating BPD.
Self-care
Living with borderline personality disorder can be difficult. You may realize your behaviors and thoughts are self-destructive or damaging yet feel unable to control them. Treatment can help you learn skills to manage and cope with your condition.
Other things you can do to help manage your condition and feel better about yourself include:
- Sticking to your treatment plan
- Attending all therapy sessions
- Practicing healthy ways to ease painful emotions, rather than inflicting self-injury
- Not blaming yourself for having the disorder but recognizing your responsibility to get it treated
- Learning what things may trigger angry outbursts or impulsive behavior
- Not being embarrassed by the condition
- Getting treatment for related problems, such as substance abuse
- Educating yourself about the disorder so that you understand its causes and treatments
- Reaching out to others with the disorder to share insights and experiences
