Borderline personality disorder is a long-lasting mental health problem that causes difficulty regulating or handling emotions or controlling impulses.
Borderline personality disorder (BPD) is a serious, long-lasting and complex mental health problem. People with BPD have difficulty regulating or handling their emotions or controlling their impulses. They are highly sensitive to what is going on around them and can react with intense emotions to small changes in their environment. People with BPD have been described as living with constant emotional pain, and the symptoms of BPD are a result of their efforts to cope with this pain.
It is very common for someone with BPD to have other mental health problems. These include:
major or moderate to mild depression
substance use disorders
posttraumatic stress disorder (PTSD)
Sometimes it can be difficult to diagnose BPD because the symptoms of the co-occurring disorder mimic or hide the symptoms of BPD. Relapse in one disorder may trigger a relapse in the other disorder.
Signs & Symptoms
The types and severity of BPD symptoms may differ from person to person because people have different predispositions and life histories, and symptoms can fluctuate over time.
Common symptoms include:
intense but short-lived bouts of anger, depression or anxiety
emptiness associated with loneliness and neediness
paranoid thoughts and dissociative states in which the mind or psyche “shuts off” painful thoughts or feelings
self-image that can change depending on whom the person is with
impulsive and harmful behaviours such as problematic use of substances, overeating, gambling or high-risk sexual behaviours
non-suicidal self-injury such as cutting, burning with a cigarette or overdose that can bring relief from intense emotional pain (onset usually in early adolescence); up to 75 per cent of people with BPD self-injure one or more times
suicide (about 10 per cent of people with BPD take their own lives)
intense fear of being alone or of being abandoned, agitation with even brief separation from family, friends or therapist (because of difficulty to feel emotionally connected to someone who is not there)
impulsive and emotionally volatile behaviours that may lead to the very abandonment and alienation that the person fears
volatile and stormy interpersonal relationships with attitudes to others that can shift from idealization to anger and dislike (a result of black and white thinking that perceives people as all good or all bad).
Causes & Risk Factors
Our current understanding is that a person’s genetic inheritance, biology and environmental experiences all contribute to the development of BPD. A person is born with certain personality or temperamental characteristics because of the way his or her brain is “wired,” and these characteristics are further shaped by environmental experiences—and possibly by cultural experiences—as the person grows up.
Researchers have found differences in certain areas of the brain that might explain impulsive behaviour, emotional instability and the way people perceive events. As well, twin and family history studies have shown a genetic influence, with higher rates of BPD and/or other related mental health disorders among close family members.
Environmental factors that may contribute to the development of BPD in vulnerable individuals include separation, neglect, abuse or other traumatic childhood events. However, families that provide a nurturing and caring environment may still have children who develop BPD, while children who experience appalling childhoods do not necessarily develop BPD.
Though histories of physical and sexual abuse are reported to be high among those with BPD, many other experiences can play a role for a child who is already emotionally vulnerable.
Diagnosis & Treatment
In the past, specialized treatment for BPD was hard to find, but the disorder is now being better recognized and diagnosed, and more communities have established specialized treatment programs that significantly improve outcomes for people with BPD.
Specialized psychosocial treatment approaches are chosen to fit the goals of the client and the skills base of the clinician. These may include:
system training for emotional predictability and problem solving
Though there is no specific medication for BPD, medication may be prescribed to reduce the impact of specific symptoms (e.g., depression, psychotic-like symptoms such as paranoia). Though medication can reduce the severity of symptoms, it does not cure BPD and is not appropriate for everyone with this diagnosis.
Treatment outcome research has found that for many people, treatment does work. Many people with BPD learn to cope with their symptoms and do things differently, particularly as they reach middle age. Because of the serious and complex nature of their symptoms, people affected by BPD frequently require long-term treatment, often over several years.