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What Causes Borderline Personality Disorder?

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Clinically Reviewed by:
Lindsey Rae Ackerman, LMFT

Written by:
Alex Salman, MPH on March 7, 2024

Borderline personality disorder (BPD) is a complex, often misunderstood mental health condition that impacts millions of people across the world. Individuals with BPD often face immense challenges in their personal and social lives—to say nothing of the stigma that this condition often carries—making it essential to shed light on its causes and explore available treatment options. In today’s blog, Clear Behavioral Health will delve into the intricacies of BPD, examining its potential origins and stigmatization and exploring the various treatment approaches available for individuals grappling with this mental health condition.

What is borderline personality disorder?

BPD is a mental health disorder characterized by an ongoing pattern of unstable relationships, self-image, emotions, and behavior. More specifically, BPD is classified as a personality disorder. People with BPD may experience intense mood swings, difficulties in regulating emotions, and an unstable sense of self, causing a host of interpersonal and intrapersonal difficulties. Persistent fears of abandonment and difficulties in maintaining emotional boundaries can disrupt family life and relationships (be they romantic, platonic, or work/school-related).

BPD can also lead to engaging in impulsive and elf-destructive actions, and substance use has often been found to co-occur with this condition. Self-harm behavior can be common, with approximately 65-80% of all individuals diagnosed with BPD engaging in some form of non-suicidal self-injury. Suicide also remains as a looming concern for those suffering, with up to 10% of BPD patients passing away by suicide.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnosis of borderline personality disorder is marked by a pervasive pattern of instability in relationships/self-image/emotion, as well as marked impulsivity beginning in early adulthood, as indicated by meeting five (or more) of the following symptoms:

  1. The fear of abandonment
  2. Unstable or frequently-changing relationships
  3. Unstable self-image; struggles with one’s identity or sense of self
  4. Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating, etc.)
  5. Suicidal behavior or self-injury/self-harm
  6. Varied or seemingly random mood swings
  7. Constant feelings of worthlessness and lingering sadness, sometimes alternating with rage
  8. Problems with anger, including frequent loss of temper or physical fights
  9. Stress-related paranoia or a loss of contact with reality

What causes borderline personality disorder?

The exact causality of BPD remains uncertain, although a growing body of research suggests that its development is likely a result of complex interactions of genetic, environmental, and neurobiological factors, along with experiencing chronic instability, neglect, and/or trauma during one’s formative years.

This pervasive and challenging disorder has seen significant advances in the knowledge of its developmental phenomenology during late childhood and adolescence, with various genetic, neurobiological, psychological, and social factors all being identified in BPD’s emerging etiology.

As such, some of the identified factors which may contribute to the development of BPD include:

Genetic predisposition

Research suggests that there may be a genetic component to BPD. Individuals with a family history of BPD or other mood disorders may be at a higher risk of developing this mental health condition, with two genes (DPYD and PKP4) being primarily identified.

Brain structure, development, and function

Studies using brain imaging techniques have noted differences in the brain structure and functioning of individuals with BPD—differences which may impact emotional regulation and regulate one’s response to stressors.

Early (and adverse) life experiences

Traumatic experiences—such as childhood neglect, physical or emotional abuse, or an unstable family environment—may increase the risk of developing BPD, particularly under a multifactorial and bi-directional lens. Adverse childhood experiences (ACEs) can influence emotional development and coping mechanisms later in life under any circumstances; they may also combine with the above factors to later develop into BPD.

Environmental factors

Other environmental factors, such as exposure to chronic stress, social isolation, or difficulties in forming secure attachments with others, are also likely to contribute to the development of BPD, particularly in conjuncture with other causalities.

It is crucial to note that not everyone exposed to these risk factors will go on to develop BPD. The interaction of various factors and individual differences plays a role in determining the likelihood of developing the disorder, along with several other potential avenues that are currently awaiting further study.

Why is BPD stigmatized?

The stigmatization of mental health conditions, including BPD, remains a significant challenge for those who are suffering to seek help, work towards better outcomes, and feel more comfortable within themselves. People with BPD in particular often face many judgments and misconceptions about their condition—even from some clinicians—which causes their available support to shrink even further down and increase their isolation. The ongoing stigma of BPD may also come about from various other factors, such as media portrayals, lack of understanding, and fear of the unknown, along with societal stigma and stereotypes.

One common misconception is that all individuals with BPD are manipulative or attention-seeking. In reality, these behaviors are often misunderstood coping mechanisms which are used to deal with intense emotions and a constant, crushing fear of rejection or abandonment.

What are the available treatment options for BPD?

While BPD can present significant challenges across the spectrum, effective treatment options are available to help individuals manage their symptoms and improve their sense of self and overall quality of life. Treatment for BPD often involves a combination of psychotherapy, medication, and ongoing support:

Dialectical Behavior Therapy (DBT)

DBT is a specialized form of cognitive-behavioral therapy (CBT) that can help individuals with BPD learn to better regulate their emotions, develop coping skills, and improve their interpersonal relationships. Developed by Marsha Linehan (herself a psychologist and person with BPD), this structured treatment protocol has been widely studied and shown to be effective in the treatment of BPD, and can also be adapted into group and family therapy.


In some cases, medication may be prescribed to manage specific symptoms or co-occurring conditions of BPD, such as depression, anxiety, or mood swings. Antidepressants, mood stabilizers, and antipsychotic medications may be used under the guidance of a qualified healthcare professional to assist in calming the complex and frequently co-occurring symptomatology of BPD and its related conditions.

Group Therapy

Group therapy can be beneficial for individuals with BPD, as it provides a supportive space to connect with others who may share similar experiences and challenges. Often paired with DBT and CBT skills-learning, group therapy is often a valuable part of the overall treatment picture for those suffering with this condition.

Family Therapy

Family therapy can also be beneficial for BPD—particularly because there have been so many studies that demonstrate how the condition tends to develop around early instability and trauma. Family sessions involve working with the family constellation to improve communication, set healthy boundaries, and address any family dynamics that may contribute to and/or worsen BPD symptoms.

Additionally, early intervention for those suffering from developing BPD can be critical to achieving better outcomes in the long term, and there are several programs and treatment groups organized around delivering essential treatment and resources to those in need.

Get help and support for borderline personality disorder

Borderline Personality Disorder is a complex and multifaceted mental health condition, impacted by a combination of genetic, environmental, and neurobiological factors. Working to better understand the causes and presentation of BPD and exploring available treatment options is essential for promoting compassion, support, and effective care for those navigating their journey of recovery.

Clear Behavioral Health offers several unique environments to nurture healing, from outpatient and inpatient settings and programs for teens and early intervention for adults. Recovery from BPD is absolutely possible—so contact Clear Behavioral Health to take your first steps toward healing today.

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