What is BPD? Everything You Need to Know About Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a commonly stigmatized and often misunderstood mental health condition that affects an estimated 1.4% of the adult US population (or nearly 5 million Americans) [1].  

BPD is characterized by patterns of intensity and instability across multiple areas in your life. If you suffer from BPD, you may deal with intense emotional reactions and difficulty regulating your emotions. Additionally, if you have BPD, you might engage in erratic and/or impulsive behavior. You also might have difficulty controlling and regulating your emotions, anger, and responses to stimuli that may seem mundane or normal to others. Instability might plague your relationships, mood, and self-image; you might have a distorted image of yourself and others and struggle to relate in healthy ways.  

Whether you suffer from BPD or have a relative or client/patient with BPD, it’s essential to gain a clear understanding of the disorder. BPD education is particularly important because, historically, the disorder has been misunderstood and stigmatized. Due to the intense stigma, BPD has been labeled as untreatable; however, this conclusion is misinformed, and effective treatment is possible.

How is Borderline Personality Disorder Diagnosed? 

The diagnosing of BPD has a complex history marked by misunderstanding and stigma. In the 1930s and 40s, psychologists identified a set of symptoms that they did not understand and were unable to diagnose. It wasn’t until the third edition of the DSM was published in 1980 that BPD was formally introduced as a diagnosis.   

The National Alliance on Mental Illness reports that, today, nearly 75% of those diagnosed with BPD are women; however, recent research suggests that there is an equivalent occurrence of the disorder in men and women, but men are often misdiagnosed with other disorders [1].  

The average age of onset for BPD is late adolescence to early adulthood, with some symptoms of the disorder often being apparent earlier in life. For many years, it was clinical practice to not diagnose BPD before the age of 18 due to a fear of misdiagnosis. There is still a significant misunderstanding among mental health professionals whether the diagnosis can be made before someone turns 18. However, as of 2013 with the release of the DSM-5, the American Psychiatric Association has allowed for the diagnosis of BPD in adolescents [2].  

DSM-5 – TR Categorical Criteria for BPD  

The diagnostic criteria laid out in the DSM-5 for borderline personality disorder is as following:  

A pervasive pattern of instability of interpersonal relationships and self-image and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of the following:  

1. Frantic efforts to avoid real or imagined abandonment  
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation  
3. Identity disturbance: markedly and persistently unstable self-image or sense of self 
4. Impulsivity in at least 2 areas that are potentially self-damaging, for example, spending, substance abuse, reckless driving, sex, or binge eating  
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior  
6. Affective instability due to a marked reactivity of mood, for example, intense episodic dysphoria, anxiety, or irritability, usually lasting a few hours and rarely more than a few days 
7. Chronic feelings of emptiness 
8. Inappropriate, intense anger or difficulty controlling anger, for example, frequent displays of temper, constant anger, or recurrent physical fights 
9. Transient, stress-related paranoid ideation or severe dissociative symptoms [2]. 

Signs and Symptoms of BPD  

There are many borderline personality disorder symptoms, including intense emotions, maladaptive coping strategies, difficulties in relationships, unstable identity, dissociation, and suicidal ideation [3].  

BPD and Intense Emotions  

If you have BPD, you may struggle with intense emotions and emotional dysregulation. You are likely to be a highly sensitive person that is deeply affected by what happens around and inside you. Your emotions might occur loudly and unexpectedly, can last for prolonged periods of time, and are difficult to control. Your responses might be outside of what would be considered the norm for what you are experiencing.  Emotional dysregulation often includes emotional lability, or mood swings, with rapid alternation in emotional states [3].   

BPD and Maladaptive Coping Mechanisms  

Due to difficulty controlling your emotions, it is common to engage in maladaptive coping strategies, such as substance use, self-harm, and impulsive behaviors. You might engage in risky sexual behavior, overspending, reckless driving, or other similar behaviors. These behaviors can be destructive, causing damage to your personal and professional lives – sometimes even causing medical, financial, or legal consequences [3].  

BPD and Unstable Identity  

Suffering from BPD also contributes to having an unstable view of yourself – you might struggle to identify your own values, beliefs, and purpose in the world. In short, you have difficulty knowing who you are and what your purpose is. Oftentimes, you may resonate with an intense feeling of internal emptiness, boredom, or darkness – sometimes describing it as void that exists within you [3].  

BPD and Difficulty with Relationships  

Borderline personality disorder is marked by instability in interpersonal relationships. Having BPD makes you highly sensitive to, and impacted by, the real or perceived behavior of others. This causes chronic stress and conflict in relationships. You have an intense fear of abandonment – you strongly desire intimacy and connection but are terrified of it at the same time. This often results in having short and intense relationships, lashing out at those close to you, or engaging in a pattern of alternating between idealizing and devaluing people in your life.  

It may seem that one moment someone is the most important person in the world to you and soon thereafter that same person is viewed as unimportant or threatening. Whether conscious or unconscious, it is important to understand that this behavior protects you from your own fear of abandonment in interpersonal relationships. 

Interpersonal difficulties are also indicated by your experience with and expression of anger. You can experience anger at environmental stimuli that may not trigger anger for others. Additionally, you may struggle to control your anger and to express it within appropriate social norms and will often lash out and rage at those around you, contributing to interpersonal difficulties as well as intense and unstable relationships [3].  

BPD and Suicidal Behaviors  

Non-suicidal self-harming behaviors and suicidal ideation are common when struggling with BPD. Non-suicidal self-harming behavior is often seen as a maladaptive way to cope with intense emotional experiences. This behavior can include cutting, burning, and head banging, among other things. Rates of suicidal ideation and suicidal behavior among people with BPD are also high. Oftentimes, these behaviors are connected to an inability to cope with the false belief that others would be better off without you [3].

Related: Suicide Prevention: Navigating Thoughts and Available Resources  

Causes and Risk Factors of BPD  

There are many potential causes and risk factors associated with the development of BPD. Biological factors, such as genetics and abnormalities in the brain have been connected to the risk of developing BPD. Reseach also suggests that if you have a close relative with BPD, you are more likely to develop the disorder [4].  

Environmental Factors and BPD  

Environmental factors, such as childhood trauma, abandonment in childhood, and hardship in the person’s family of origin are also risk factors for the development of BPD [4].  

Psychological Factors and BPD  

Psychological risk factors can also increase the likelihood of BPD, such as having an insecure attachment style and a tendency to be highly emotionally sensitive people [4].  

Sociocultural Factors and BPD  

Finally, sociocultural factors can impact the development of BPD. These factors include socioeconomic status, access to education and health care, and community support. Deficits in any of these areas can increase the likelihood of the development of mental health disorders [4].

Related: What Causes Mental Illness? 

Impact of BPD on Daily Life  

BPD can have major impacts in every part of your daily life. Functioning in interpersonal relationships, upholding responsibilities in professional and educational settings, and maintaining personal care and well-being can all be impacted. The symptoms and behaviors related to BPD can also frequently result in legal and financial consequences. Treatment for BPD can help mitigate these issues and assist in learning skills to help you function across all areas of your life [5].  

Co-Occurring Disorders  

Successful treatment for BPD includes addressing any co-occurring disorders. Other mental health disorders that commonly occur with BPD are mood disorders (i.e. depression, bipolar disorder), anxiety disorders, substance use disorders, eating disorders, and Post-Traumatic Stress Disorder [2].   

Prognosis and Long-Term Management  

BPD is not a life sentence, you have the potential to experience a rewarding, well-balanced life. You can have healthy relationships, a successful career, and fulfilling hobbies. The long-held stigma that BPD is untreatable and a lifelong affliction that cannot improve is false. Studies on remission rates have shown that remission of BPD is possible and even probable.   

Treatment is central to the remission process. Long-term management of BPD requires consistent use of coping skills learned in treatment and engagement in continued mental health care. This includes building a support network of family, friends, and mental health professionals. Recurrences of symptoms are possible, of course, but also treatable [2].   

Supporting a Loved One with BPD  

Supporting a loved one with BPD can present its own unique set of challenges. The biggest key to supporting a loved one is gaining an understanding of the disorder so that you have an idea of what your loved one is dealing with daily. From there, you can better exercise empathy, ask questions, and potentially encourage them to seek treatment when needed. Seeking your own therapy or engagement in support groups can also help you learn communication skills, boundary setting skills, and self-care strategies that can be immensely helpful as you support your loved one [2].

Related: How to Help a Loved One Experiencing Severe Mental Illness or a Crisis 

How is Borderline Personality Disorder Treated? 

Clear Behavioral Health is committed to providing empathetic, well-informed, and evidence-based mental health treatment for BPD. At Clear, we create individualized and evidence-based treatment plans to fit the unique needs of each client. From residential treatment to outpatient programs, our multi-disciplinary team of experts helps clients focus on long-term healing and skill-building. Our multiple levels of care allow us to treat clients at whatever level is appropriate for them and provide continued care as more stability and healing is achieved.  

Psychotherapy to Treat BPD  

The primary form of treatment for borderline personality disorder is psychotherapy. At Clear Behavioral Health, we offer evidence-based practices, such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), which have been used to treat BPD with significant success.   

CBT can help you identify and alter the negative beliefs about yourself, others, and the world leading to a reduction in anxiety, mood swings, and self-harming and suicidal behaviors [4]. DBT was created specifically for BPD and focuses on building skills, based in mindfulness and awareness, that can help you navigate more effectively through the world – managing your relationships, behaviors, and impulses [4].  

At Clear, we provide psychotherapy with a trauma-informed lens by helping you understand the trauma you’ve endured and develop healthy coping mechanisms to build emotional resilience.  

Additionally, our therapists take a relational approach to psychotherapy, focusing on building a strong and trusting connection between you and your therapist. Using this relationship as a foundation, our therapists will then help you explore dynamics in your other interpersonal relationships, which is incredibly helpful if you have BPD and struggle connecting to others. 

Group Therapy to Treat BPD  

Group therapy and support groups can be very impactful if you suffer from BPD. The group dynamic can offer space for you to learn from and relate to each other, gain coping skills and strategies, and put interpersonal skills into practice. Group therapy and support groups can also provide a sense of connection and social support, which can be integral to recovery. Clear Behavioral Health programs offer group therapy to support this growth and connection for our clients.  

Family Therapy to Treat BPD  

Family therapy can also be an effective treatment for BPD, offering support and healing for you and your family, depending on your individual needs. When appropriate, CBH offers family therapy service. Family therapy can help your family communicate more effectively, assist your family in learning about your loved one’s diagnosis, understanding them better, and address family members’ own coping and stress management skills.  

Medication Management to Treat BPD  

Medication can also be used to treat BPD, though they are not typically the main treatment. More commonly, medications are prescribed to address specific symptoms or co-occurring disorders like anxiety or depression [4]. Medications prescribed can include antidepressants, antipsychotics, and mood stabilizers depending on your unique symptoms and needs. Our team at Clear Behavioral Health can help determine your needs and assist with medication management.   

Holistic Approaches to Treat BPD  

Clear also offers holistic approaches, including mindfulness and meditation, music therapy, and art therapy, which have been shown to be helpful in treating many mental health disorders, including BPD [6].

Overcoming BPD is Possible 

Borderline Personality Disorder is a highly stigmatized diagnosis that is characterized by patterns of instability and intensity across multiple areas of an individual’s life. Despite the stigma, BPD is treatable, and the outlook is hopeful. If you or someone you love is struggling with BPD, please reach out to learn more about our treatment programs including mental health residential treatment for severe mental health conditions, outpatient mental health programs for ongoing support, teen treatment programs, and virtual IOP providing accessible care in Los Angeles, Santa Clarita, and throughout California. Our team is here to support you every step of the way. 

References:  

1. National Alliance on Mental Illness. (2024, October 10). Borderline Personality Disorder | NAMI. NAMI. https://www.nami.org/about-mental-illness/mental-health-conditions/borderline-personality-disorder/ 
2. Gunderson, J. G. (2009). Borderline Personality Disorder: Ontogeny of a diagnosis. American Journal of Psychiatry, 166(5), 530–539. https://doi.org/10.1176/appi.ajp.2009.08121825 
3. Borderline Personality disorder. (2024, May 13). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/borderline-personality-disorder 
4. Borderline Personality disorder. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/borderline-personality-disorder#part_2246 
5. Agrawal, H. R., Gunderson, J., Holmes, B. M., & Lyons-Ruth, K. (2004). Attachment Studies with Borderline Patients: A Review. Harvard Review of Psychiatry, 12(2), 94–104. https://doi.org/10.1080/10673220490447218 
6. Diagnostic and Statistical Manual of Mental Disorders | Psychiatry Online. (n.d.). DSM Library. https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596