Borderline Personality Disorder

What is Borderline Personality Disorder?

Like other personality disorders, borderline personality disorder (BPD) is a mental health condition that impacts people’s thoughts and feelings about themselves and others. People with this disorder often experience impairments in everyday life due to self-image issues, a pattern of unstable relationships, and difficulty managing their behavior and emotions.

One of the most common features of BPD is the intense fear of being abandoned by friends, family, or romantic partners. Individuals struggling with BPD frequently experience intense anger or sudden mood swings that affect their close relationships. Sometimes they will perceive problems with a perfectly healthy relationship and push that person away, only to panic and swing back into believing that person is abandoning them.

The unstable back and forth can make interpersonal relationships difficult for people with BPD. Sometimes mistaken for “raging hormones,” borderline usually develops by early adulthood and may gradually improve with age. Despite the havoc, this disorder can wreak on the individual’s early life, many patients can enjoy healthy relationships with the proper treatment and support.

About Personality Disorders

People with personality disorders usually have an abnormal, unhealthy pattern of behaving and thinking that leads to considerable impairments in daily life. Most people with a personality disorder don’t realize anything is wrong, as their symptoms appear as normal behavior to themselves.

Because they have difficulty understanding their peers or specific situations, it’s usually friends and family who identify the disordered behavior. Psychiatry groups personality disorders into three clusters based on their similar characteristics.

The three clusters include:

• Cluster A (abnormal, eccentric)
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
• Cluster B (overly dramatic or unpredictable)
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Narcissistic Personality Disorder
• Cluster C (anxious, fearful)
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder

Symptoms of Borderline Personality Disorder

BPD affects how a person sees themselves and relates to others. Sometimes these individuals have a distorted self-image or disordered way of thinking about themselves, which can lead to impulsive, extreme, and even self-harming behavior.

While the most notorious issue people face is the irrational fear of abandonment, there are several other BPD symptoms to consider. Many of these symptoms are described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and are necessary to receive an official diagnosis.

Symptoms of borderline personality disorder may include:

• Intense fear of abandonment and taking extreme measures to avoid real or imagined separation or rejection
• Ongoing feelings of emptiness
• Dissociation or loss of one’s sense of self
• A pattern of intense and unstable relationships (e.g., idealizing someone one moment and suddenly believing the person doesn’t care enough or is cruel the next)
• Rapid changes in self-identity and self-image, such as shifting goals or suddenly seeing yourself as bad
• Impulsive and self-destructive behavior, such as reckless driving, gambling, unsafe sex, overspending, binge eating, drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship
• Periods of paranoid thoughts and loss of contact with reality
• Suicidal threats or suicidal behavior (i.e., self-injury), often in response to the fear of separation or rejection
• Intense emotions, including significant mood swings lasting from a few hours to a few days
• Inappropriate, intense anger, being sarcastic or bitter, or having physical fights

Borderline Personality Disorder VS Bipolar Disorder

Borderline personality disorder (BPD) is often confused with or compared to bipolar disorder (BP) due to its similar symptoms and abbreviations. Despite the overlap in traits, these two disorders are quite different.

Bipolar disorder is a mood disorder characterized by cycles of depressive episodes and manic episodes. The length of these episodes will depend on the type of bipolar the person has, but often these cycles last at least one week.

On the other hand, BPD is a personality disorder known for having mood swings that can look like depression or mania but may only last a few hours or days.

Furthermore, bipolar symptoms are theoretically caused by imbalances of chemicals in the brain, while BPD symptoms are simply part of the person’s personality. This distinction gives BPD a complicated reputation, as society often views personality disorders as equivalent to being “good” or “bad” people. Bipolar individuals also experience stigmas, but generally, most people view BPD as “worse than” bipolar disorder.

Development of Borderline Personality Disorder

Like other personality disorders, BPD is believed to be caused by a mixture of genetic traits, brain abnormalities, and unstable or traumatic upbringing. Symptoms of borderline tend to appear in late teens and early adulthood, making the transition to college or adult life even more difficult.

Risk Factors for BPD

Certain hereditary traits can make an individual more vulnerable to developing a personality disorder. Knowing your family history of borderline personality disorder can help determine if an increased risk exists. In addition, specific brain abnormalities have been linked to emotion regulation, impulsivity, and aggression.

Aside from genetic risk factors, a stressful or unstable childhood has been linked to the development of BPD. Many people with the disorder have reported sexual or physical abuse or neglect during childhood. Hostile conflict and unstable family relationships can trigger BPD to develop, especially for those vulnerable to the disorder.

How Common is Borderline Personality Disorder?

According to research published in the Journal of Abnormal Psychology, 1.6% of the general population has borderline personality disorder, with a lifetime prevalence of 5.9%.

Based on research compiled by the National Education Alliance for Borderline Personality Disorder:

• BPD affects 50% more people than Alzheimer’s disease and nearly as many as schizophrenia and bipolar combined (2.25%)
• BPD affects 20% of patients admitted to psychiatric hospitals
• BPD affects 10% of people in outpatient mental health treatment

Common Comorbidities and Related Conditions

Comorbidities are prevalent among people with BPD. Many individuals find they have symptoms of other personality disorders and may receive the diagnosis of just one personality disorder.

Research shows that other common comorbidities BPD patients often have include:

• Depression
• Alcohol use disorder or substance use disorder
• Anxiety disorders
• Eating disorders
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Attention-deficit/hyperactivity disorder (ADHD)

Borderline Personality Disorder and Addiction

The risk-taking behaviors individuals with BPD experience can easily lead to substance abuse and addiction. Many people struggle with impulsive control and feeling of emptiness, leading them to experiment with alcohol or substances.

Addiction can form as the individual uses more and more of the substance, creating a dependence on it in the process. Self-harm and suicidal ideation are also frequent issues for this disorder, so sadly, the misuse or abuse of substances may play a part in their efforts to hurt themselves or end their lives.

Diagnosis of Borderline Personality Disorder

BPD can be difficult to diagnose because many people won’t perceive their abnormal behavior as an issue. Their actions and thought patterns may feel natural to them, so friends and family members often are the ones who notice something is wrong.

During an evaluation, a physician typically bases the diagnosis on the criteria listed in the DSM-5. Tests like the McClean Screening Instrument for Borderline Personality Disorder and the Personality Diagnostic Questionnaire may also be used.

Questions about family and medical history might be relevant during the evaluation, especially if you’ve previously been hospitalized for mental illness-related incidents. After all the necessary interviewing and testing, the physician will provide a likely diagnosis and proposed treatment options.

Treatment of Borderline Personality Disorder

Luckily, there are clear steps to obtaining a diagnosis when working with a licensed mental health professional or psychiatrist to undergo a psychiatric evaluation. Once the doctor identifies the diagnosis, a treatment plan can be developed, often including a combination of therapy and medication.

As with other personality disorders, effective treatment for BPD usually includes a combination of psychotherapy (aka “talk therapy”) and medication.

The most effective therapies for BPD are Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and group therapy. In therapy, patients with BPD can learn to identify destructive thought patterns and learn to redirect them into more productive thoughts and behaviors.

Regarding medications, there are currently no drugs approved by the Food and Drug Administration specifically for treating borderline personality disorder. However, certain medications may help with symptoms or co-occurring problems such as depression, impulsiveness, aggression, or anxiety.

Common medications used for treating symptoms of BPD include:

• Antidepressants
• Antipsychotics
• Mood-stabilizers
• Anti-anxieties

Getting Help For Borderline Personality Disorder

Despite the stigma surrounding borderline personality disorder and the seriousness of some of its symptoms, individuals with this disorder deserve empathy, love, and treatment.

If you or someone you love is struggling with BPD, many healthcare providers are ready to provide the help you need. Individuals with BPD can enjoy healthy relationships and happy, fulfilled lives with the right therapy, medication, and support.