Borderline Personality Disorder (BPD)
Living with borderline personality disorder (BPD) involves a pattern of intense mood swings and dramatic shifts in feelings for others. Understanding BPD and how it is diagnosed can help shed light on what causes it and how it is treated.
What is borderline personality disorder?
BPD is a mental health disorder that involves volatile emotional states and impulsive, unpredictable behavior. People with borderline personality disorder often experience extreme mood swings that can last from a few hours to days.
According to the Diagnostic and Statistical Manual of Mental Disorders, people with BPD often display instability and fear of abandonment by others. They may experience erratic relationships that swing between closeness and being cut out of the individual’s life. They may also engage in reckless behaviors and have suicidal or self-harming thoughts or tendencies (American Psychiatric Association, 2013). Living with a personality disorder like BPD affects how people feel about themselves and how they treat others around them.
Possible causes of borderline personality disorder
While there is no one cause of BPD, research shows certain risk factors may be involved. These can include genetic factors that can affect the structure and chemistry of the parts of the brain responsible for impulse control, decision-making, and regulating emotions. Other factors can include a family history of BPD or previous trauma, such as abuse, abandonment, or another significant life event (Leichsenring et al, 2010).
Who is more likely to have borderline personality disorder?
While anyone can be diagnosed with BPD, some studies suggest women are more likely to experience BPD (Sansone et al, 2011). Other studies report as many as 75% of BPD diagnoses occurring in women (Skodol et al, 2003). Additionally, women in the various stages of motherhood may be at a heightened risk for BPD.
Some studies have shown that men diagnosed with BPD may experience different symptoms that are more dominant, including substance abuse issues and aggression (Johnson et al, 2003), while women tend to have more depressive symptoms.
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Symptoms of borderline personality disorder
The symptoms of BPD will often show up in ways that are behavioral, emotional, and related to impulse. Symptoms of BPD can include:
- Drastic or dramatic severing of relationships in an attempt to avoid being abandoned, regardless of whether this abandonment is real or imagined
- Dangerous or impulsive behaviors, including the use of drugs, alcohol, or substances, reckless sexual activity, and/or wild financial spending
- Having a self-image that is erratic, insecure, and unstable
- Feeling dissociated, disconnected, separate, or outside of one’s own body
- Recurring feelings of boredom or constant sensations of emptiness
- Outbursts of intensive or uncontrollable anger, sometimes followed by feelings or expressions of intense guilt or shame
- Attempting or following through on self-harming actions (including cutting or other self-induced bodily harm)
- Harboring suicidal thoughts or tendencies
How is borderline personality disorder diagnosed?
Being diagnosed with BPD requires a consultation with a doctor or clinician. As there is no single test to diagnose BPD, a mental health clinician will conduct a range of evaluations.
These may include questionnaires to assess a person’s condition and symptoms as well as a medical exam and review of their medical history. People are usually diagnosed with BPD as adults. In adults, symptoms will often emerge more strongly and noticeably than in children and teens. For many children and teens, symptoms similar to BPD dissipate as they mature.
Treatments for borderline personality disorder
Therapy and medication are the two most common ways to treat BPD. These treatments can help people restore balance and control to their lives, curb impulsive actions, and increase awareness of their own emotions and those around them.
Therapy, also called talk therapy or psychotherapy, is the most common treatment for people with BPD. This is typically conducted in a one-on-one setting with a therapist or with others in a group setting.
Dialectic behavioral therapy (DBT) is a kind of therapy commonly used to treat BPD. This skills-based therapy teaches patients how to manage emotions, build a tolerance for stress, and balance self-acceptance while also acknowledging the need for change.
Medication is another treatment method for BPD. While there is no single medication prescribed specifically for borderline personality disorder, a doctor may prescribe antidepressants, antipsychotics, or mood-stabilizing medications.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2010). Borderline personality disorder. The Lancet, 377(9759), 74–84. https://doi.org/10.1016/s0140-6736(10)61422-5
Sansone, R. A., & Sansone, L. A. (2011). Gender patterns in borderline personality disorder. Innovations in clinical neuroscience, 8(5), 16–20.
Skodol, A.E., Bender, D.S. Why Are Women Diagnosed Borderline More Than Men?. Psychiatr Q 74, 349–360 (2003). https://doi.org/10.1023/A:1026087410516
Johnson, D. M., Shea, M. T., Yen, S., Battle, C. L., Zlotnick, C., Sanislow, C. A., Grilo, C. M., Skodol, A. E., Bender, D. S., McGlashan, T. H., Gunderson, J. G., & Zanarini, M. C. (2003). Gender differences in borderline personality disorder: Findings from the Collaborative Longitudinal Personality Disorders Study. Comprehensive Psychiatry, 44(4), 284–292. https://doi.org/10.1016/s0010-440x(03)00090-7
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