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Borderline personality disorderBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442
Borderline personality disorder (BPD) is a mental health disorder that generates significant emotional instability. This can lead to a variety of other stressful mental and behavioral problems.
With borderline personality disorder, you may have a severely distorted self-image and feel worthless and fundamentally flawed. Anger, impulsiveness and frequent mood swings may push others away, even though you may desire to have loving and lasting relationships.
If you have borderline personality disorder, don't get discouraged. Many people with this disorder get better with treatment and can live satisfying lives.
Borderline personality disorder affects how you feel about yourself, how you relate to others and how you behave.
Signs and symptoms of borderline personality disorder may include:
- Impulsive and risky behavior, such as risky driving, unsafe sex, gambling sprees or illegal drug use
- Awareness of destructive behavior, including self-injury, but sometimes feeling unable to change it
- Wide mood swings
- Short but intense episodes of anxiety or depression
- Inappropriate anger and antagonistic behavior, sometimes escalating into physical fights
- Difficulty controlling emotions or impulses
- Suicidal behavior
- Feeling misunderstood, neglected, alone, empty or hopeless
- Fear of being alone
- Feelings of self-hate and self-loathing
When you have borderline personality disorder, you often have an insecure sense of who you are. Your self-image, self-identity or sense of self often rapidly changes. You may view yourself as evil or bad, and sometimes you may feel as if you don't exist at all. An unstable self-image often leads to frequent changes in jobs, friendships, goals and values.
Your relationships are usually in turmoil. You may idealize someone one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even minor misunderstandings. This is because people with borderline personality disorder often have difficulty accepting gray areas — things seem to be either black or white.
When to see a doctor
If you're aware that you have any of the signs or symptoms above, talk to your doctor or a mental health provider. Proper treatment can help you feel better about yourself and help you live a more stable, rewarding life.
If you notice signs or symptoms in a family member or friend, talk to that person about seeing a doctor or mental health provider. But you can't force someone to seek help. If the relationship causes you significant stress, you may find it helpful to see a therapist yourself.
As with other mental disorders, the causes of borderline personality disorder aren't fully understood. Experts agree, though, that the disorder results from a combination of factors. Factors that seem likely to play a role include:
- Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental disorders among family members.
- Environmental factors. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.
- Brain abnormalities. Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.
Personality is shaped both by inherited tendencies and environmental factors, as well as experiences during childhood. Some factors related to personality development can increase the risk of developing borderline personality disorder. These include:
- Hereditary predisposition. You may be at a higher risk if a close family member — your mother, father, brother or sister — has the same or a similar disorder, particularly a mood or anxiety disorder.
- Childhood abuse. Many people with the disorder report being sexually or physically abused during childhood.
- Neglect. Some people with the disorder describe severe deprivation, neglect and abandonment during childhood.
Also, borderline personality disorder is diagnosed more often in young adults and adult women than in men.
Borderline personality disorder can damage many areas of your life. It can negatively affect intimate relationships, jobs, school, social activities and self-image. Repeated job losses and broken marriages are common. Self-injury, such as cutting or burning, can result in scarring and frequent hospitalizations. Suicide rates among people with BPD are high.
In addition, you may have other mental health disorders, including:
- Alcohol or substance abuse and dependency
- Anxiety disorders
- Eating disorders
- Bipolar disorder
Because of risky, impulsive behavior, you are also more vulnerable to unplanned pregnancies, sexually transmitted infections, motor vehicle accidents and physical fights. You may also be involved in abusive relationships, either as the abuser or the abused.
Preparing for your appointment
If you have a pattern of difficult relationships or personality traits that seem common to borderline personality disorder, call your doctor. After an initial appointment, your doctor may refer you to a mental health provider, such as a psychiatrist.
Use the information below to prepare for your appointment and learn what to expect from your doctor.
What you can do
- Write down any symptoms you or people close to you have noticed, and for how long.
- Write down key personal information, including traumatic events in your past and any current, major stressors.
- Make a list of your medical information, including other physical or mental health conditions and the names and amounts of medications or supplements you take.
- Take a family member or friend along, if possible. Someone who has known you for a long time may be able to share important information with the doctor or mental health professional, with your permission.
- Write down the questions you want to ask your doctor so that you can make the most of your appointment.
For symptoms common to borderline personality disorder, basic questions to ask your doctor or a mental health provider include:
- What is likely causing my symptoms or condition?
- Are there any other possible causes for my symptoms or condition?
- What treatments are most likely to be effective for me?
- How much can I expect my symptoms to improve with treatment?
- How frequently will I need therapy sessions and for how long?
- Are there medications that can help?
- What are the possible side effects of the medication you may prescribe?
- Do I need to take any precautions or follow any restrictions?
- I have these other health conditions. How can I best manage them together?
- How can my family members help me in my treatment?
- Do you have any printed material that I can take home? What websites do you recommend?
Don't hesitate to ask questions during your appointment if you don't understand something.
What to expect from your doctor
A doctor or mental health provider is likely to ask you a number of questions to aid in diagnosis of borderline personality disorder. Possible questions include:
- What are your symptoms?
- When did you first notice these symptoms?
- How are these symptoms affecting your life, including your personal relationships and work?
- How often during the course of a normal day do you experience a mood swing?
- How often have you felt betrayed, victimized or abandoned? Why do you think that happened?
- How well do you manage anger?
- How well do you manage being alone?
- Do you get bored easily?
- How would you describe your sense of self-worth?
- Have you ever felt you were bad, or even evil?
- Have you had any problems with self-destructive or risky behavior?
- Have you ever thought of or tried to harm yourself or attempted suicide?
- Do you use alcohol or illegal drugs or abuse prescription drugs? How often?
- How would you describe your childhood, including your relationship with your parents?
- Were you physically abused or neglected as a child?
- Have any of your close relatives been diagnosed with a mental health problem, including a personality disorder?
- Have you been treated for any other mental health problems? If yes, what diagnoses were made, and what treatments were most effective?
- Are you currently being treated for any other medical conditions?
In the meantime, if you have suicidal thoughts
If you have fantasies about hurting yourself or have other suicidal thoughts, get help right away by taking one of these actions:
- Call 911 or your local emergency number immediately.
- Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
- Call your mental health specialist, doctor or other health care provider.
- Reach out to a loved one, close friend, trusted peer or co-worker.
- Contact someone from your faith community.
Tests and diagnosis
Personality disorders are diagnosed based on:
- Thorough interview with your doctor or mental health provider
- Psychological evaluation
- Complete clinical history
- Signs and symptoms
To be diagnosed with borderline personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published and updated by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.
For borderline personality disorder to be diagnosed, at least five of the following signs and symptoms must be present:
- Intense fear of abandonment
- Pattern of unstable relationships
- Unstable self-image or sense of identity
- Impulsive and self-destructive behaviors
- Suicidal behavior or self-injury
- Wide mood swings
- Chronic feelings of emptiness
- Anger-related problems, such as frequently losing your temper or having physical fights
- Periods of paranoia and loss of contact with reality
A diagnosis of borderline personality disorder is usually made in adults, not in children or teenagers. That's because what appear to be signs and symptoms of borderline personality disorder may go away as children get older and become more mature.
Treatments and drugs
Borderline personality disorder treatment may include psychotherapy, medications or hospitalization.
Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline personality disorder. Types of psychotherapy that have been found effective include:
- Dialectical behavior therapy (DBT). DBT was designed specifically to treat borderline personality disorder. Generally done through individual, group and phone counseling, DBT uses a skills-based approach combined with physical and meditation-like exercises to teach you how to regulate your emotions, tolerate distress and improve relationships.
- Cognitive behavioral therapy (CBT). With CBT, you work with a mental health counselor (therapist) to become aware of inaccurate, negative or ineffective thinking; view challenging situations more clearly and objectively; and search for and put into practice alternative solution strategies.
- Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you identify and separate your own thoughts and feelings from those of people around you. MBT emphasizes thinking before reacting.
- Schema-focused therapy (SFT). SFT combines therapy approaches to help you evaluate repetitive life patterns and life themes (schema) so that you can identify positive patterns and change negative ones.
- Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations.
Medications can't cure borderline personality disorder, but they can help associated co-occurring clinical problems, such as depression, impulsiveness and anxiety. Medications may include antidepressants, antipsychotics and anti-anxiety drugs. Medications must be appropriately prescribed by your doctor, in adequate doses, and with consistent supervision through scheduled follow-up visits.
At times, you may need more intense treatment in a psychiatric hospital or clinic. Hospitalization can also keep you safe from self-injury or suicidal thoughts or behaviors.
Because treatment can be intense and long term, you have the best chance for success when you consult mental health providers who have experience treating borderline personality disorder.
Coping and support
Living with borderline personality disorder can be difficult. You may realize your behaviors and thoughts are self-destructive or damaging, yet you feel unable to control them. Treatment can help you learn skills to manage and cope with your condition.
You can help manage your condition and feel better about yourself if you:
- Learn about the disorder so that you understand its causes and treatments
- Stick to your treatment plan
- Attend all therapy sessions
- Take medications as directed and report to your doctor the benefits and side effects you experience
- Practice healthy ways to ease painful emotions and prevent impulsive behaviors, such as self-inflicted injuries
- Don't blame yourself for having the disorder but recognize your responsibility to get it treated
- Learn what may trigger angry outbursts or impulsive behavior
- Don't feel embarrassed by the condition
- Get treatment for related problems, such as substance abuse
- Reach out to others with the disorder to share insights and experiences
- Keep up a healthy lifestyle, such as eating a healthy diet, being physically active and engaging in social activities
Remember, there's no one right path to recovery from borderline personality disorder. Usually, the best results come from a combination of treatment strategies.
The condition seems to be worse in young adulthood and may gradually get better with age. Many people with the disorder find greater stability in their lives during their 30s and 40s. As your inner distress and sense of misery decreases, you can go on to maintain loving relationships and enjoy meaningful careers.
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