What is a Borderline Personality Disorder

What is a Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious mental illness characterized by long-standing, ongoing patterns in both moods and relationships. People with BPD experience widely variant self-image and moods, which influences similarly unstable behavior—including relationships. BPD prompts mood swings, impulsive actions, and other behavioral symptoms that make all kinds of relationships difficult, from friendships and relationships with colleagues to romantic and familial relationships.

Borderline Personality Disorder: In a Nutshell

People with BPD are likely to experience intense feelings of depression, anger, and especially anxiety that lasts for hours, days, or longer. Anxiety in particular is a real problem for people with BPD, who then react to their anxieties in relationships, hoping to avoid abandonment—whether or not it is real. This makes for labile moods, unreliable self-image and opinions, and sometimes destructive decision-making.

An important characteristic many sufferers from BPD share is the experience of bouncing back and forth between all of the variables in their life. On one day, a BPD patient might wake up feeling confident in their romantic relationship, only to perceive some sort of slight by their partner. This slight—real or imagined—can then throw the entire relationship into doubt in the BOD sufferer’s mind, and this might cause them to leave, make unreasonable ultimatums, or simply to lash out.

The BPD sufferer’s emotions, opinions, feelings about their own self-worth and self-image, and relationships can change day by day as they react to whatever happens in their world. Bad news, a difficult day, stress, or a perceived insult can turn the world of someone with BPD upside-down. For all of these reasons, a deeper feeling of calm, contentment, or satisfaction with life is rare for a BPD sufferer. Instead, they are frequently plagued by feelings of boredom, loneliness, and loss.

The Meaning of “Borderline”

“Borderline” suggests something that straddles two realities, something in-between. The origin of the actual BPD diagnosis arose from clinicians working to diagnose patients they found “difficult” to peg via traditional diagnostic means. Patients who exhibited a range of psychotic and neurotic symptoms were thought to be riding the line between those two areas of mental illness.

However, despite this history and the notions a layperson might attach to the word “borderline,” as there are no formal diagnostic criteria for BPD. This is not to say that BPD doesn’t serve as a diagnosis of last resort in some cases which are difficult (and which, perhaps, don’t receive as much attention as they should). However, the idea that BPD merely marks the difference between psychosis and neurosis lacks empirical support.

Unfortunately, there is one additional problem that arises from the “borderline” history: people with BPD have now gotten the reputation of being patients that are difficult to treat. This not only makes it harder for people with BPD to seek and receive appropriate treatment. This also means that there is an ongoing danger of abuse of the BPD diagnosis—a label for difficult patients no one wants to treat or who are not doing well in therapy. BPD sufferers deal with this stigma every day, and especially when they are most vulnerable: asking for professional help.

Symptoms of Borderline Personality Disorder

For people with BPD, there are nine specific symptoms to watch for:

  • Attempts to avoid abandonment that may range from mild to extreme (whether that abandonment is real or imagined);
  • An ongoing pattern of unstable relationships;
  • Identity disturbance, self-image that changes frequently;
  • Self-destructive impulsivity;
  • Self-harm and suicidal behavior, threats, or gestures;
  • Wild mood swings caused by emotional instability;
  • Deep feelings of emptiness;
  • Feelings of anger that are inappropriately intense, or difficulty managing anger;
  • Dissociative and/or paranoid thoughts or behaviors.

People with BPD often see the world in black-and-white, extreme terms. People love them or hate them; things are all bad or all good. If you’re not with me, you’re against me. They typically experience mood swings and rapid, extreme shifts in their self-image and their role in life. This causes fluctuations in even their core values that can be just as swift and extreme.

Not every person with BPD experiences all of these symptoms, and the triggering events are different for each person. See more about symptoms of BPD here.

Risks for and Causes of Borderline Personality Disorder

There is no single, clear cause of BPD. However, research indicates that brain structure and function, cultural and environmental factors, family history and genetics, and social factors all contribute to the risk of developing BPD. Taking a closer look, there are several areas a diagnosing healthcare professional will explore as they work with someone with BPD:

  • Brain structure and function. People with BPD appear in some studies to have physical differences in the areas of their brains that deal with emotional regulation and impulse control. These differences can be both structural and functional. However, scientists don’t yet know if these differences cause BPD or put a person at higher risk for it, or if BPD causes the changes in the brain.
  • Cultural and environmental factors. Many BPD patients developed through their formative years in situations that exposed them to trauma. For example, emotional, mental, physical, and sexual abuse can contribute to the diagnosis. Children that are otherwise exposed to difficult life situations such as extreme poverty or violence, or abandonment, are also at risk.
  • Family history and genetics. Patients who have a sibling, parent, or other close family member with BPD may have a higher risk of developing BPD themselves.
  • Social factors. Some people with BPD have been exposed to hostile, invalidating, unstable relationships, which can put them at risk. How a person is exposed to stress and learns to cope with it, coupled with their temperament, will in part determine how they deal with negative social factors early in life, and throughout life as well.

Risk factors might make it more likely that a person develops BPD, but they don’t mean that developing the disorder is a sure thing. Similarly, people without any of these risk factors at all can still develop BPD. Most experts credit a biopsychosocial causation model for BPD. This means that they think it’s most likely that BPD arises when biological, psychological, and social factors, and the complex and intertwined way these factors interact, are right.

Treatment of Borderline Personality Disorder

In the “bad old days” of dealing with BPD, it was thought of as notoriously difficult to treat. However, modern, evidence-based treatment has lessened this stereotype significantly. Today, many people with BPD experience fewer symptoms or less severe versions of their symptoms—and, as a result, greatly improved relationships and life satisfaction. However, this is only true when BPD sufferers receive care that is specialized and evidence-based, from someone with particular expertise and training in caring for BPD patients. Standard treatments for other disorders are not likely to be of great benefit to someone with BPD.

BPD treatment usually includes some kind of long-term psychotherapy, such as dialectical behavioral therapy(DBT), with a BPD specialist. There are also some medications that can mitigate against symptoms that are more debilitating. Once treatment begins, there is no quick and easy fix; symptoms may improve quickly, or only after a significant amount of time and effort have been invested in the process. For the loved ones of people with BPD, patience is the main concept here. Find out more about how to live with someone with BPD here.

Tests and Diagnosis

Of course, there is no instant test for detecting BPD. Only a licensed mental health professional—such as a clinical social worker, psychiatrist, or psychologist—who has experience diagnosing mental disorders and treating them can diagnose BPD. For a diagnosis of BPD, a clinician will typically have to take several steps:

  • Conduct a thorough interview, discussing all symptoms in detail
  • Perform a thorough medical exam to rule out other potential causes of symptoms
  • Taking a complete family medical history, including all mental illness

It’s critical that this kind of diagnosis only be undertaken by an experienced professional. BPD frequently occurs alongside other mental illnesses. When it does, the BPD and other mental illness are co-occurring disorders. Co-occurring disorders often have symptoms and behaviors that overlap; for example, both substance abuse and depression are common among people with BPD—but they are also common among people with other mental illnesses. This means BPD is even tougher to diagnose and treat in many cases.

Find out more about signs of BPD here.

Get Help, and Stick With Your Treatment Plan

Research indicates that people with untreated BPD or whose treatment is inadequate are more likely to make unhealthy lifestyle decisions and more likely to develop other mental illnesses and chronic medical problems. BPD is also correlated with a much higher than average risk of self-harm and even suicide. For all of these reasons, seeking out treatment, and sticking with it, is critical for people with BPD.

Psychotherapy for BPD

Psychotherapy is the most important component of treatment for people with BPD. One-on-one treatment with a skilled therapist can provide insights and coping strategies for the patient, and therapist-led group sessions can assist people with BPD in learning how to express themselves and interact with others in healthier and more effective ways. All therapy relies on trust and bonding between patient and therapist, and this kind of connection can be difficult to sustain for someone with BPD. There is no substitute for a motivated patient—or for an experienced therapist.

Reach Out For Help

If you or someone you love is suffering with BPD, don’t wait to ask for help. Start the process today. Caring professionals can improve the lives of people with BPD immeasurably—why should you suffer in silence?