Borderline Personality Disorder: Causes, Symptoms, and Treatment (2023)

overview

What is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a mental illness characterized by extreme mood swings, instability in interpersonal relationships, and impulsiveness.

People with BPD have an intense fear of abandonment and have trouble regulating their emotions, especially anger. They are also prone to impulsive and dangerous behaviors such as reckless driving and threats of self-harm. All of these behaviors make it difficult to maintain relationships.

Borderline Personality Disorder is part of a group of disorders known as "Cluster B".personality disorderthat involve dramatic and unpredictable behavior. Personality disorders are chronic (long-term) dysfunctional behavior patterns that are inflexible and pervasive, leading to social problems and distress.

Many people living with borderline personality disorder are unaware they have it and may not realize that there is a healthier way to behave and interact with others.

What is the difference between Borderline Personality Disorder and Bipolar Disorder?

Whilebipolar disorderit is also characterized by wide swings in mood and behavior and is distinct from borderline personality disorder (BPD).

In BPD, mood and behavior change rapidly in response to significant stress, particularly when interacting with others, while in bipolar disorder, mood is more sustained and less reactive. People with bipolar disorder also experience significant changes in energy and activity levels, unlike people with BPD.

Who Does Borderline Personality Disorder Affect?

Most personality disorders begin in adolescence as your personality develops and matures. As a result, nearly all people diagnosed with borderline personality disorder are over the age of 18.

While anyone can develop BPD, it's more common if you have a family history of BPD. People with other mental illnesses, such asAngst,Depressionoreating disorder, are also at higher risk.

Almost 75% of people diagnosed with BPD are assigned female at birth (AFAB). Research suggests that people who were assigned a male gender at birth (AMAB) may be similarly affected by BPD but may be misdiagnosedPost-Traumatic Stress Disorder (PTSD)or depression.

How common is borderline personality disorder?

Borderline personality disorder is relatively rare. Approximately 1.4% of the US adult population has BPD.

symptoms and causes

What are the signs and symptoms of Borderline Personality Disorder (BPD)?

The signs and symptoms of borderline personality disorder usually appear in late adolescence or early adulthood. A worrying event or experience can trigger or worsen symptoms.

Over time, symptoms usually subside and may go away completely.

Symptoms can range from manageable to very severe and can include any combination of the following:

• fear of being abandoned: It is common for people with BPD to feel uncomfortable when they are alone. When people with BPD feel abandoned or neglected, they experience intense fear or anger. You can track the whereabouts of your loved ones or prevent them from leaving. Or they push people away before getting too close to avoid rejection.
• Unstable and intense relationships: People with BPD find it difficult to maintain healthy personal relationships because they tend to change their opinions about others abruptly and dramatically. You can quickly go from idealizing others to devaluing them and vice versa. Their friendships, marriages, and relationships with family members are often chaotic and unstable.
• Unstable self-image or sense of self: People with BPD often have a distorted or unclear self-image and often feel guilty or ashamed and see themselves as "bad". They may also change their self-image abruptly and dramatically, as shown by a sudden change in their goals, opinions, careers, or friends. They also tend to sabotage their own progress. For example, they might intentionally fail a test, ruin relationships, or get fired from a job.
• Rapid mood swings: People with BPD can experience sudden changes in how they feel about others, themselves, and the world around them. Irrational emotions — including uncontrollable anger, fear, anxiety, hate, sadness, and love — change frequently and suddenly. These swings usually only last a few hours and rarely last more than a few days.
• Impulsive and dangerous behavior: Episodes of reckless driving, fighting, gambling, drug use,Binge Eatingand/or unsafe sexual activity is common in people with BPD.
• Repeated self-harm or suicidal behavior: People with BPD can cut, burn, or injure themselves (self-harming) or threaten to do so. You may also have suicidal thoughts. These self-destructive acts are usually triggered by rejection, possible abandonment, or disappointment from a significant other or lover.
• Persistent feelings of emptiness: Many people with BPD feel sad, bored, unhappy, or “empty.” Feelings of worthlessness and self-loathing are also common.
• problems with anger management: People with BPD have trouble controlling their anger and are often very angry. They can express their anger with caustic sarcasm, bitterness, or angry tirades. Shame and guilt often accompany these episodes.
• Temporary paranoid thoughts:dissociative episodes, paranoid thoughts and sometimes hallucinations can be triggered by extreme stress, usually fear of abandonment. These symptoms are transient and usually not severe enough to be considered a disease in their own right.

Not everyone with borderline personality disorder has all of these symptoms. The severity, frequency, and duration of symptoms are unique to each person.

What Causes Borderline Personality Disorder?

Healthcare professionals believe BPD results from a combination of factors, including:

• child abuse and trauma: Up to 70% of people with BPD have had sexual, emotional, or physical experiencesabuse as a child🇧🇷 Maternal separation, poor maternal bonding, inappropriate family boundaries, and parental substance use disorder are also associated with BPD.
• Genetic: Studies show that borderline personality disorder runs in families. If you have a family history of BPD, you're more likely - but not guaranteed - to develop the condition.
• brain changes: In people with BPD, the parts of the brain that control emotions and behavior don't communicate properly. These problems affect how the brain works.

diagnosis and testing

How is borderline personality disorder diagnosed?

The personality continues to develop in the course of childhood and adolescence. For this reason, health professionals typically do not diagnose anyone with borderline personality disorder before age 18. Occasionally, a person under the age of 18 can be diagnosed with BPD if symptoms are significant and last for at least a year.

Personality disorders, including borderline personality disorder, can be difficult to diagnose because most people with a personality disorder lack awareness of their disruptive behavior and thought patterns.

When they seek help, it is often because of conditions such as anxiety or depression that stem from the problems caused by their personality disorder, such as divorce or lost relationships, and not the disorder itself.

A licensed psychiatrist – such asPsychiatrist,psychologistor clinical social worker - may diagnose borderline personality disorder based on the American Psychiatric Association's diagnostic criteria for BPDDiagnostic and Statistical Manual of Mental Disorders.

They do this by conducting a thorough interview and talking through the symptoms. You ask questions that clarify:

• Personal medical history and family history, especially histories of mental illness.
• history of the work.
• impulse control.

Psychiatrists often work with the person's family and friends to gather more information about their behavior and history.

management and treatment

How is borderline personality disorder treated?

BPD has historically been difficult to treat. But with newer, evidence-based treatment, many people with borderline personality disorder experience fewer and less severe symptoms, better functioning, and a better quality of life.

But effective treatment takes time, patience, and commitment. Treatment may include psychotherapy (talk therapy), medication, or both.

Your doctor may recommend short-term hospitalization if you are very distressed or at risk of harming yourself or others. During your stay, your doctor will work with you to develop a treatment plan.

People with borderline personality disorder often have other mental illnesses, including:

• mood swings(80% to 96% of people with BPD).
• Anxiety disorders (88%).
• Substance use disorder (64%).
• Eating disorders (53%).
• Attention Deficit Hyperactivity Disorder (ADHD)(10 % bis 30 %).
• Bipolar disorder (15%).
• Somatoform disorders (10%).

If they have a co-existing condition, they need treatment for that too.

Psychotherapeutic treatment of BPD

Psychotherapy (talk therapy) is the treatment of choice for borderline personality disorder. The goal of treatment is to help you discover the motivations and fears associated with your thoughts and behavior and to help you learn to be more positive about others.

Types of therapies that can help treat BPD include:

• Dialectical Behavioral Therapy (DBT): This type of therapy was specifically designed for people with BPD. DBT focuses on helping you accept the reality of your life and behavior, and helping you learn how to change your life, including unhelpful behaviors. Teaches you skills to help you deal with intense emotions, reduce self-destructive behavior, and improve relationships.
• Cognitive Behavioral Therapy (CBT): This is a structured and goal-oriented form of therapy. Your therapist or psychologist will help you look more closely at your thoughts and emotions. You will understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thought patterns and habits.
• group therapy: is a form of psychotherapy in which a group of people come together to describe and discuss their problems together, under the supervision of a therapist or psychologist. Group therapy can help people with BPD interact more positively with others and express themselves more effectively.

Medication for BPD

Because the usefulness of prescription medications in borderline personality disorder is unclear, healthcare professionals generally do not prescribe medications as the main treatment for BPD.

However, in some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental illnesses. Medications can treat anxiety and depression, regulate mood swings, or help control impulsive behavior. Antipsychotic (neuroleptic) medications help some people with BPD.

prevention

Can borderline personality disorder be prevented?

Unfortunately, there is no way to prevent borderline personality disorder.

BPD is usually inherited (passed down in families), which means you're at higher risk of developing the condition if you have a family history of BPD. Ask your doctor how to spot the signs of the condition so you can get treatment as soon as possible.

Outlook / Forecast

What is the prognosis (outlook) for borderline personality disorder?

Most often, the symptoms of BPD gradually decrease with age. For some people, symptoms disappear in their 40s. With the right treatment, many people with BPD learn to manage their symptoms and improve their quality of life.

Without treatment, people with borderline personality disorder are at increased risk of:

• substance use disorder etcalcohol use disorder.
• Depression.
• self-mutilation.
• Suicide.

The risk of suicide in people with BPD is 40 times higher than in the general population. About 8% to 10% of people with BPD die by suicide.

Many people with untreated BPD also experience unstable or chaotic personal relationships and have trouble keeping a job. They are at higher risk of divorce, estrangement from family members, and difficult friendships. Legal and financial problems are also common.

to live with

How can I help someone with Borderline Personality Disorder?

If you know someone living with borderline personality disorder, here are some ways you can help:

• Take the time to educate yourself about BPD to understand what your loved one is going through.
• Encourage loved ones to seek treatment for BPD and ask about family therapy if they are relatives of yours.
• Offer emotional support, understanding, and patience. Change can be difficult and frightening for people with BPD, but their symptoms may improve over time with treatment.
• Seek therapy for yourself if you are experiencing significant stress or symptoms of mental health issues such as anxiety or depression. Choose a different therapist than the person your loved one sees.

People with BPD have significantly higher rates of self-harm and suicidal behavior than the general population.

People with BPD who are considering harming themselves or attempting suicide need help right away.

If you or someone you know is in imminent danger or have thoughts of harm, call the National Suicide Prevention Lifeline toll-free at 1.800.273.TALK (8255).

A note from the Cleveland Clinic

It's important to remember that borderline personality disorder (BPD) is a mental illness. As with all mental illness, seeking help as soon as symptoms appear can help reduce disruption in life. Mental health professionals can offer treatment plans that can help people with BPD gain control of their thoughts and behaviors.

Family members and loved ones of people with borderline personality disorder often experience stress, depression, sadness, and isolation. It's also important to take care of your mental health and seek help if you have these symptoms.