Borderline Personality Disorder

(BPD)

Definition

Borderline personality disorder (BPD) is a mental health disorder. People with BPD may often have dramatic, emotional, erratic, and attention-seeking moods. This behavior is severe enough to cause problems with family and work life, long-term planning, and sense of self.

Causes    TOP

The causes of BPD are not fully understood. People who develop BPD may have genes that make them more likely to develop mental illness. Certain experiences and types of stress may then further increase their chance of developing BPD. Many BPD sufferers are found to have had childhood abuse, neglect, separation, sexual abuse, violence, or brain injury.

Central Nervous System—Brain

Brain face skull
BPD is thought to develop from a combination of chemical imbalances in the brain and traumatic life experiences.
Copyright © Nucleus Medical Media, Inc.

Risk Factors    TOP

BPD is more common in females. The following factors increase your chances of developing BPD:

  • A history of abuse, neglect, or abandonment as a child
  • A history of sexual abuse or violence
  • Inborn sensitivity to stress
  • Immediate family members with BPD

Symptoms    TOP

The symptoms of BPD vary. People with BPD tend to be extremely sensitive to rejection. They may react with anger and be upset at even mild separation from friends or family. Symptoms often become more severe when people with BPD feel isolated and lonely or during times of stress.

Traits that are common to people with BPD include:

  • Fears of being left alone—resulting in frantic behaviors to avoid being left alone
  • Extreme and unpredictable mood swings and difficulty managing emotions or moods
  • Difficulty in relationships—dramatic swings or viewing people as all good or all bad
  • Unstable self-image
  • Impulsive behavior
    • Excessive spending
    • Promiscuity, risky sexual behavior
    • Gambling
    • Substance abuse
    • Binge eating
  • Repetitive self injuring through cutting, scratching, or burning
  • Feeling misunderstood, bored, and empty
  • Having deep-seated feelings of being flawed or bad in some way
  • Using defense mechanisms to avoid taking responsibility for behavior, or to blame others
  • Problems with anger management, manifested as periods of intense, uncontrollable and often unreasonable anger
  • Episodes of intense paranoia, dissociation, or thought patterns bordering on psychosis—often provoked by stress

BPD can affect anyone. It is usually diagnosed in adolescents and young adults.

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. If BPD is suspected, you may be referred to a psychiatrist who specializes in personality disorders.

A diagnosis of BPD may be made if a person has a history of the symptoms listed above. In addition, BPD patients almost always have other mental health problems such as:

Treatment    TOP

Treatment options have improved as BPD is better understood. Many BPD sufferers are helped by psychotherapy and medications.

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Psychotherapy

Individual, group, and family therapy form the basis of BPD treatment. Individual psychotherapy usually consists of 2-3 sessions a week for a period of years. Group therapy may focus on the same goals but take place in a group of fellow participants. The goal of therapy is to help the person with BPD:

  • Understand their behavior
  • Improve their ability to tolerate frustration, anxiety, loneliness, and anger
  • Control impulsive behavior
  • Improve social skills

Psychotherapy may use a combination of different therapies. Common therapy approaches include:

  • Dialectical behavior therapy (DBT)—Help the person face and accept emotions rather than struggle with them. It also focuses on finding balance and using coping methods.
  • Schema-focused therapy—Identify unmet emotional needs that are linked to poor behaviors. Work to create healthy patterns.
  • Mentalization-based therapy (MBT)— Strengthen feelings to gain a sense of self and others.
  • Systems training for emotional predictability and problem-solving (STEPPS)—Group therapy designed to help people manage behaviors. Focuses on helping to understand feelings and how to react to them.
  • Transference-focused psychotherapy (TFP)— Uses the relationship between the therapist and patient. The therapist gauges the emotional reaction of questions. Then, both parties can work through emotions in the moment.

Family therapy may help family members deal with the effects of BPD. It can also provide additional support for the person with BPD.

Medication

Medication may be prescribed and adjusted based on your symptoms. Medication options may include:

  • Antidepressant drugs
  • Mood stabilizers
  • Antipsychotic drugs—may be used in low doses to control distorted thinking or anxiety

Prevention    TOP

Nothing has been shown to prevent BPD.

RESOURCES:

National Association for Borderline Personality Disorder
http://www.nabpd.org

CANADIAN RESOURCES:

Borderline Personality Disorder
http://www.borderlinepersonality.ca
Canadian Psychological Association
https://cpa.ca

References:

Blum N, St. John D, Pfohl B, et al. Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry. 2008;165(4):468-478.
Borderline personality disorder. EBSCO DynaMed Plus website. Available at:
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Updated June 22, 2017. Accessed February 1, 2018.
Borderline personality disorder. National Mental Health Association website. Available at: https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml. Updated December 2017. Accessed February 1, 2018.
Borderline personality disorder (BPD). Merck Manual Professional Version website. Available at:
...(Click grey area to select URL)
Updated . Accessed February 1, 2018.
Types of therapy. Good Therapy website. Available at: https://www.goodtherapy.org/learn-about-therapy/types. Accessed February 1, 2018.
Last reviewed December 2017 by EBSCO Medical Review Board Adrian Preda, MD
Last Updated: 2/1/2018

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