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.
The causes of BPD are not fully understood. It is likely due to a mix of genes and life events and environment. Some types of gene may allow changes in the brain that cause mental health issue. Life experiences and types of stress may increase the risk of thee changes happening.
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BPD is more common in those with:
- A history of abuse, neglect, or abandonment as a child
- A history of sexual abuse or violence
- Inborn sensitivity to stress
- Siblings or parents who have BPD
BPD can affect anyone. It is usually diagnosed in adolescents and young adults. People with BPD may have:
- Fears of being left alone—leads to frantic behaviors to avoid being left alone
- Extreme and unpredictable mood swings and hard time controlling emotions or moods
- Hard time with relationships—dramatic swings or viewing people as all good or all bad
- Unstable self-image
- Excessive spending
- Promiscuity, risky sexual behavior
- 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 which can show as periods of intense, uncontrollable and often unreasonable anger
- Episodes of intense paranoia, dissociation, or thought patterns bordering on psychosis—often triggered by stress
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 severe when people with BPD feel lonely or during times of stress.
The doctor will ask about symptoms and past health. A mental health screening test will be done. It will ask about mood, outlook, and effects on day to day life. This will help the doctor assess mental health concerns. A physical exam and tests may be done. It will help to rule out other medical conditions that can cause similar problems. A psychiatrist may make the diagnosis. There is not test for BPD. Instead the doctor will look at symptoms over a long period of time to see which mental health issues may be present.
Psychotherapy can help to understand and manage BPD. The goal of therapy is to:
- Improve their ability to tolerate frustration, anxiety, loneliness, and anger
- Control impulsive behaviors
- Improve social skills
Therapy may be one on one or include family therapy. The exact type of therapy will be based on each person's needs. Some types of therapy used with BPD are:
- 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.
- 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.
Medicine is not a main part of BPD treatment. It may be used to treat severe symptoms or other mental health issues such as depression.
The cause of BPD is not clear so there are no steps for prevention.
National Association for Borderline Personality Disorder
Mental Health America
Borderline Personality Disorder
Canadian Psychological Association
Borderline personality disorder. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/borderline-personality-disorder. Accessed February 1, 2020.
Borderline personality disorder. National Mental Health Association website. Available at: https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml. Accessed February 1, 2020.
Kaess M, Brunner R, Chanen A. Borderline personality disorder in adolescence. Pediatrics. 2014 Oct;134(4):782-93.
National Health and Medical Research Council (NHMRC) clinical practice guideline on management of borderline personality disorder. Available at: https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guideline-borderline-personality-disorder. Accessed February 1, 2020.
Last reviewed February 2020 by EBSCO Medical Review Board Adrian Preda, MD Last Updated: 2/1/2020