Borderline personality disorder (BPD) is a mental health condition that plays a major role in your mood, behavior, and self-image.
If you have a borderline personality disorder (BPD) diagnosis, you’re likely familiar with turbulent and quickly changing emotions and a lack of stability in your personal relationships and self-image.
As mental health conditions go, BPD is one of the most stigmatized, even among some mental health professionals. Part of this is linked with the historical idea that BPD is untreatable — but we now know that this isn’t the case.
While there is still much to learn about this complex condition, recent research has shown that some types of therapy, such as dialectical behavioral therapy (DBT), can be effective at reducing symptoms and improving your quality of life.
What is borderline personality disorder?
Having BPD is usually associated with instability: in relationships, in self-image, and emotions. Often, this instability stems from a fear of abandonment.
BPD is a cluster B personality disorder. Disorders in this cluster affect the person’s emotions and relationships and lead to behaviors that others believe to be extreme or irrational.
Other cluster B disorders include narcissistic personality disorder and antisocial personality disorder.
Among people with BPD, impulsive and potentially self-damaging behavior is common. Self-harm and suicidal thoughts and actions are also common. Treatments aim to help you manage these intense feelings and reduce distress so that they occur less often.
While there’s no “cure” for BPD, many people with the condition go into “remission,” which means that their symptoms become less intense to the point where they no longer meet the diagnostic criteria.
Far from being untreatable, some studies have suggested that remission rates are above 90% over a 10-year period, although the authors of the study note that many of those individuals were avoiding interpersonal relationships, which contributes to the remission.
BPD is defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In some countries and regions, clinicians use the World Health Organization’s International Classification of Diseases (ICD-10), which uses the term emotionally unstable personality disorder (EUPD) instead of BPD.
Is BPD really a “personality disorder”?
The term “personality disorder” is controversial, with many people (clinicians included) rejecting the label. This is because the term itself can be stigmatizing.
It can be upsetting to be told that your mental health disorder is a part of your personality. People with this condition may feel like the emotions and actions of BPD are a rational response to difficult life experiences and not some defect within the person or their personality.
Taking this view, mental health professionals should consider the underlying cause of the person’s emotional responses, rather than determining that there’s a problem with the individual.
While people disagree about the label “personality disorder,” having a label of some sort can serve as a useful way to access support. And some people feel that having a BPD diagnosis is helpful in allowing them to understand and explain their experiences, both to themselves and the people around them.
There are nine symptoms associated with BPD, according to the DSM-5.
You have to have five or more of the following symptoms to be diagnosed with borderline personality disorder:
frantic efforts to avoid abandonment, whether the abandonment is real or imagined
unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
difficulties with identity, such as a quickly changing self-image or sense of self
impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance use, reckless driving, binge eating)
recurrent suicidal thoughts, suicidal behaviors, or self-harm
emotional instability and quick-changing moods (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
chronic feelings of emptiness
extreme anger or difficulty controlling anger
stress-related paranoid thoughts or severe dissociative symptoms
Because of intense fears around abandonment, you might interpret situations as though you are being abandoned, even when that’s not the case.
For example, if a friend changes plans at the last minute for an unavoidable reason, you might have an immediate, automatic fear of being abandoned and feel very hurt or distressed.
When you feel rejected, you might become irrationally angry at the person who you believe is rejecting you (though it may feel rational at the time). You might also feel that you are being rejected because you’re a bad person, even though this is not the case.
Personality disorders are usually diagnosed in people ages 18 and older, even if they have had symptoms for years. This is because a mental health professional will need to look back at patterns formed over the years before diagnosing a personality disorder.
According to the DSM, if BPD is diagnosed in a teen or child, the symptoms have to be present for at least a year.
How common is BPD?
According to a recent study, about 1.6% of the general population in the United States has BPD. This means that there are about 4 million people with borderline personality disorder in the United States alone.
Borderline personality disorder is quite common among the inpatient psychiatric population. In fact, it affects about 20% of the people in this group.
However, it’s worth noting that there is some uncertainty around these statistics. BPD is often misdiagnosed as bipolar disorder and vice versa.
According to the National Institutes of Mental Health, about 75% of people diagnosed with BPD are female. However, some research suggests that the rates may be similar in males, but that they more commonly receive a misdiagnosis of depression or post-traumatic stress disorder (PTSD). Females may also be misdiagnosed with BPD when it should be a different diagnosis.
Researchers today don’t know why some people develop BPD and others do not, but studies have shown that many aspects of your life can play a role, including biology, psychology, and environmental factors.
Most professionals subscribe to a biopsychosocial model of causation. This means that the causes of BPD are a combination of:
biological and genetic factors
social, cultural, and environmental factors, such as the person’s experiences with family, friends, and other children in their early development
psychological factors, such as the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress
Many people with a BPD diagnosis report having experienced traumatic life events during childhood. This might include abuse, abandonment, or other forms of trauma. Many people also had difficult relationships in childhood, such as hostile conflicts, invalidation from others, and unstable relationships.
BPD can run in families. If you have a close family member with a BPD diagnosis, such as a parent or sibling, you may have a higher risk of developing it, too.
No single factor is responsible for BPD — rather, it is the complex and likely intertwined nature of all three factors.
Treatment of BPD typically involves long-term psychotherapy (talk therapy) with a therapist who has experiencetreating this kind of personality disorder.
A few kinds of psychotherapy are available for people with BPD.
Dialectical behavior therapy (DBT) is often called the “gold standard” of borderline personality disorder treatment. It teaches you self-awareness, emotional regulation, and healthy relationship skills. It aims to help you develop the skills to cope with difficult emotions.
Mentalization-based therapy (MBT) helps you to examine the thoughts you have about yourself and others. It aims to help you deepen your understanding of yourself and other’s mental states.
Other therapies might include cognitive behavioral therapy (CBT) and psychodynamic therapy.
While there is no specific medication to treat BPD, other medications — such as antidepressants and mood stabilizers — might help people manage some symptoms they find challenging.
In times of crisis, a hospital visit can help provide the resources that you need to feel better. This is typically a short-term hospital stay of a week or so, but this depends on the individual’s situation. Hospitalization is considered if you might harm yourself or others.
Self-help strategies can help ease your symptoms. This could include using BPD workbooks, learning DBT skills at home, or finding healthy emotional outlets, such as a creative hobby or exercise. Connecting with support groups might also be helpful.
Maintaining a balanced diet, exercising regularly, and getting quality sleep also benefit your mental and physical health.
When to talk with a doctor
If you think you or a loved one has BPD, the first step is typically to speak with a medical professional.
You could either talk with a primary care doctor, who will likely refer you to a mental health professional, or find a therapist with experience in treating BPD.
Whether you have BPD or not, if you’re experiencing distress, it’s a good idea to seek help. Remember that you’re not alone and that many forms of treatment are available.