This page has been reviewed and edited by Eualalee Thompson, MSc, PGDip, a trained and practicing psychotherapist and counselor in private practice since 2005. She commonly assists her clients with anxiety, depression, post-traumatic stress disorder (PTSD), and surviving sexual abuse.
Definition - Borderline Personality Disorder (BPD) is a serious mental illness characterized in the DSM 5 as pervasive instability in moods, interpersonal relationships, self-image, and behavior.
The pervasive instability in a person with BPD often disrupts relationships in family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation.
While less well known than
schizophrenia or
bipolar disorder (manic-depressive illness), BPD is more common, affecting about 2% of adults (mostly young women), according to the National Institute of Mental Health (NIMH), or by another estimate, 1-3% of the general population in terms of lifetime occurrence.
Some suggest that the name itself, Borderline Personality Disorder, is an inappropriate term for this disorder, or "a misleading label." The disorder has nothing to do with neurosis or psychosis, but rather involves emotional volatility; what one reporter described as "a [very] thin emotional skin." Self-loathing, poor self-esteem, and
suicidality are also part of the profile of BPD.
High Rate of Self-Injury in Borderline Personality Disorder
1. There is a high rate of self-injury without suicidal intent, as well as a significant rate of
suicide attempts and completed suicide in severe cases of BPD. Between 69 and 80% of persons with BPD engage in suicidal behavior.
2. Patients with BPD often need extensive mental health services, and account for 20% of psychiatric
hospitalizations (NIMH, 2009). Forty percent of the highest users of inpatient psychiatric services receive a diagnosis of BPD. Many are helped through psychiatric services. However, about 50% or 46% have repeat hospitalization despite long-term or extended-term care (Tucker, 1987).
Inner Conflicts Involved with Borderline Personality Disorder
While a person with
depression or bipolar disorder typically experiences the same mood for weeks, a person with BPD may experience intense bouts of anger,
depression, and
anxiety within a short period of time, perhaps within a few hours or at most, a day.
These variations in emotional expressions may be associated with episodes of impulsive aggression, self-injury, and drug or
alcohol abuse.
Self-hate, self-loathing: Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad or unworthy.
With borderline personality disorder, one's self-image is distorted, making one feel worthless and fundamentally flawed. The anger, impulsivity, and frequent mood swings associated with BPD may push others away, even though the person with BPD yearns for loving relationships [Mayo Clinic].
People with BPD may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, which may result in frantic efforts to avoid being alone.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). For instance, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they quickly switch to the other extreme and angrily accuse the other of not caring for them at all.
Mayo Clinic: “Your relationships are usually in turmoil. You often experience a love-hate relationship with others. Difficulty accepting grey areas. Often a result of childhood
sexual or other abuse.”
Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless.
Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments. People with BPD exhibit other impulsive behaviors, such as excessive spending, binge-eating, and risky sex. BPD often occurs together with other psychiatric problems, particularly
bipolar disorder,
depression,
anxiety disorders,
substance abuse, and other personality disorders.
Some of the emotions and behaviors which contribute to the label
of borderline personality disorder
Impulsive and risky behavior, such as risky driving, unsafe sex, or gambling sprees
Drug or alcohol abuse
Self-destructive behavior
Self-hate, self-loathing
Feelings of social isolation
Unstable relationships
Frequent changes in life plans, careers, jobs
Poor self-image
Feelings of emptiness, being mistreated, bored
Strong emotions that wax and wane frequently
Intense but short episodes of anxiety or depression
Inappropriate anger, sometimes escalating into physical confrontations
Difficulty controlling emotions or impulses
Wide mood swings
Suicidal behavior
Fear of being alone
Fear of abandonment
Periods of paranoia, loss of touch with reality
Current Treatment Approaches
The first treatment for borderline personality disorder is the non-pharmaceutical approach that incorporates some elements of Eastern religious practice, Dialectical Behavior Therapy or
DBT.
As with all psychiatric treatment, pharmaceutical drugs are prescribed whether they are proved effective or not for that particular disorder. In the case of BPD,
antidepressants are often utilized for the disorder itself or for concurrent depression. The same could be said for
mood stabilizers and
antipsychotics in addressing other symptoms.
Note: There is no evidence that inpatient
hospitalization is an effective treatment for
suicidality in borderline personality disorder patients. Therefore, it may be that inpatient admissions for
suicide ideation were actually iatrogenic* rather than therapeutic.
While those in DBT therapy were less likely to take medication while on therapy, those in expert community care were both more likely to be on medication or much more likely to be hospitalized. This raises the thought that community therapy resorts to hospitalization and depend more on drugs for treatment, and therefore may be less effective than more intensified therapy through specific well-trained therapists.
Also of note is that many of the symptoms of borderline personality disorder can basically be described as the intense side of the residual effects of child abuse. That is, child abuse, especially sexual child abuse, produces most of the symptoms in later life for some people, as described for borderline personality disorder. If a client is treated for child abuse — if there has been this experience in his or her life — then it might be the best way of dealing with the issues, rather than focusing on labeling and medicating.
*iatrongenic - (of a medical disorder) caused by the diagnosis, manner, or treatment of a physician.
Please Note: This site informs and educates the reader on specific treatments, but does not necessarily recommend or endorse DBT. Please see note at bottom of page (
dialectical behavior therapy).
References for Symptoms of Borderline Personality Disorder and Treatment page
1. Borderline Personality Disorder. (May 13, 2009). National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/index.shtml
2. Borderline Personality Disorder. (May 14, 2008). Mayo Clinic. https://www.mayoclinic.com/health/borderline-personality-disorder/ds00442
3. Brody, J. (June 15, 2009). An Emotional Hair Trigger, Often Misread. New York Times. https://www.nytimes.com/2009/06/16/health/16brod.html?_r=1&scp=6&sq=borderline%20%20personality%20disorder&st=cse
Korzekwa, M.I., Dell, P.F., Links, P.S., Thabane, L. & Webb, S.P. (2008). Estimating the prevalence of borderline personality disorder in psychiatric outpatients using a two-phase procedure. Comprehensive Psychiatry, 49(4), 380-386.
4. Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z. Gallop, R.J., Heard, H.L. Korslund, K.E., Tutek, D.A., Reynolds, S.K., Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and Borderline Personality Disorder. Archives of General Psychiatry,63. 757-766. https://archpsyc.ama-assn.org/cgi/content/full/63/7/757
5. Tucker, L., et al., (1987). Long term treatment of borderline patients: A descriptive outcome study. American Journal of Psychiatry, 144, 1443-1448. https://ajp.psychiatryonline.org/cgi/reprint/144/11/1443?ijkey=7b3811f2d7dd690d7517c475e263ed11ea22e967
