BPD Symptoms
A BPD diagnosis requires at least five of the following. Symptoms can be triggered by ordinary events.
- Ongoing feelings of emptiness: Persistent numbness or emptiness that attempts to fill with food, sex, alcohol, or drugs can’t resolve.
- Fear of abandonment: Intense fear of real or imagined separation or rejection, leading to frantic efforts to avoid it — rapidly initiating relationships or cutting off contact preemptively.
- Unstable and intense relationships: Extreme, rapid shifts in how others are perceived — adoring someone one moment, finding them cruel the next.
- Shifting self-image: Abrupt changes in self-identity, goals, and values; may include seeing oneself as fundamentally bad or non-existent.
- Mood swings: Intense but short-lived shifts between happiness, irritability, shame, sadness, or anxiety — often lasting hours or minutes rather than days.
- Risky behavior: Impulsive actions such as drug use, gambling, reckless driving, or sabotaging success.
- Intense anger: Frequent, extreme rage directed at self or others; may involve screaming, throwing objects, or physical altercations.
- Dissociation: Feeling cut off from oneself, seeing oneself from outside the body, losing touch with reality, or feeling foggy and spaced out.
- Self-harm: Threats of self-harm or suicidal thoughts, often in response to fear of separation or perceived rejection.
Types of BPD
- Discouraged (Quiet) BPD: Frequent shame, guilt, social anxiety, feelings of inadequacy, and obsessive patterns.
- Impulsive BPD: Intense need for immediate gratification, discounting delayed rewards, strong feelings of rejection and anger.
- Self-destructive BPD: Frequent self-sabotage of relationships and engagement in risky behaviors with little regard for consequences.
- Petulant BPD: Inappropriate anger outbursts, unstable self-image, urge to manipulate or control others, difficulty maintaining relationships.
Causes of BPD
The exact cause is unknown. However, research shows BPD occurs equally in men and women. Risk factors are not the same as causes — many people develop BPD without any known risk factors.
- Genetics: More common in people with a first-degree relative with BPD, though family history doesn’t guarantee development.
- Brain structure: Physical changes and abnormalities in brain structure or function may increase risk.
- Environmental factors: Childhood abuse (sexual, physical, or emotional), fear of abandonment in childhood or adolescence, or an unstable family environment.
Treatment for BPD
Evidence-based treatments are proven to help people experience fewer and less severe symptoms. A treatment plan may include therapy, medication, hospitalization, or a combination.
1. Therapy
- Dialectical behavior therapy (DBT): Developed specifically for BPD. Uses mindfulness and acceptance to teach skills for controlling intense emotions, reducing self-destructive behavior, and improving relationships.
- Cognitive behavioral therapy (CBT): Identifies and changes unhealthy beliefs, behaviors, and inaccurate perceptions; helps develop healthier responses to anger, insecurity, and anxiety.
- Outpatient/inpatient treatment: For severe symptoms. Hospitalization or emergency care may be needed in instances of self-harm.
2. Medication
Medication does not cure BPD but can relieve symptoms. An in-person or online psychiatrist may prescribe antidepressants, antipsychotics, or anti-anxiety medications. Always used alongside therapy, not as a standalone treatment.
3. Alternative & Natural Treatments
Holistic and natural remedies are increasingly used alongside therapy to manage BPD symptoms.
Conditions Similar to BPD
Many people with BPD also have signs of at least one additional condition. Symptoms can appear similar across conditions, but each has distinguishable differences and its own treatment approach.
Other Personality Disorders
- Cluster A: Odd or eccentric thinking/behavior: paranoid, schizoid, and schizotypal personality disorders.
- Cluster B: Dramatic, emotional, or unpredictable behavior: antisocial, BPD, histrionic, and narcissistic personality disorders.
- Cluster C: Anxious or fearful thinking: avoidant, dependent, and obsessive-compulsive personality disorders.
Depression
Depression: A mood disorder causing persistent sadness, loss, or anger that severely impacts quality of life. Affects ~8.1% of U.S. adults and commonly co-occurs with BPD.
Anxiety Disorders
Anxiety disorders: Feelings of fear or apprehension that last longer than six months and impair daily life. Can co-occur with BPD.
Bipolar Disorder
Bipolar disorder shares some similarities with BPD — both involve extreme emotions and impulsive behavior — but they are distinct conditions with different treatment approaches. See: Borderline Personality Disorder vs. Bipolar Disorder.
PTSD
PTSD is triggered by traumatic events and can involve severe anxiety and intrusive thoughts. PTSD symptoms overlap with BPD, complicating diagnosis.
ADHD
ADHD: Ongoing inattention and impulsive hyperactivity that can negatively affect daily functioning. Shares some behavioral overlap with BPD.
