Borderline personality disorder is a mental health condition that causes someone to experience ongoing patterns of turbulent and unstable emotions. It impacts an estimated 1.4 percent of adults in the United States and affects individuals’ mood, self-image, and behavior over a long period of time, often resulting in impulsive actions and relationship problems. 

Recognizable symptoms of borderline personality disorder typically surface during teenage years and through early adulthood. Someone with this disorder may experience anger, depression, and anxiety lasting anywhere from a few hours to a few days. Many people with borderline personality disorder show noticeable improvement over time and can manage symptoms with treatment. 

What is Borderline Personality Disorder?

Borderline personality disorder is a serious mental illness centered on a person’s inability to manage their emotions and the tendency to view things in the extreme. It can have a negative effect on interpersonal relationships because of its ongoing patterns of unstable moods and impulsive actions and behaviors. Like many other personality disorders, someone can be diagnosed with borderline personality disorder along with other disorders, such as depression, anxiety, eating disorders, and substance and/or alcohol abuse, which come with additional symptoms and effects. 

Borderline Personality Disorder Symptoms and Behaviors 

Those who have borderline personality disorder experience frequent emotional and relational instability. Their interests and values can change quickly and extreme shifts in feelings can lead to intense and rocky relationships. It is common to see problems with romantic relationships, friendships, and issues within the workplace. The most common behaviors and symptoms of borderline personality disorder include:

  • Ongoing feelings of emptiness: feeling “empty” or numb is normal for those with borderline personality disorder. Often, even when these individuals try to shake the feeling with food, sex, alcohol, or drugs, nothing feels truly satisfying.  
  • Fear of abandonment: an intense fear of abandonment can lead to real or imagined separation or rejection from others. It also may result in efforts to avoid abandonment, such as rapidly initiating intimate relationships and cutting off communication with someone in anticipation of being abandoned (whether this threat is real or perceived).
  • Patterns of unstable and intense relationships: those with borderline personality disorder experience rapid, intense shifts in relationships. They might adore someone in one moment and suddenly finding that same person cruel in the next. This can also include ending positive relationships without a significant reason.
  • Shifting Self-Image: abrupt changes in self-identity and self-image, including shifts in goals, and values is typical for those with borderline personality disorder. One might even see themselves as a bad person or non-existent.
  • Mood swings: short- and long-term mood swings, including intense happiness, irritability, shame, sadness and/or anxiety can come quickly and intensely for those with borderline personality disorder. Unlike the emotional mood swings of anxiety and depression, however, these mood swings pass relatively fast lasting for a few hours or minutes.
  • Risky Behavior: experiencing impulsive and risky behavior, such as drug use, gambling, reckless driving, and/or sabotaging success.
  • Intense anger: those with borderline personality disorder might frequently lose their  temper and experience extreme rage at themselves or others. Screaming, throwing things, and engaging in physical fights is typical.
  • Feelings of dissociation:, being cut off from oneself, seeing oneself from outside one’s body, losing touch with reality, and feeling foggy and spaced out, is characteristic of borderline personality disorder. 
  • Self-harm: threats of self harm and suicidal thoughts are common in people with borderline personality disorder and might occur in response to fear of separation or perceived rejection.
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These symptoms can be triggered by seemingly ordinary events, such as becoming distressed while traveling to work or when being separated from someone else for a short period of time. It is important to note that not everyone with borderline personality disorder will experience every symptom. In order to be diagnosed with borderline personality disorder, a person must show at least five of the above symptoms, but some individuals will experience less than others. Someone who is consistently experiencing one or more of these borderline personality disorder symptoms should talk to their doctor or mental health care provider. 

Borderline Personality Disorder Risk Factors

As is the case with other mental health conditions, the causes of borderline personality disorder aren’t completely understood. While the exact cause of this mental health condition is unknown, research has shown that this disorder occurs equally in men and women, and there are some genetic, familial, and social risk factors that can play a role, including:

Genetics

Personality disorders are more common in people who have a first-degree relative with the condition, such as a parent or sibling. However, just because someone has family members with a history of borderline personality disorder doesn’t mean that everyone in the family will develop it. Most people who have borderline personality disorder in their family history will never actually develop it. 

Brain structure

There are biological differences in those that have the disorder, including physical changes to their brains. Any abnormalities in the structure or functions of the brain may increase the risk for borderline personality disorder.

Environmental factors

Beyond biology and family history, environmental factors can contribute to developing borderline personality disorder as well. Childhood sexual, physical, or emotional abuse, a real or imagined fear of abandonment in childhood or adolescence, and trauma or unstable family life at a young age can play a role.

It is important to note that risk factors are not the same as a cause — just because a person experiences some of the risk factors does not mean they will develop borderline personality disorder. In fact, just as many people develop the disorder without any risk factors.

Conditions Similar to Borderline Personality Disorder

Additional personality disorders and mental health issues can have an impact on those diagnosed with borderline personality disorder. In fact, many people with one personality disorder also have signs and symptoms of at least one additional disorder. In some cases, symptoms can appear similar, yet they each have distinguishable differences and treatment plans. These include:

Other personality disorders

Besides borderline personality disorder, there are many other types of personality disorders that change the way a person thinks and behaves. Types of personality disorders are grouped into three clusters based on similar characteristics and symptoms. 

Depression

This mood disorder is marked by feelings of sadness, loss, or anger and can severely impact a person’s quality of life. Depression is a fairly common mental health illness experienced by an estimated 8.1 percent of American adults ages 20 and over, according to the Centers for Disease Control and Prevention (CDC). Depression can also occur alongside a borderline personality disorder diagnosis.  

Anxiety disorders

Anxiety occurs as a person’s natural response to stress. It is a feeling of fear or apprehension about what is to come, such as a job interview. Feelings of anxiety that last longer than six months and impact daily life are considered to be anxiety disorders. 

Bipolar disorder

Bipolar disorder is a common mental illness that can be severe and persistent. It causes a person to experience extreme highs and lows in their mood.  

Post-traumatic stress disorder (PTSD)

This mental health condition is triggered by a traumatic event. Whether a person experiences it, or witnesses it, symptoms of PTSD can include severe anxiety, as well as uncomfortable thoughts and feelings that can interfere with a person’s daily life. 

Attention-deficit hyperactivity disorder (ADHD)

ADHD is marked by an ongoing pattern of inattention and impulsive hyperactivity. It can negatively impact a person’s normal functioning by causing a need to move about constantly and make hasty actions with the potential for harm. 

Treating Borderline Personality Disorder

While borderline personality disorder has historically been viewed as difficult to treat, there are more recent, evidence-based treatments that are proven to help people with borderline personality disorder experience fewer and less severe symptoms. A mental health professional may recommend a treatment plan that includes one or more treatments, such as psychotherapy, medication, and hospitalization. Over time, these treatments help improve a person’s daily functioning, outlook, and quality of life. The key is to seek specialized treatment from an appropriately trained and credentialed mental health professional and stick with the treatment plan. 

Getting diagnosed

The first step in treating borderline personality disorder is getting diagnosed. You can either speak to your primary care doctor to request a referral for a therapist or psychiatrist, or start today by giving online therapy a try. 

The diagnosis process consists of a therapist asking you thorough questions about your current symptoms and emotional state and helping to determine if you have borderline personality disorder. Only a licensed professional can make an official diagnosis.

Therapy

Psychotherapy is the primary treatment method used to help a person manage borderline personality disorder symptoms over the long term. Therapy is a highly effective treatment for this illness, as it helps change harmful and destructive thought patterns that drive emotional instability. Over time, new patterns of thinking can have a positive impact on your behavior and outlook. The following therapies may be applied:

  • Dialectical behavior therapy. This therapy type was developed for those who have borderline personality disorder and uses concepts of mindfulness and acceptance to help improve symptoms. This treatment teaches skills that can help a person better control intense emotions, reduce self-destructive behavior and improve relationships.
  • Cognitive behavioral therapy. This form of therapy helps a person identify and change unhealthy beliefs, behaviors and inaccurate perceptions they have about themselves or others. Through this treatment, a person with borderline personality disorder can learn healthier ways to react when feeling angry, insecure or anxious. 
  • Outpatient treatments. If a person is experiencing severe symptoms and needs intensive intervention and treatment, inpatient care and treatments may be used, as well as hospitalization or emergency care in instances of self-harm. 

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Medications

In some cases, a psychiatrist may determine that medication is also needed to assist in your treatment plan in addition to talk therapy. While medication does not cure borderline personality disorder, it can relieve its symptoms. A doctor may prescribe antidepressants, antipsychotics or antianxiety medications to treat mood swings, depression, anxiety and any mental health disorders that may occur concurrently. 

Psychiatry

Psychiatric treatment from a licensed prescriber

When to Get Immediate Help

If you or someone you know with borderline personality disorder is having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. Calls are free and your information is kept confidential.

When a person is diagnosed with borderline personality disorder, they can expect to face lifelong challenges and may struggle to control ongoing patterns of turbulent and unstable emotions. The key is to seek out professional medical help and stick with the treatment plan prescribed by a doctor. Over time, the combination of medication, therapy, and an overall healthy lifestyle can lead to increased satisfaction and stability following a diagnosis of borderline personality disorder.


Medically reviewed by
Ashley Ertel, LCSW, BCD

Reviewed On: June 1, 2021