6. Borderline personality disorder

What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, theDiagnostic and Statistical Manual for Mental Disorders, Third Edition(DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name "borderline personality disorder" is misleading, a more accurate term does not exist yet.

Most people who have BPD suffer from:

• Problems with regulating emotions and thoughts
• Impulsive and reckless behavior
• Unstable relationships with other people.

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Causes

Research on the possible causes and risk factors for BPD is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.

Studies on twins with BPD suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

Social or cultural factors may increase the risk for BPD. For example, being part of a community or culture in which unstable family relationships are common may increase a person's risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

Signs & Symptoms

According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:

• Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
• A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
• Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
• Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
• Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
• Intense and highly changeable moods, with each episode lasting from a few hours to a few days
• Chronic feelings of emptiness and/or boredom
• Inappropriate, intense anger or problems controlling anger
• Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Suicide and Self-harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.

Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with BPD. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may self-harm to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.

Who Is At Risk?

According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.  BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood.

Diagnosis

Unfortunately, BPD is often underdiagnosed or misdiagnosed.

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional's attention.

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, BPD is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder. According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also meet the diagnostic criteria for another mental illness. Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia. These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat BPD and other mental disorders.

No single test can diagnose BPD. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with BPD showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe BPD showed a more intense emotional response than people who had less severe BPD.

Treatments

BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.

BPD can be treated with psychotherapy, or "talk" therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional's care, it is essential for the professionals to coordinate with one another on the treatment plan.

The treatments described below are just some of the options that may be available to a person with BPD. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.

Psychotherapy

Psychotherapy is usually the first treatment for people with BPD. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.

It is important that people in therapy get along with and trust their therapist. The very nature of BPD can make it difficult for people with this disorder to maintain this type of bond with their therapist.

Types of psychotherapy used to treat BPD include the following:Cognitive behavioral therapy (CBT). CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

1. Dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. This therapy differs from CBT in that it seeks a balance between changing and accepting beliefs and behaviors.
2. Schema-focused therapy. This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.

Therapy can be provided one-on-one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with BPD how to interact with others and how to express themselves effectively.

One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists funded by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviors of BPD, relieve symptoms of depression, and improve quality of life. The effectiveness of this type of therapy has not been extensively studied.

Families of people with BPD may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms.

Some therapies, such as DBT-family skills training (DBT-FST), include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with BPD. Other therapies, such as Family Connections, focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in BPD. Studies with other mental disorders suggest that including family members can help in a person's treatment.

Other types of therapy not listed in this booklet may be helpful for some people with BPD. Therapists often adapt psychotherapy to better meet a person's needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section onpsychotherapy.

Some symptoms of BPD may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent. People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder. However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with BPD had a relapse after remission.

Medications

No medications have been approved by the U.S. Food and Drug Administration to treat BPD. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with BPD are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.

Medications can cause different side effects in different people. People who have BPD should talk with their prescribing doctor about what to expect from a particular medication.

Other Treatments

Omega-3 fatty acids. One study done on 30 women with BPD showed that omega-3 fatty acids may help reduce symptoms of aggression and depression. The treatment seemed to be as well tolerated as commonly prescribed mood stabilizers and had few side effects. Fewer women who took omega-3 fatty acids dropped out of the study, compared to women who took a placebo (sugar pill).

With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with BPD to be patient and to receive appropriate support during treatment.

Living With

Some people with BPD experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.

How can I help a friend or relative who has BPD?

If you know someone who has BPD, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.

To help a friend or relative you can:

Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with BPD, but it is possible for them to get better over time

• Learn about mental disorders, including BPD, so you can understand what your friend or relative is experiencing
• With permission from your friend or relative, talk with his or her therapist to learn about therapies that may involve family members, such as DBT-FST.

Never ignore comments about someone's intent or plan to harm himself or herself or someone else. Report such comments to the person's therapist or doctor. In urgent or potentially life-threatening situations, you may need to call the police.

How can I help myself if I have BPD?

Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.

To help yourself:

• Talk to your doctor about treatment options and stick with treatment
• Try to maintain a stable schedule of meals and sleep times
• Engage in mild activity or exercise to help reduce stress
• Set realistic goals for yourself
• Break up large tasks into small ones, set some priorities, and do what you can, as you can
• Try to spend time with other people and confide in a trusted friend or family member
• Tell others about events or situations that may trigger symptoms
• Expect your symptoms to improve gradually, not immediately
• Identify and seek out comforting situations, places, and people
• Continue to educate yourself about this disorder.

Is this you? Someone you know?

Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to manage emotions effectively.  The disorder occurs in the context of relationships:  sometimes all relationships are affected, sometimes only one.

While some persons with BPD are high functioning in certain settings, their private lives may be in turmoil.  Other disorders, such as depression, anxiety disorders, eating disorders, substance abuse and other personality disorders. can often exist along with BPD

The diagnosis of BPD is frequently missed  and a  misdiagnosis of the BPD diagnosis has been shown to delay and/or prevent recovery.   Bipolar disorder is one example of a misdiagnosis as it also includes mood instability.

Officially recognized in 1980 by the psychiatric community, BPD is more than two decades behind in research, treatment options, and family psycho-education compared to other major psychiatric disorders. BPD has historically met with widespread misunderstanding and blatant stigma.  However, evidenced-based treatments have emerged over the past two decades bringing hope to those diagnosed with the disorder and their loved ones.

Diagnostic Criteria

A pervasive pattern of instability of interpersonal relationships, self image and affects, and marked impulsivity beginning by early adulthood  and present in a variety of contexts, as indicated by five (or more) of the following:

1)   Frantic efforts to avoid real or imagined abandonment.

2)   A pattern of unstable and intense interpersonal relationships characterized by alternating between  extremes of idealization and devaluation.

3)  Identity disturbance:  markedly and persistently unstable self-image or sense of self.

4)   Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

5)   Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

6)   Affective [mood] instability.

7)   Chronic feelings of emptiness.

8)   Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9)   Transient, stress-related paranoid ideation or severe dissociative symptoms.

*Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association

Officially recognized in 1980 by the psychiatric community, BPD is more than two decades behind in research, treatment options, and family psycho-education compared to other major psychiatric disorders. BPD has historically met with widespread misunderstanding and blatant stigma.  However, evidenced-based treatments have emerged over the past two decades bringing hope to those diagnosed with the disorder and their loved ones.

 Prevalence:

• BPD afflicts up to 5.9% of adults (approximately 14 million Americans)
• BPD is more common than schizophrenia and bipolar disorder
• 20% of inpatients admitted to psychiatric hospitals, 10% of outpatients have BPD

BPD Overview

About Borderline Personality Disorder (BPD)

Brief Overview

Borderline personality disorder (BPD) is a serious mental illness that causes unstable moods, behavior, and relationships. It usually begins during adolescence or early adulthood.

Most people who have BPD suffer from:

• Problems regulating their emotions and thoughts
• Impulsive and sometimes reckless behavior
• Unstable relationships

Incidence

• BPD affects 5.9% of adults (about 14 million Americans) at some time in their life
• BPD affects 50% more people than Alzheimer’s disease and nearly as many as schizophrenia and bipolar combined (2.25%).
• BPD affects 20% of patients admitted to psychiatric hospitals
• BPD affects 10% of people in outpatient mental health treatment

Prognosis

Research has shown that outcomes can be quite good for people with BPD, particularly if they are engaged in treatment. With specialized therapy, most people with borderline personality disorder find their symptoms are reduced and their lives are improved. Although not all the symptoms may ease, there is often a major decrease in problem behaviors and suffering. Under stress, some symptoms may come back.  When this happens, people with BPD should  return to therapy and other kinds of support.

Many individuals with BPD experience a decrease in their impulsive behavior in their 40’s.

The Diagnosis

Overview

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on

• An in-person interview to discuss symptoms
• Input from a family or close friend that adds to the information provided by the individual coming for treatment.

A careful and thorough medical exam can help rule out other possible causes of symptoms.

Making for Diagnosis

Unfortunately, BPD is too often misdiagnosed. Some people who have borderline personality disorder are misdiagnosed with bipolar disorder. There are important differences between these conditions but both involve unstable moods. For the person with bipolar disorder, the mood changes exist for weeks or even months. The mood changes in BPD are much shorter and are often within a day.

To be diagnosed with BPD, a person must experience at least five of the following symptoms:

1. Fear of abandonment
2. Unstable or changing relationships
3. Unstable self-image; struggles with identity or sense of self
4. Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating).
5. Suicidal behavior or self-injury
6. Varied or random mood swings
7. Constant feelings of worthlessness or sadness
8. Problems with anger, including frequent loss of temper or physical fights
9. Stress-related paranoia or loss of contact with reality

Causes of Borderline Personality Disorder

Research on the causes and risk factors for BPD is still in its early stages. However, scientists generally agree that genetic and environmental influences are likely to be involved.

Imaging studies in people with BPD have shown abnormalities in brain structure and function, evidence that biology is a factor.  In people with BPD, more activity than usual has been seen in the parts of the brain that control feeling and expressing emotions.

Certain events during childhood may also play a role in the development of the disorder, such as those involving emotional, physical and sexual abuse. Loss, neglect and bullying may also contribute. The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk.

 Co-morbidities

Borderline personality disorder often occurs with other illnesses. This can make it hard to diagnose, especially if symptoms of other illnesses overlap with the BPD symptoms

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, substance abuse or eating disorders. In men, BPD is more likely to accompany disorders such as substance abuse or antisocial personality disorder.

According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also suffer from another mental illness.⁵

Most of these are listed below, followed by the estimated percent of people with BPD who have them:

• Major Depressive Disorder – 60%
• Dysthymia (a chronic type of depression) – 70%
• Substance abuse – 35%
• Eating disorders (such as anorexia, bulimia, binge eating) – 25%
• Bipolar disorder – 15%
• Antisocial Personality Disorder – 25%
• Narcissistic Personality Disorder – 25%
• Self-Injury – 55%-85%

Research on Borderline Personality Disorder

Recent neuroimaging studies show differences in brain structure and function between people with BPD and people who do not have this illness. ¹ Some research suggests that brain areas involved in emotional responses become overactive in people with BPD when they perform tasks that they see as negative. ² People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods seen in BPD.³

Another study showed that, when looking at emotionally negative pictures, people with BPD used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues. ⁴

What does the name “Borderline Personality Disorder” mean?

Historically, the term “borderline” has been the subject of much debate. BPD used to be considered on the “borderline” between psychosis and neurosis. The name stuck, even though it doesn’t describe the condition very well and, in fact, may be more harmful than helpful. The term “borderline” also has a history of misuse and prejudice—BPD is a clinical diagnosis, not a judgment.

Current ideas about the condition focus on ongoing patterns of difficulty with self-regulation (the ability to soothe oneself in times of stress) and trouble with emotions, thinking, behaviors, relationships and self-image.  Some people refer to BPD as “Emotional Disregulation.”

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1. Emotion-Regulating Circuit Weakened in Borderline Personality Disorder. (ed)^(eds).www.nimh.nih.gov/science-news/2008/emotion-regulating-circuit-weakened-in-borderline-personality-disorder.shtml. Accessed on Oct 10, 2008.   King-Casas B, Sharp C, Lomax-Bream L, Lohrenz T, Fonagy P, Montague PR. The rupture and repair of cooperation in borderline personality disorder. Science. 2008 Aug 8; 321(5890): 806–10.
2. Kernberg OF, Michels R. Borderline personality disorder. Am J Psychiatry. 2009 May; 166(5): 505–8.
3. Lis E, Greenfield B, Henry M, Guile JM, Dougherty G. Neuroimaging and genetics of borderline personality disorder: a review. J Psychiatry Neurosci. 2007 May; 32(3): 162–73;  Silbersweig D, Clarkin JF, Goldstein M, Kernberg OF, Tuescher O, Levy KN, Brendel G, Pan H, Beutel M, Pavony MT, Epstein J, Lenzenweger MF, Thomas KM, Posner MI, Stern E. Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. Am J Psychiatry. 2007 Dec; 164(12): 1832–41.
4. Koenigsberg HW, Siever LJ, Lee H, Pizzarello S, New AS, Goodman M, Cheng H, Flory J, Prohovnik I. Neural correlates of emotion processing in borderline personality disorder.Psychiatry Res. 2009 Jun 30;172(3):192–9.
5. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Sep 15; 62(6): 553–64.
6. Zanarini MC, Barison LK, Frankenburg FR, Reich DB, Hudson JI. Family history study of the familial coaggregation of borderline personality disorder with Axis I and non-borderline dramatic cluster Axis II disorders. Journal of Personality Disorders.2009; 23:357–369.  [PubMed]

Borderline Personality Disorder Symptoms

By PSYCH CENTRAL STAFF

The main feature of borderline personality disorder (BPD) is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive, oftentimes demonstrating self-injurious behaviors (risky sexual behaviors, cutting, suicide attempts).

Borderline personality disorder occurs in most by early adulthood. The unstable pattern of interacting with others has persisted for years and is usually closely related to the person’s self-image and early social interactions. The pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability(fluctuating back and forth, sometimes in a quick manner) in a person’s emotions and feelings.

These individuals are very sensitive to environmental circumstances. The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. They experience intense abandonment fears andinappropriate anger, even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g., sudden despair in reaction to a clinician’s announcing the end of the hour; panic or fury when someone important to them is just a few minutes late or must cancel an appointment). They may believe that this “abandonment” implies they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Relationships and the person’s emotions may sometimes be seen by others or characterized as being shallow.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Specific Symptoms of Borderline Personality Disorder

A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:

• Frantic efforts to avoid real or imagined abandonment
• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
• Identity disturbance, such as a significant and persistent unstable self-image or sense of self
• Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
• Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, oranxiety usually lasting a few hours and only rarely more than a few days)
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
• Transient, stress-related paranoid thoughts or severe dissociative symptoms

Do you have borderline personality disorder?

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Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.

Borderline personality disorder is more prevalent in females (75 percent of diagnoses made are in females). It is thought that borderline personality disorder affects between 1.6 and 5.9 percent of the general population.

Like most personality disorders, borderline  personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

Details about Borderline Personality Disorder Symptoms

Frantic efforts to avoid real or imagined abandonment.

The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.

Unstable and intense relationships.

People with borderline personality disorder may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficient supports or as cruelly punitive. Such shifts other reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.

Identity disturbance.

There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing and support. These individuals may show worse performance in unstructured work or school situations.

You can also learn more about the detailed characteristics of borderline personality disorder.

How is Borderline Personality Disorder Diagnosed?

Personality disorders such as borderline personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose borderline personality disorder.

Many people with borderline personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for  borderline personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Borderline Personality Disorder

Researchers today don’t know what causes borderline personality disorder. There are many theories, however, about the possible causes of borderline personality disorder. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Treatment of Borderline Personality Disorder

Treatment of borderline personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see borderline personality disorder treatment.