Borderline Personality Disorder

What is it?

Personality disorders are deeply ingrained patterns of behavior that violate social norms and cause problems in interpersonal relationships. They are broken into three categories — Cluster A, B and C. 

Personality disorders are previously known as axis two disorders — a group of conditions that impact a person’s function in relation to others. They are ego-syntonic, meaning a person with a personality disorder often doesn’t believe they have a problem. The disorder is consistent with their world view, perception of others and perception of themselves. They usually begin during a person's teenage years or early adulthood, and in some cases, become less obvious in middle age. It is common for people with one personality disorder to have symptoms of another.

Borderline personality disorder, also called BPD, is a Cluster B disorder. Cluster Bs are characterized by dramatic, emotional or erratic behavior. People with BPD have trouble regulating their emotions. They often struggle with self-image issues, managing emotions and behavior, and have a pattern of unstable relationships.  BPD is characterized by an intense fear of abandonment or instability. A person with the disorder may have difficulty being alone, however, their mood swings and inappropriate behavior(s) often push people away. Symptoms usually arise in early adulthood and worsen with age.

BPD often occurs alongside other mental health conditions including depression, anxiety disorders, PTSD, eating disorders and substance abuse. It’s estimated that around 1.9% of the U.S. population has BPD, but that number could be as high as 5.9%. It is more common in women than men.

What are the symptoms?

People with BPD feel emotions very intensely. They often panic or become angry if they think they’re being abandoned or wronged by others. These emotional responses lead to rocky relationships. They sometimes switch quickly between idolizing people, and hating them. Their emotional highs and lows can lead to impulsive behavior, such as self-harm, having lots of sex, making drastic changes in their appearance, or spending lots of money. 

Additional symptoms include: 

• An intense fear of abandonment 
• Going to extreme lengths to avoid being abandoned, such as threating suicide 
• Having a pattern of unstable or abusive relationships 
• Undergoing sudden changes in self-identity or self-image, such as changing careers, homes or fashion very quickly 
• Experiencing periods of paranoia in which they lose contact with reality 
• Engaging in impulsive or risky behavior, including drug use or self-sabotage 
• Threatening suicide or self-injury 
• Experiencing substantial mood swings that last for hours or days 
• Experiencing intense happiness, irritability, shame or anxiety 
• Feeling empty 
• Intense expressions of anger, including screaming or starting physical fights

What are some common warning signs?

BPD is characterized by intense emotions and codependent behavior. Because of this, a loved one with BPD might display noticeable symptoms at home, at work or in social settings. Pay attention to their emotional reactions, social habits and relationships with others. Ask yourself the following questions: 

• Do they fear being alone or abandoned by family, friends and partners? 
• Do they go through sudden, drastic changes in appearance, such as cutting or dying their hair, getting piercings or dressing differently? 
• Do they go through sudden, drastic changes in their life goals, such as switching jobs, moving, or changing their personal beliefs? 
• Do they threaten suicide or self-harm when they get upset? 
• Do they become overly angry or aggressive when they think they’ve been wronged? 
• Do they become attached or obsessed with people very quickly? 
• Do you have to “tip-toe” around them out of fear of upsetting them? 

None of these behaviors confirm a BPD diagnosis, but they do hint at one. If you feel comfortable doing so, talk to your loved one about this behavior and why you’re concerned. Keep in mind that symptoms aren’t always obvious. People battling chronic mental health conditions often learn to hide their pain from others. It’s possible to appear outwardly fine, while facing mental difficulties in secrecy.

What causes BPD?

The exact causes of BPD are unknown. Doctors believe a range of factors play a role in its development, including being genetically predisposed (i.e. other family members struggle with BPD or other mental disorders), having a history of trauma (such as being emotionally or physically abused as a child), or having brain abnormalities such as issues with serotonin production, or problems in areas of the brain involved in emotion regulation, impulsivity and aggression.

How is it treated?

The primary treatment method for all personality disorders, BPD included, is psychotherapy (aka talk therapy). Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT) and Psychodynamic psychotherapy are the most commonly recommended approaches. Additional approaches include Schema-focused therapy, Mentalization-based therapy (MBT), Systems training for emotional predictability and problem-solving (STEPPS), and Transference-focused psychotherapy (TFP). 

Medications are not commonly used to treat personality disorders. However, they may be recommended to address severe cases or symptoms that stem from co-occurring conditions.  

Common medications include anti-depressants such as SSRIs or SNRIs, anti-anxiety medications (aka Benzodiazepines), mood-stabilizers and antipsychotics. 

It’s important to remember that treatment plans are personalized. If you’re seeking help, make sure you work one-on-one with a doctor to create a plan that fits your needs. Just because a medication or therapy helps someone else recover, doesn’t mean it’ll be the right solution for you. Don’t ever feel guilty about asking for help, taking meds or going to therapy. Addressing your mental health is a productive and courageous thing to do.

How can I help a loved one with BPD?

Caring for someone with BPD is not easy. Your relationship may feel turbulent and toxic at times. It’s important to remember that their insecurities or emotional responses don’t mean you’re a bad person. 

It can also be hard to know how to support them. Do they want to talk about their behavior? Will they push you away if you try to help? There are no easy answers to these questions. Every person handles their mental health differently. That said, we all want to feel loved and supported. Showing someone that you’re invested in their wellbeing can make a world of difference. 

Here are some ways to do so: 

• Educate yourself: Read up on symptoms, treatment options, and healthy living recommendations. Try and understand what your loved one is going through so you are better equipped to talk to them about it. This will also make you a valuable resource when it comes time to find treatment. 
• Advocate treatment: Asking for help can be hard. Societal stigma often keeps people from opening up to others about their symptoms. Support your loved one by helping them research different treatment methods, or doctors in their area. If they’d like, go to a few sessions with them. Remind them that there’s nothing weird about getting help, and that you’re proud of them for following through. 
• Tell them you care: Let them know that you love them and are there for them. Compliment them when they look good or do something well. People with BPD are often self-conscious and insecure. These acknowledgements will be reassuring. 
• Set boundaries: You want to be understanding of their symptoms, but that doesn’t mean you have to put up with everything. Make rules for what you will and won’t tolerate. Stick to these boundaries and follow through on consequences when they’re broken. 
• Be patient: Don’t take it personally if they lash out at you. They are battling something that’s very hard to overcome. Their distance has nothing to do with who you are as a person. Keep showing up for them even when it feels like it’s not helping. The act alone lets them know that they have people in their life who care.s