Personality Disorders Community

What is Borderline Personality Disorder?

Bookmark and Share

In-depth look at Borderline Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.

Borderline personality disorder is often a devastating mental condition, both for the people who have it and for those around them.

Perhaps shaped by harmful childhood experiences or brain dysfunctions, people diagnosed with borderline personality disorder live in a world of inner and outer turmoil. They have difficulty regulating their emotions and are often in a state of upheaval. They have distorted images of themselves, often feeling worthless and fundamentally bad or damaged.

And while they yearn for loving relationships, people with borderline personality disorder typically find that their anger, impulsivity, stormy attachments and frequent mood swings push others away.

With borderline personality disorder, there is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.

advertisement

Over the last 10 years, increasing awareness and research are helping improve the treatment and understanding of borderline personality disorder. At the same time, it remains a controversial condition, particularly since so many more women than men are diagnosed with it, raising questions about gender bias. Although definitive data are lacking, it's estimated that 1 percent to 2 percent of American adults have borderline personality disorder (BPD). It occurs in about one in every 33 women, compared with one in every 100 men, and is usually diagnosed in early adulthood.

Even though a very troubling personality disorder, with consistent help, many with BPD improve over time and are eventually able to lead productive lives.

Borderline Personality Disorder Signs and Symptoms

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that n-depth look at Borderline Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. 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 borderline personality disorder view themselves as fundamentally bad, or unworthy. They 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, and 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). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

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. In fact, suicide rates among people with BPD are very high, reaching 10 percent.

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, self-injury (such as cutting and burning) and other personality disorders.

Because of their risky, impulsive behavior, people with BPD are also more vulnerable to unplanned pregnancies, sexually transmitted diseases, motor vehicle accidents and physical fights. They may also be involved in abusive relationships, either as the abuser or the abused.

Causes of Borderline Personality Disorder

What causes someone to develop Borderline Personality Disorder? Possible causes of BPD include:

  • Genetics. Some studies of twins and families suggest that personality disorders may be inherited.
  • Environmental factors. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.
  • Brain abnormalities. Some research shows changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

Most likely, a combination of these issues results in borderline personality disorder.

How is Borderline Personality Disorder Diagnosed?

Personality disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with borderline personality disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV):