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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:
- frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
- a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- identity disturbance: markedly and persistently 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). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
- recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety 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 ideation or severe dissociative symptoms
A diagnosis of BPD is usually made in adults, not children or adolescents. That's because what appear to be signs and symptoms of BPD may go away with maturity.
What are the risk factors for Borderline Personality Disorder?
Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments, as well as impulsivity and poor judgment in choosing partners and lifestyles.
NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.
How is Borderline Personality Disorder treated?
Treatments for BPD have improved. Group and individual psychotherapy are at least partially effective for many patients. Peer reinforcement of appropriate behavior may be more successful than one-on-one counseling because difficulties with authority figures often prevent learning in such situations. Group therapy can also be helpful in modifying specific impulsive behaviors.
A relatively new psychosocial treatment termed dialectical behavior therapy (DBT) has been developed specifically to treat BPD, and this technique has looked promising in treatment studies.
Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and, or, labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.
Is there self-help for Borderline Personality Disorder?
Living with borderline personality disorder can be difficult. You may fully realize that your behaviors and thoughts are self-destructive or damaging yet feel unable to control them. Treatment can help you learn skills to manage and cope with your condition.
Other things you can do to help manage your condition and feel better about yourself include:
- Sticking to your treatment plan
- Attending therapy sessions as scheduled
- Practicing healthy ways to ease painful emotions, rather than inflicting self-injury
- Not blaming yourself for having the disorder but recognizing your responsibility to get it treated
- Learning what things may trigger angry outbursts or impulsive behavior
- Not being embarrassed by having this condition
- Getting treatment for related problems, such as substance abuse
- Educating yourself about the disorder so you understand its causes and treatments better
- Reaching out to others with the disorder to share insights and experiences
Remember, there's no one right path to recovery from BPD. The condition seems to be worse in young adulthood and may gradually get better with age. Many people with the disorder find greater stability in their lives during their 30s and 40s. Their inner misery may lessen and they go on to sustain loving relationships and enjoy meaningful careers.
Additional Information on Borderline Personality Disorder
Sources:
- American Psychiatric Association pamphlet on Personality Disorders
- HTML clipboard American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC.
- NIMH
next: Dependent Personality Disorder
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