What is Borderline Personality Disorder (BPD)?
More and more people are becoming aware of borderline personality disorder after Saturday Night Live star Pete Davidson opened up about having the disorder. Even though public awareness of BPD has increased, there are a lot of myths about the disorder. These myths can keep people from seeking treatment.
Borderline personality disorder (BPD) is a mental illness that is defined by chronic mood instability, impulsive behaviors, and difficulty regulating emotions. People with BPD are prone to angry outbursts and overreactions, especially to criticism. This can set the stage for very volatile relationships. Self-harm and suicidal behaviors occur frequently among people with BPD.
The good news is that borderline personality disorder is not the untreatable illness that some people assume. According to leading psychologists, the disorder can be treated and has a surprisingly good prognosis. Most people with the BPD do get better with time.1
What Causes Borderline Personality Disorder?
The cause of BPD isn’t fully understood. However, BPD may be linked to the following:2
Environmental factors. There are higher rates of childhood neglect and abuse among people with BPD.
Brain abnormalities. Research has found differences in the areas of the brain responsible for emotional regulation, empathy, and impulsivity among people with BPD. This suggests that certain areas of the brain may not function properly in people with the disorder.
Genetics. Studies have also found higher rates of borderline personality disorder and other mental disorders in relatives of people with BPD. This suggests that there is a genetic component involved in the disorder.
Prevalence and Risk Factors
BPD occurs in about six percent of the population, according to some estimates. Although BPD is often diagnosed more frequently in women than men, it is thought that the disorder affects men and women equally. People with borderline personality disorder are more likely to have other co-occurring mental illnesses, such as substance abuse, post-traumatic stress disorder and major depression.
Signs & Symptoms
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the signs of borderline personality disorder include:3
- Intense mood swings. Intense mood swings are a hallmark feature of BPD. They may include periods of intense irritability, anxiety, or anger that may last anywhere from a couple of hours to days.
- A pattern of unstable relationships and difficulty in relationships. Borderline personality disorder often causes serious challenges in interpersonal relationships. Because of their emotional reactivity, a person with BPD may be loving towards their partner one minute and enraged the next. These emotional outbursts, as well as the other symptoms of BPD, tends to drive others away. People with BPD may have a difficult time understanding how their behavior impacts others’ feelings. This makes relationships even more difficult for people with BPD.4
- Explosive anger. People who have borderline personality disorder may react to normal situations with intense anger. They may have a very difficult time controlling the rage.
- Chronic feelings of emptiness. BPD can trigger feelings of emptiness or boredom.
- Frantic efforts to avoid abandonment. People with BPD may resort to self-destructive or other extreme behaviors to avoid abandonment by others.
- Impulsive, risky behaviors. Substance abuse, gambling, reckless driving, binge eating, and unsafe sexual practices are often seen in BPD.
- Recurrent self-injury or suicidal thoughts. People with borderline personality disorder have a much higher rate of suicide due to a combination of impulsivity and severe mood swings. Approximately 80 percent of people with BPD have a history of suicide attempts. The rate of completed suicide is about 10 percent among those with BPD.
- Stress-related paranoia. This type of paranoia is different than that seen in schizophrenia and other psychotic disorders. It is non-delusional and usually triggered by interpersonal stress. A person with BPD may feel that their loved ones are out to get them.5
- Severe dissociative symptoms. Severe stress can cause dissociative symptoms, such as detachment and feelings of unreality in a person with BPD.5
Treatments For BPD
Borderline personality disorder was historically seen as a highly-disabling, even untreatable condition even among those in the mental health community.6 This is just a myth. More recent research has found that the long-term outcomes for people with BPD are very good with the right treatment. Here are some of the most effective treatments for borderline personality disorder.
Psychotherapy is an essential part of any treatment plan for borderline personality disorder. There are various types of psychotherapy for BPD, including:
- Dialectical Behavioral Therapy (DBT). DBT was developed by Dr. Marsha Linehan, who struggles with borderline personality disorder herself.7 This treatment combines several different psychological techniques, including relaxation, cognitive-behavioral therapy, and mindfulness. DBT has been extensively studied and is effective for DBT.8
- Cognitive Behavioral Therapy (CBT). Cognitive behavioral therapy helps people with BPD learn how to identify and change negative or maladaptive thoughts that trigger out of control behaviors. By changing these thoughts, people with BPD can better control behaviors and not feel so out of control.9
- Family Therapy. When a person has borderline personality disorder, it significantly affects their relationships with family members and significant others. It is quite common for family members of those with BPD to feel overwhelmed by their loved ones’ symptoms. Family therapy can help parents, spouses or partners, siblings, and children of people with BPD learn skills and work together to help their loved one.10
Medical experts who specialize in borderline personality disorder believe that medications are an important part of treatment for people with BPD.11 Although there are no specific medications approved by the Food and Drug Administration (FDA) for treating borderline personality disorder, research has found that they do help for specific symptoms. Medications are also useful in treating disorders that often occur with BPD, such as depression. Here are some of the medications that have been found to be helpful for specific symptoms of BPD:12
- Antipsychotic medications. Antipsychotic medications, such as Abilify, Seroquel, and Zyprexa, have been found effective in reducing treat paranoid thinking, hostility, and suspiciousness in BPD.
- Mood stabilizers. Mood stabilizers like Depakote and Lamictal can help reduce unstable mood, impulsivity and decrease risky behaviors and self-harm.
Finding the Right Therapist For BPD
The key to getting better is to find the right therapist. It is important to choose a mental health provider who is experienced in treating borderline personality disorder. Here are some questions to ask when choosing a therapist for borderline personality disorder:
- What is your experience in treating BPD? Look for a therapist who has experience in successfully treating BPD.
- What kind of professional licenses do you hold? If you do a Google search for therapists, thousands of results may come up. But, not all of those therapists have the expertise to treat BPD. Make sure the person holds a professional license. The exact license will vary from state to state, but common credentials include LCSW, LPCC, LCPC, and Ph.D. Don’t be afraid to ask what the particular therapist’s credentials mean.
- Are you trained in dialectical behavioral therapy or other treatments for BPD? Look for professional certifications or education in treatments specifically for borderline personality disorder. The therapist that you choose should have some specific education related to BPD.
- U.S. Department of Health And Human Services. (2010). Report to Congress on Borderline Personality Disorder. Retrieved April 24h, 2019 from http://www.ncdsv.org/images/SAMHSA_Report-to-Congress-on-Borderline-Personality-Disorder_5-2011.pdf.
- Mayo Clinic. (June 2018). Borderline Personality Disorder. Retrieved April 24h, 2019 from https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
- Science Daily. (August 2015). Borderline Personality Traits Linked To Lowered Empathy. Retrieved April 24h, 2019 from https://www.sciencedaily.com/releases/2015/08/150829123819.htm.
- The Body Is Not An Apology. (January 2019). The Highest Highs and Lowest Lows: Living with Borderline Personality Disorder. Retrieved April 24h, 2019 from https://thebodyisnotanapology.com/magazine/borderline-personality-disorder/.
- Biskin RS. The Lifetime Course of Borderline Personality Disorder. Can J Psychiatry. 2015;60(7):303–308. Retrieved April 24h, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500179/.
- The New York Times. (June 2011). Expert on Mental Illness Reveals Her Own Fight. Retrieved April 24h, 2019 from https://www.nytimes.com/2011/06/23/health/23lives.html.
- Linehan MM, Comtois KA, Murray AM, et al. Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Arch Gen Psychiatry. 2006;63(7):757–766. Retrieved April 24h, 2019 from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/209726?wvsessionid=wva10f976c512d482483c58a30780519f2.
- National Institute Of Mental Health. (2019). Borderline Personality Disorder. Retrieved April 24h, 2019 from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml#part_145390.
- McLean Hospital. (January 2019). Training the Next Generation to Treat Borderline Personality Disorder. Retrieved April 24h, 2019 from https://www.mcleanhospital.org/news/training-next-generation-treat-borderline-personality-disorder.
- Borderline Personality Disorder Demystified. (2018). Medications In The Treatment Of Borderline Personality Disorder: The Appropriate Use. Retrieved April 24h, 2019 from http://www.bpddemystified.com/treatments/medication/.
- Belli H, Ural C, Akbudak M. Borderline personality disorder: bipolarity, mood stabilizers and atypical antipsychotics in treatment. J Clin Med Res. 2012;4(5):301–308. Retrieved April 24h, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449426/.