Borderline Personality Disorder
What is borderline personality disorder?
Borderline personality disorder is a mental illness that causes intense mood swings, impulsive behaviors, and severe problems with self-worth. It can lead to troubled relationships in every area of a person's life.
Most of the time, signs of the disorder first appear in childhood. But problems often don't start until early adulthood. Treatment can be hard, and getting better can take years. Problems with emotions and behaviors are hard to improve. But with treatment, most people with severe symptoms do get better over time.
What causes this disorder?
Experts don't know exactly what causes borderline personality disorder. Problems with chemicals in the brain that help control moods may play a role. It also seems to run in families.
Often, people who get it faced some kind of childhood trauma such as abuse, neglect, or the death of a parent. The risk is higher when people who had childhood trauma also have problems coping with anxiety or stress.
What are the symptoms?
Everyone has problems with emotions or behaviors sometimes. But if you have borderline personality disorder, the problems are severe, repeat over a long time, and disrupt your life. The most common symptoms include:
- Intense emotions and mood swings.
- Harmful, impulsive behaviors. These may include things like substance use, binge eating, out-of-control spending, risky sexual behavior, and reckless driving.
- Relationship problems. You may see others as either "good" or "bad" and may shift from one view to the other suddenly, for minor reasons. This can make relationships very difficult.
- Low self-worth.
- A frantic fear of being left alone (abandoned). This fear may lead to frantic attempts to hold on to those around you. Or it may cause you to reject others before they can reject you.
- Aggressive behavior.
Other symptoms may include:
- Feeling empty inside.
- Problems with anger, such as violent temper tantrums.
- Hurting yourself, such as cutting or burning yourself.
- Suicide attempts and suicidal thoughts.
- Times when you feel paranoid or lose a sense of reality (psychosis).
It's easy to confuse this disorder with other mental illnesses. And they may overlap. So if you think that you or someone you know may have borderline personality disorder, see a doctor. Don't try to diagnose yourself.
How is it treated?
Borderline personality disorder can be hard to treat. It's common for symptoms to return. And many people with the disorder have troubled relationships with their counselors and doctors.
But you can take steps to help control the disorder. Long-term treatment can reduce symptoms and harmful behaviors and help you better manage your emotions. Treatment may include:
- Counseling and therapy. It's important to find a counselor you can build a stable relationship with. This can be hard, because your condition may cause you to see your counselor as caring one minute and cruel the next, especially when he or she asks you to try to change a behavior. Try to find a counselor who has special training in dialectical behavioral therapy (DBT) to treat this disorder.
- Medicines, such as antidepressants, mood stabilizers, and antipsychotics. In combination with counseling or therapy, they may be helpful in treating symptoms of borderline personality disorder.
- Healthy habits, such as getting enough sleep, eating healthy foods, getting regular exercise, and avoiding alcohol and drugs. These habits can help reduce stress and anxiety. And they can help make your symptoms less severe and less frequent.
Many people find relief from harmful symptoms within the first year of treatment.footnote 1 And about half of those treated find that they no longer have most of the behaviors after about 10 years of treatment.footnote 1
Unfortunately, many people don't seek treatment for mental health problems. They may think that their symptoms aren't bad enough or that they can work things out on their own. But getting treatment is key to improving your symptoms and the quality of your life.
People with this disorder often have other mental health problems such as depression, eating disorders, or substance use disorder. Treatment can help with these problems too.
How can family and friends help? What can they do to cope?
Accepting that a loved one has a personality disorder can be hard. You may feel helpless. But there are things you can do to help. Show love, and learn as much as you can about the illness. Understand that the behavior you may see—which may include anger directed at you—is caused by the illness, not by the person you love.
Know when to get help. This disorder can cause a person to become angry, violent, or suicidal. Take these situations seriously. Call for help if you think the person may be in danger or may harm someone else.
Finding your own support is important too. Ask your local or state health department about local support organizations, or contact the National Alliance on Mental Illness. For more information, go to www.nami.org.
- American Psychiatric Association (2000). Personality disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 706–710. Washington, DC: American Psychiatric Association.
Other Works Consulted
- Coid J, et al. (2009). Borderline personality disorder: Health service use and social functioning among a national household population. Psychological Medicine, 39(10): 1721–1731.
- Gunderson J (2011). Borderline personality disorder. New England Journal of Medicine, 364(21): 2037–2042.
- Gunderson JG (2008). Borderline Personality Disorder: A Clinical Guide, 2nd ed., Washington, DC: American Psychiatric Publishing.
- Oldham JM (2005). Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder, 2nd ed., pp. 1–9. Arlington, VA: American Psychiatric Association.
Current as of: January 31, 2020
Author: Healthwise Staff
Sarah Marshall MD - Family Medicine
Kathleen Romito MD - Family Medicine
Elizabeth T. Russo MD - Internal Medicine
Christine R. Maldonado PhD - Behavioral Health
Current as of: January 31, 2020