Borderline Personality Disorder
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a serious psychiatric disorder marked by unstable moods, self-image, thinking and behavior. Most people who have BPD suffer from:
- Problems with regulating emotions and thoughts
- Impulsive self-damaging behavior
- Unstable, intense relationships with other people.
Some people with BPD experience severe symptoms and require intensive, sometimes in-patient, care. Others may benefit from outpatient treatment alone, and some may improve without any treatment.
How common is borderline personality disorder?
An estimated 1.6 percent of adults in the United States have BPD in a given year. BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood. It affects individuals of every race, ethnicity and economic status. Symptoms typically decrease in intensity with age, subsiding by the time people reach their 40s or 50s.
Signs & Symptoms
Individuals with BPD typically exhibit several of the following symptoms:
- Noticeable mood swings with periods of intense depressed mood, irritability and/or anxiety lasting a few hours to a few days
- Impulsive behaviors that are potentially self-damaging, such as excessive spending, sexual encounters, substance use, shoplifting, reckless driving or binge eating
- Inappropriate, intense or uncontrollable anger
- Recurring suicidal threats or non-suicidal self-injurious behavior, such as cutting or burning oneself
- Unstable, intense personal relationships, sometimes alternating between “all good” idealization, and “all bad” devaluation
- Persistent uncertainty about self-image, long-term goals, friendships and values
- Chronic boredom or feelings of emptiness
- Frantic efforts to avoid abandonment
- Paranoid thoughts, delusions or temporary psychosis
Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations from people to whom they feel close, or to sudden changes in plans.
Suicide and Self-harm
As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide. They may also engage in self-harming behaviors in an attempt to regulate their emotions, express their pain or punish themselves. These include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. Although self-harming behaviors do not signal a desire to die, some of them can be life-threatening.
Borderline personality disorder is diagnosed by mental health professionals following a comprehensive psychiatric interview and discussion of symptoms. This process may involve talking with the individual’s previous clinicians, review of prior records, a medical evaluation, and when appropriate, interviews with friends and family. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making them difficult to distinguish from BPD.
Many people with borderline personality disorder who receive proper treatment improve over time and experience fewer or less severe symptoms. Long-term, outpatient psychotherapy is the primary treatment approach for individuals with BPD. Psychotherapy, or “talk” therapy, helps them recognize and learn to control their behaviors and mood swings, and process negative thoughts and feelings. Although medications can help treat specific symptoms and stabilize mood swings, they are rarely effective without a foundation of therapy.
Psychotherapy is typically the cornerstone of treatment for people with BPD. The types of psychotherapy used to treat BPD include the following:
- Cognitive behavioral therapy (CBT). CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others, and their problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
- Dialectical behavior therapy (DBT). This type of therapy is considered the most well-researched and useful treatment for borderline personality disorder. DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. It encourages practicing mindfulness and incorporates individual and group therapy. Research studies have shown it can reduce suicide in people with BPD.
- Schema-focused therapy. This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. It is based on the idea that BPD stems from a dysfunctional self-image that affects how people react to their environment, interact with others and cope with problems or stress.
Therapy can be provided one-on-one with the patient, or in a group or family setting. Therapist-led group sessions help teach people with BPD how to interact with others and how to express themselves effectively.
No medications have been approved by the FDA to treat BPD, and there is little research showing that they are necessary or effective for people with this illness. Although medications do not cure BPD, some may be helpful in reducing specific symptoms, such as anxiety, depression, impulsiveness or aggression.
NIMH-funded research indicates that some 85 percent of people with borderline personality disorder also meet the diagnostic criteria for another mental illness. Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, BPD is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder.