illness marked by unstable moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental
Disorders, Third Edition (DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental
health professionals use the DSM to diagnose mental illnesses.
Because some people with severe BPD have brief psychotic
episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name "borderline personality disorder" is misleading, a more accurate term does not exist yet.
Most people who have BPD suffer from:
- Unstable relationships with other people.
- Problems with regulating emotions and thoughts
- Impulsive and reckless behavior
disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.
Signs & Symptoms
According to the DSM, Fourth Edition, Text Revision
(DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:
- Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived.
- A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme
- Distorted and unstable self-image or sense of self, which can
result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
- Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
- Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
- Intense and highly changeable moods, with each episode lasting from a few hours to a few days
- Chronic feelings of emptiness and/or boredom
- Inappropriate, intense anger or problems controlling anger
- Having stress-related paranoid thoughts or severe
dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with
Who Is At Risk?
According to data from a subsample of participants in a
national survey on mental disorders, about 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.
What Causes BPD?
As with other mental disorders, the causes of borderline personality disorder aren't fully understood. Experts agree, though, that the disorder results from a combination of factors. Factors that seem likely to play a role include:
- Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental disorders among family members.
- 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 has shown 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.
Treatment for BPD
Borderline personality disorder treatment may include psychotherapy, medications or hospitalization.
Psychotherapy — also called talk therapy —
is a fundamental treatment approach for borderline personality disorder. Types of psychotherapy that have been found effective include:
- Dialectical behavior therapy (DBT). DBT was designed specifically to treat borderline personality disorder. Generally done through individual, group and phone counseling, DBT uses a skills-based approach combined with physical and meditation-like exercises to teach you how to regulate your emotions, tolerate distress and improve relationships.
- Cognitive behavioral therapy (CBT). With CBT, you work with a mental health counselor (therapist) to become aware of inaccurate, negative or ineffective thinking; view challenging situations more clearly and objectively;
and search for and put into practice alternative solution strategies.
- Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you identify and separate your own thoughts and feelings from
those of people around you. MBT emphasizes thinking before reacting.
- Schema-focused therapy (SFT). SFT combines therapy
approaches to help you evaluate repetitive life patterns and life themes (schema) so that you can identify positive patterns and change negative ones.
- Transference-focused psychotherapy (TFP). Also called
psychodynamic psychotherapy, TFP aims to help you understand your emotions and
interpersonal difficulties through the developing relationship between you and
your therapist. You then apply these insights to ongoing situations.
Medications can't cure borderline personality disorder, but they can help associated co-occurring clinical problems, such as
depression, impulsiveness and anxiety. Medications may include antidepressants, antipsychotics and anti-anxiety drugs. Medications must be appropriately prescribed by your doctor, in adequate doses, and with consistent supervision through scheduled follow-up visits.
At times, you may need more intense treatment in a psychiatric hospital or clinic. Hospitalization can also keep you safe from self-injury or suicidal thoughts or behaviors.
Because treatment can be intense and long term, you have the best chance for success when you consult mental health providers who have experience treating borderline personality disorder.