Borderline personality disorder (BPD) is characterized by a recurring, long-standing pattern of having unstable relationships with others — whether they be romantic relationships, friendships, children, or relationships with family members. The condition is marked by an effort to avoid abandonment (regardless of whether it’s real or simply imagined), and impulsivity in decision-making.
People with borderline personality disorder often swing from one emotion to another easily and quickly, and their self-image changes just as often.
If there’s an overarching defining characteristic of someone who suffers from borderline personality disorder, it’s that they often seem like they are ping-ponging back and forth between everything in their life. Relationships, emotions, and self-image change as often as the weather, usually in reaction to something happening around them, such as stress, bad news, or a perceived slight. They rarely feel satisfaction or happiness in life, are often bored, and filled with feelings of emptiness.
Because of these feelings, many people with BPD make a suicide attempt, or contemplate suicide regularly. Suicidal thoughts are common and can lead some people to make a plan or try and carry out suicide. Therefore assessment of suicide and suicidal intent is regularly conducted.
The term “borderline” means in-between one thing and another. Originally, this term was used when the clinician was unsure of the correct diagnosis because the client manifested a mixture of neurotic and psychotic symptoms. Many clinicians thought of these clients as being on the border between neurotic and psychotic, and thus the term “borderline” came into use.
The term “borderline” has sometimes been used in a number of ways in society that are quite different from the formal diagnostic criteria for borderline personality disorder (BPD). In some circles, “borderline” is still used as a “catch-all” diagnosis for individuals who are hard to diagnose or is interpreted as meaning “nearly psychotic,” despite a lack of empirical support for this conceptualization of the disorder.
Additionally, with the recent popularity of “borderline” as a diagnostic category and the reputation of these clients as being difficult to treat, “borderline” is often used as a generic label for difficult clients — or as a reason (or excuse) for a patient’s psychotherapy going badly. It is one of the most stigmatized mental disorders, even among mental health professionals.
There are nine specific symptoms associated with borderline personality disorder. The symptoms of this condition include: efforts to avoid abandonment (whether it is real abandonment, or imagined); a pattern of unstable relationships with others; disturbance in identity; impulsivity that tends to be damaging to themselves; suicidal behavior, gestures or threads; emotional instability due to wild mood swings; feelings of emptiness that are never-ending; inappropriately intense anger, or difficulty controlling their anger; and paranoid thoughts or dissociative symptoms from time to time.
Learn more: Symptoms of borderline personality disorder
Researchers today don’t know what causes borderline personality disorder. There are many theories, however, about the possible causes of BPD. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress).
Scientific research to date suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.
The prevalence for borderline personality disorder in the United States is between 0.5 and 5.9 percent in the general US population (APA, 2013; Leichsenring et al., 2011). The median prevalence has been reported to be 1.35 percent (Torgersen et al., 2001).
There is no evidence that borderline personality disorder is more common in women.
In clinical populations, borderline personality disorder is the most common personality disorder. In outpatient psychiatric settings, 10 percent of all psychiatric outpatients report having BPD, while in inpatient settings, between 15 and 25 percent report having BPD. In a study of a non-clinical sample, a high rate of borderline personality disorder was reported — 5.9 percent. This may indicate that many individuals with BPD don’t seek out psychiatric treatment (Leichsenring et al., 2011).
Treatment of borderline personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Several methods of psychotherapy are available for patients with borderline personality disorder, including dialectical behavior therapy (a form of cognitive-behavioral therapy or CBT), interpersonal, and psychodynamic treatments. Dialectical behavior therapy (DBT) has the greatest and most strong research support for its use in helping to successfully treat BPD (Leichsenring et al., 2011).
Medications may also be prescribed to help with specific troubling and debilitating symptoms. Evidence for the use of psychiatric medications to treat BPD varies, but tends to be less robust than the evidence supporting the use of psychotherapy. As noted by Leichsenring et al. (2011), “Beneficial effects on depression, aggression, and other symptoms were reported in some RCTS, but not in others.” In consultation with a psychiatrist or physician, a person with BPD should consider medications if needed for specific symptom relief.