The main feature of borderline personality disorder (BPD) is a significant pattern of instability in interpersonal relationships, self-image, and emotions. People with borderline personality disorder can be very impulsive and may demonstrate self-injurious behaviors (e.g., risky sexual behaviors, cutting, or suicide attempts).
Borderline personality disorder occurs in most people by early adulthood (early 20s). A person with this condition will have experienced an unstable pattern of interacting with others for years. This pattern of behavior is usually closely related to the person’s self-image and early social interactions with friends and family. The behavior pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) of a person’s emotions and feelings.
People with borderline personality disorder are usually more sensitive than most people to environmental circumstances. The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior.
They experience intense abandonment fears and inappropriate anger, even when faced with a realistic time-limited separation or when there are unavoidable changes in plans. For instance, a person with this condition may experience sudden despair in reaction to a clinician’s announcing the end of the hour; or panic and fury when someone important to them is just a few minutes late or must cancel an appointment. They may believe that this “abandonment” implies that they are a “bad person.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Relationships and the person’s emotions may sometimes be seen by others or characterized as being shallow.
A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. In order for a personality disorder to be diagnosed, the behavior pattern must be seen in two or more of the following areas: cognition (thinking); affect (feeling); interpersonal functioning; or impulse control.
In personality disorders, this enduring pattern of behavior is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.
A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:
- Frantic efforts to avoid abandonment, whether the abandonment is real or imagined
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Identity disturbance, such as a significant and persistent unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoid thoughts or severe dissociative symptoms
Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes, and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.
Borderline personality disorder is more prevalent in females (75 percent of diagnoses made are in females). It is thought that this disorder affects between 1.6 and 5.9 percent of the general population.
Like most personality disorders, BPD typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.
Frantic efforts to avoid real or imagined abandonment.
The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.
Unstable and intense relationships.
People with BPD may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.
There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing, and support. These individuals may show worse performance in unstructured work or school situations.
Personality disorders such as BPD are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood, or genetic tests that are used to diagnose borderline personality disorder.
Many people with this disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.
A diagnosis for borderline personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.
Treatment of borderline personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see borderline personality disorder treatment.