The symptoms of BPD can show up in all aspects of your life — especially in your mood, behavior, and self-image. But with the right treatment, they can become much easier to manage.
Each person’s experience with BPD is unique, but there are some common experiences many people with BPD can relate to — like having difficult feelings toward yourself and others, instability in your relationships and your view of yourself (self-image), and periods of anger, depression, or anxiety that can last for hours to days.
It’s also common to view things in extremes, such as only good or only bad. Many feelings and behaviors in BPD are based in a fear of abandonment or an effort to avoid being abandoned.
There’s a lot of misinformation and stigma around BPD, partly because of a historic idea that it’s untreatable — but this is not the case.
The truth is that BPD is treatable, and many people reach a point of “remission” with the help of therapy, especially dialectical behavioral therapy (DBT). This means they experience few to no BPD symptoms and may even no longer meet the criteria for BPD diagnosis.
The diagnostic criteria for BPD are listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, you must have five or more of the following symptoms to receive a BPD diagnosis:
- Frantic efforts to avoid abandonment, whether real or imagined.
- A pattern of unstable and intense interpersonal relationships, which can include a tendency to see others as “all good” (idealization) or “all bad” (devaluation).
- Identity disturbance, such as a significant and persistent unstable self-image or sense of self. You might feel like you don’t know who you really are, and your likes and dislikes might change often.
- Impulsivity in at least two areas that are potentially self-damaging (such as spending, sex, substance use, reckless driving, or binge eating).
- Recurrent suicidal ideation, suicidal actions, or self-harm behaviors.
- Emotional instability, or turbulent, quickly changing emotions. Periods of intense anger, depression, or anxiety can last for hours to days.
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger, which might lead to frequent displays of temper, arguments, or physical fights.
- Transient, stress-related paranoid thoughts or severe symptoms of dissociation.
Many people use coping methods such as substance use or self-harm to deal with difficult emotions. Treatment plans aim to help you manage intense feelings and reduce distress so you resort to these methods less often.
Although people with BPD usually receive a diagnosis in early adulthood, they will likely have experienced certain BPD symptoms for years. This is partly because diagnosing a personality disorder requires medical professionals to look back at patterns that have formed over a long period.
It’s not common to receive a personality disorder diagnosis in childhood or adolescence because children and teens are still developing, maturing, and experiencing personality changes. For a diagnosis to occur in early life, the features must have been present for at least a year.
Like those of most personality disorders, BPD symptoms typically decrease in intensity with age. Many people with BPD might find that they have fewer symptoms by the time they’re in their 40s or 50s.
Note that the term “personality disorder” is controversial, and many people (clinicians included) reject this label because the term itself can be stigmatizing.
Efforts to avoid abandonment
People with BPD are often very sensitive to what’s happening around them and to them. Many of the feelings and behaviors in people with this diagnosis result from an intense fear of abandonment. Even if you’re not truly being abandoned, the feeling is so strong that you can become very upset, angry, or distressed.
For example, you might feel very angry with a friend who is a few minutes late to a lunch date. If a loved one moves away, you might feel a strong sense of loss and personal rejection.
When something like this happens, your self-image might take a hit. You might automatically interpret the real or imagined abandonment to mean that you are worthless, bad, or even evil.
These abandonment fears are related to difficulty tolerating being alone and a need to have other people with you. Frantic efforts to avoid abandonment may include impulsive actions such as self-harm or suicidal behavior.
Instability in your relationships
Unstable and intense personal relationships are a common experience in BPD and are the source of many challenges for people living with this diagnosis and their loved ones.
You might idealize potential friends, lovers, or caregivers at the first or second meeting, demand or insist on spending a lot of time with them, and share the most intimate details early in a relationship. However, you may switch quickly from idealizing people to devaluing them and feeling like they don’t care enough, don’t give enough, or are not “there” enough.
You might experience sudden and dramatic shifts in your view of others, alternately seeing people as kindly supportive or cruelly punitive. These shifts reflect disillusionment with a caregiver whose nurturing qualities you had idealized or whose rejection or abandonment you expected.
Instability in your identity
Many people with a BPD diagnosis report feeling unstable in their identity. You might experience sudden and dramatic shifts in your self-image and frequent changes in your goals, opinions, values, career plans, sexual identity, or friends.
It’s common to have a self-image based around being bad, not good enough, or evil. You may also have periods when you feel very excited and positive. You might sometimes feel like you don’t exist at all.
If you’re experiencing extreme distress in your life, regardless of whether you think you meet the criteria for BPD, talking with a medical or mental health professional can have many benefits. There are many ways to reach out and many types of help available.
You could either find a therapist who has experience in treating BPD or talk with a primary care doctor, who can refer you to an experienced mental health professional.
If you’re looking for a local therapist, the American Psychiatric Association offers a search tool that lets you locate a therapist by zip code. You could also try online therapy and read up on low cost therapy options.
You can check out Psych Central’s Find Help page for a range of helpful mental health resources.
Personality disorders such as BPD are typically diagnosed by a trained mental health professional such as a psychiatrist. So while you can consult a primary care doctor or family physician at first, they should refer you to a mental health professional for diagnosis and treatment.
There are no laboratory, blood, or genetic tests to diagnose BPD. Before offering this diagnosis, a mental health professional will talk with you about your symptoms and history. Then, they will be able to offer advice about the most effective treatments to help reduce your symptoms and improve your quality of life.
While BPD can’t exactly be “cured,” there are many effective treatments and ways to manage the symptoms and reduce distress.
BPD treatment usually includes long-term psychotherapy (talk therapy) with a therapist who has experience in treating people with symptoms like yours.
The most common type of psychotherapy suggested for people with BPD is DBT. This type of therapy is one of the most commonly prescribed treatments for BPD. It teaches you skills like self-awareness, mindfulness, distress tolerance, emotional regulation, and healthy relationship skills. It could include both one-on-one and group therapy.
Your therapist might also recommend cognitive behavioral therapy (CBT), a type of therapy that helps you become aware of patterns in your life, including harmful behavior and thought patterns. CBT teaches you how to address those thoughts and feelings and react in a less harmful way.
Psychodynamic therapy uses principles of psychoanalysis to help you and your therapist identify and better understand certain patterns in your life that affect your relationships, emotions, thoughts, and behavior.
Depending on your situation, another type of therapy might also be helpful for you. For more information about treatment, you can read Psych Central’s article on borderline personality disorder treatment.
There are no medications specifically made for BPD. However, other medications, such as antidepressants, may be helpful in managing some BPD symptoms. Mood stabilizers and low-dose antipsychotic medications may also help. However, not everyone who has BPD needs to use medication.
In times of crisis, someone with BPD might benefit from a short-term stay in a hospital. This usually occurs only if there’s a risk of harm to that person or others.
While they’re not a replacement for therapy, self-help strategies can often help people with BPD manage their symptoms and improve their overall well-being.
Some people find workbooks helpful. These books aim to empower you with the knowledge and skills you need to manage your BPD symptoms. Some examples include:
- “The Borderline Personality Disorder Workbook: An Integrative Program to Understand and Manage Your BPD“
- “The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD“
- “The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation and Distress Tolerance“
Other self-help strategies include the following:
- Find healthy emotional outlets. This could include journaling, exercise, or a creative hobby. These activities could help you express, understand, and process your feelings in a healthy way.
- Try mindfulness. Mindfulness can be helpful for people with BPD. You could try yoga, guided meditations on YouTube, or a meditation app.
- Have a few go-to calming exercises to do when you’re in distress. These could include breathing exercises, watching a funny movie or video, taking a bath or shower, or listening to music that lifts your spirits.
- Learn DBT skills at home. One resource is My Dialectical Life (MDL), a daily email on DBT skills from a DBT specialist. You could also find online classes on DBT, such as this one from EmotionallySensitive.com.
- Practice good self-care. Habits like eating nutritious foods, exercising, getting enough sleep, and drinking enough water go a long way. When your body feels nourished, rested, and relaxed, you’ll be in a better position to deal with situations and emotions that come up.
Connecting with others
Some people find it powerful to connect with other people who have BPD. There are many online forums for BPD, including the following:
- BPD Beautiful Support Group on Facebook is open to people with BPD as well as their loved ones.
- Healing from Borderline Personality Disorder is for people recovering from BPD.
- Emotions Matter is a nonprofit organization for people with BPD and offers an online support group.
If you have a BPD diagnosis, your relationships with your loved ones might experience strain. Treatment will help you work on these relationships. Your loved ones may benefit from reading about BPD on websites like Emotions Matter.
Most people who suspect they have BPD — even if they don’t — are facing some kind of difficulty in their everyday lives, whether that’s difficulty with relationships or a distorted sense of self-esteem. If you’re in this position, it’s a good idea to look for a therapist who has experience in treating people with BPD.
Regardless of whether you meet the diagnostic criteria for BPD, the support of an empathetic therapist can be very helpful. They will guide you through treatment, suggest self-help strategies, and maybe suggest medication if needed. Not all therapists in the United States can prescribe medication, but if necessary, your therapist can refer you to a healthcare practitioner who can.
You might find it helpful to connect with others who have BPD through the forums mentioned above. It also may be useful to check out some good BPD resources, such as the ones listed on the National Education Alliance for Borderline Personality Disorder website or the Emotions Matter website.
Lastly, know that you’re not alone. Many people have a BPD diagnosis and, thanks to treatment, many have gone on to thrive. Although there’s a great deal of stigma around BPD symptoms, it’s important to remember that your mental illness does not make you a bad person and it doesn’t mean you can’t lead a happy, healthy, and fulfilled life.