Borderline personality disorder (BPD), also known as an emotionally unstable personality disorder (EUPD), is a disorder is a mental health disorder that impacts the way you think and feels about yourself and others, causing problems functioning in everyday life. It is characterized by a long-term pattern of unstable interpersonal relationships, a distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality.
People with borderline personality disorder feel intense, uncontrollable emotions, which can make them very distressed and angry. They have trouble with their relationships and find it hard to feel comfortable in themselves. They may be very impulsive and appear to lead chaotic lives, act impulsively, or intentionally harm themselves as a way of coping.
Borderline personality disorder can be difficult for other people to understand. It can be distressing for the person with borderline personality disorder and the people around them, and it is often misunderstood.
Signs and symptoms of Borderline Personality Disorder may include:
- An intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
- Transient, stress-related paranoid ideation or severe dissociative symptoms
- A pattern of unstable intense relationships, such as idealizing someone one moment and then suddenly believing the person doesn’t care enough or is cruel
- Rapid changes in self-identity and self-image include shifting goals and values, and seeing yourself as bad or as if you don’t exist at all
- Periods of stress-related paranoia and loss of contact with reality, lasting from a few minutes to a few hours
- Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship
- Suicidal threats or behavior or self-injury, often in response to the fear of separation or rejection
- Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame, or anxiety
- Chronic feelings of emptiness
- Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights
- Intense or uncontrollable emotional reactions and rapidly shifting between different emotional states
- black and white thinking, or difficulty compromising
Other symptoms may include feeling unsure of one’s identity, morals, and values and in moderate to severe cases stress-induced breaks with reality or psychotic episodes. Individuals with a borderline personality disorder often have comorbid conditions, such as depressive and bipolar disorders, substance use disorders, eating disorders, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder.
What Causes Borderline Personality Disorder?
As with most mental health disorders, there is no single cause of borderline personality but a combination of some of the following causes may lead to Borderline Personality Disorder:
Genetics:
Genes you inherit from your parents may make you more vulnerable to developing a borderline personality disorder. Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members. However, these results have to be treated with caution as there’s no concrete evidence of a gene for borderline personality disorder.
Brain Chemical Abnormalities:
It’s thought that many people with borderline personality disorder have something wrong with the neurotransmitters in their brain, particularly serotonin. Neurotransmitters are “messenger chemicals” used by your brain to transmit signals between brain cells. Altered levels of serotonin have been linked to depression, aggression, and difficulty controlling destructive urges.
Childhood trauma:
There is a strong correlation between child abuse, especially child sexual abuse, and the development of borderline personality disorder. Many individuals with borderline personality disorder report a history of abuse and neglect as young children, but causation is still debated. Patients with borderline personality disorder are significantly more likely to report having been verbally, emotionally, physically, or sexually abused by caregivers of either sex. They also report a high incidence of incest and loss of caregivers in early childhood. It has been suggested that children who experience chronic early maltreatment and attachment difficulties may well go on to develop a borderline personality disorder.
Problem with brain development
Researchers have used MRI to study the brains of people with a borderline personality disorder. MRI scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body. The scans revealed that in many people with borderline personality disorder, 3 parts of the brain were either smaller than expected or had unusual levels of activity. These parts were:
- the amygdala – which plays an important role in regulating emotions, especially the more “negative” emotions, such as fear, aggression, and anxiety
- the hippocampus – which helps regulate behavior and self-control
- the orbitofrontal cortex – which is involved in planning and decision making
Problems with these parts of the brain may well contribute to symptoms of borderline personality disorder.
The development of these parts of the brain is affected by your early upbringing. These parts of your brain are also responsible for mood regulation, which may account for some of the problems people with borderline personality disorder have in close relationships.
How To Treat Borderline Personality Disorder
The most effective treatment combines support and psychological therapy. Medicine may help in some cases, but it is not the main treatment for borderline personality disorder. While medicine may help relieve some of the symptoms, it does not improve borderline personality disorder itself.
Psychological therapy
Psychological therapy is the main type of treatment for borderline personality disorder. Examples of therapies that can help include:
- Psychodynamic therapies, such as mentalization-based therapy and transference-focused psychotherapy.
- Dialectical behavioral therapy (DBT), which was developed specifically for treating borderline personality disorder. DBT has an educational approach with a focus on mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.
- Other forms of therapy, that teach new ways to interact with people, or ways to view yourself or the world, such as schema therapy.
Medicine
Medicine is not recommended as the main treatment for borderline personality disorder, though it can sometimes help control symptoms. Medicine may be useful if the person with a borderline personality disorder also has other mental health disorders, such as bipolar disorder, an anxiety disorder, or depression. In severe cases, a person with a borderline personality disorder may need to go to the hospital. This is usually only recommended as a short-term measure for those who are at risk of harming themselves or others. Patients are usually reviewed periodically to gauge their improvements so as to limit their medication usage.
Effects of Borderline Personality Disorder
Borderline personality disorder can damage many areas of your life. It can negatively affect intimate relationships, jobs, school, social activities, and self-image, resulting in:
- Repeated job changes or losses
- Dropping out of school or any educational institution.
- Multiple legal issues, such as jail time
- Conflict-filled relationships, marital stress, or divorce
- Self-injury, such as cutting or burning, and frequent hospitalizations
- Involvement in abusive relationships
- Unplanned pregnancies, sexually transmitted infections, motor vehicle accidents, and physical fights due to impulsive and risky behavior
- Attempted or completed suicide
In addition, you may have other mental health disorders, such as:
- Depression
- Alcohol or other substance misuses
- Anxiety disorders
- Eating disorders
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Attention-deficit/hyperactivity disorder (ADHD)
- Other personality disorders
