Borderline Personality Disorder (BPD): Symptoms, Causes And Treatment

Borderline personality disorder (BPD) is a mental health disorder characterized by difficulty regulating emotions, instability in relationships, problems maintaining a stable self-concept and challenges managing behavioral impulses.

People with BPD experience an intensity of emotion greater than that of most people, and may take longer to return to their emotional baseline. They may make frantic efforts to avoid real or imagined abandonment, are more sensitive or reactive to perceived slights from others, and have a tendency to display self-harming or self-sabotaging behaviors such as cutting, gambling, reckless spending, disordered eating and/or alcohol or drug abuse. BPD tends to develop in late adolescence or early adulthood, and impacts women more often than men.

“People with borderline personality disorder have higher than average rates of self injury, suicidal behavior, substance use problems, anger problems and behaviors associated with anger,” says Shireen L. Rizvi, Ph.D, professor of clinical psychology at Rutgers University in Piscataway, New Jersey.

“Most of these behaviors are attempts to regulate or get rid of intense distressing emotions, and they work in the short term,” she adds. “They just also tend to cause lots of problems in the long run.”

Online therapy platforms connect you with licensed providers, which can include psychiatrists, psychologists, licensed marriage and family therapists, licensed clinical social workers and licensed professional counselors. Discover our top picks and the best online therapy to fit your needs and preferences.

Theodore Millon, author and psychologist known for his work evaluating personality disorders, identified four distinct subtypes of borderline personality disorder: discouraged, self-destructive, impulsive and petulant. While each subtype shares core characteristics of BPD, symptoms may vary significantly among them.

However, it’s important to note that subtypes of BPD are not defined within the DSM-5 and currently remains just a topic of interest and discussion among some researchers and clinicians.

Discouraged BPD

Individuals experiencing symptoms of discouraged borderline personality disorder, commonly referred to as “quiet BPD,” may exhibit behaviors such as codependency and helplessness more frequently than other subtypes. Other characteristics of discouraged BPD include:

• Avoiding competition
• Misplaced loyalty and self-deprecation
• Feelings of insecurity and doubting one’s abilities
• Seeking of affection
• Reacting with anger upon perceived abandonment

Self-destructive BPD

The self-destructive subtype of borderline personality disorder is largely defined by tendencies of turning negative emotions inward rather than outward. Rather than taking out negative emotions on others, individuals within the self-destructive subtype are more likely to express anger upon themselves through means of dangerous behaviors or self harm.

Other symptoms distinct to the self-destructive subtype may include:

• Pervasive distrust of others
• Difficulty fitting into social groups
• Recurrent suicidal thoughts and attempts
• Substance misuse

Impulsive BPD

Impulsive behavior is a common symptom in individuals who are diagnosed with borderline personality disorder. However, those within the impulsive subtype may constantly seek external sources of validation and constantly shift from one source of excitement to another with little regard for others. As such, individuals within the impulsive subtype may have a hard time understanding the consequences of their actions as they attempt to free themselves of negative thoughts or feelings through risky behavior.

Because individuals within the impulsive subtype constantly seek sources of reward and excitement, they may struggle to feel stability during times of stress. As a result, individuals may experience prolonged feelings of hopelessness and depression.

Other common traits of individuals within the impulsive BPD subtype may also include:

• Charisma or excessive flirtatiousness
• Energetic and excitable behavior
• Attention-seeking behavior
• Irresponsible or risky behavior

Petulant BPD

The petulant subtype of borderline personality disorder is marked by unpredictable mood swings that typically range from angry outbursts to feelings of guilt and shame. Individuals within the petulant subtype often struggle to find comfort and stability in personal relationships and may use their negative emotions as a means of manipulating others. Following emotional outbursts, individuals may plead for forgiveness and make promises to atone for their behaviors.

Individuals within the petulant subtype may:

• Be constantly irritable or impatient
• Express envy of the happiness and success of others
• Be stubborn and demanding
• Express recurrent feelings of guilt and worthlessness
• Complain of fatigue or other somatic symptoms in response to emotional stress

While BPD hasn’t been shown to have one definite cause, experts point to several contributing factors:

• Genetics: Family studies on BPD indicate that some people may be genetically predisposed to the condition, and research also suggests that BPD is a heritable disorder. BPD is about five times more common among first degree biological relatives of those with the disorder.
• Trauma: Many (but not all) people with BPD often have a history of trauma like childhood sexual abuse. Still, many people who experience trauma do not develop BPD.
• Neurological factors: Some research suggests that BPD may be associated with differences in the brain, particularly in the parts that control emotions and make decisions.

Who Does Borderline Personality Disorder Affect?

It is estimated that borderline personality disorder affects 1.6% to 5.9% of adults in the U.S. and 75% of individuals diagnosed with the condition are women^[2]Borderline Personality Disorder. National Alliance on Mental Illness. Accessed 5/25/2023. . Individuals who have an immediate family member with BPD may be more likely to develop the condition due to shared genetic traits. Additionally, many people diagnosed with BPD report experiencing traumatic events during childhood, such as abuse or abandonment.

Signs of BPD may include the following, according to the diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

• An unstable or overly negative self-image; overt self-criticism
• A tendency to take the actions and needs of others personally and feel slighted and disproportionately angry
• Intense and unstable relationships marked by fear of abandonment and neediness
• Frequent and intense mood changes and a tendency to overreact to interpersonal slights
• Transient, stress-related paranoid thoughts
• Chronic feelings of emptiness
• Impulsivity and risk-taking in a couple of areas of life
• Suicidal ideation and self-harming behaviors

Borderline Personality Disorder vs. Bipolar Disorder

BPD is sometimes confused with bipolar disorder, but the two are distinct, different conditions, albeit with some overlapping symptoms.

Bipolar disorder is classified as a mood disorder and not a personality disorder. People with bipolar disorder experience periods of highs that are uncharacteristic of their usual behavior patterns (mania or hypomania) which alternate with episodes of depression. During manic or hypomanic episodes, their mood is elevated or irritable, and is accompanied with other symptoms including less need for sleep, racing thoughts, inflated self-esteem, high level of distractibility, increase in goal-oriented activity, and in some cases, disordered thinking such as delusions or hallucinations.

Understanding a BPD “Favorite Person”

Having unstable relationships is a central symptom of borderline personality disorder, as individuals may express fear of abandonment or rejection and exhibit emotional outbursts upon perceived interpersonal slights. However, many individuals diagnosed with BPD often have a “favorite person,” whom they rely on for emotional support, seek validation from and idealize.

A favorite person may be a significant other, friend, family member or other individual with whom a person with BPD interacts, such as a teacher or mental health counselor. Individuals with BPD may feel an inability to properly function without their favorite person and fear that their favorite person will abandon them.

Individuals with BPD may crave constant attention and validation from their favorite person, particularly during moments of fear or anxiety. When a favorite person is unavailable, it may trigger intense feelings of rejection or abandonment in a person with BPD.

Individuals with BPD may make attempts to maintain their relationship with their favorite person at all costs upon perceived rejection or abandonment. However, this may have the opposite effect of driving the favorite person away, as the relationship may become unstable or volatile, and the favorite person might feel pressured or stifled due to the individual with BPD’s recurrent attempts to keep them close.

Signs that an individual may be focused on favorite person include:

• Constant need for attention from that person
• Frequent pleas for reassurance or validation from that person
• Constantly talking about the favorite person to others, often in idealized language
• Jealousy toward outside relationships
• Emotional outbursts upon periods of (normative) non-communication
• Declarations of love, appreciation or idealization

Borderline personality disorder can be diagnosed by a mental health professional. BPD diagnosis involves an evaluation of an individual’s symptoms and family medical history. Additionally, a health care provider may perform a medical exam to rule out other possible causes of BPD symptoms.

Diagnosis for borderline personality disorder typically occurs after the age of 18, because personality is thought to be more in flux and not as stable during childhood and teenage years. Many individuals may receive a diagnosis later in life, despite showing symptoms of BPD in earlier years.

Borderline Personality Disorder Tests

There is no specific test used to diagnose borderline personality disorder. Instead, a mental health professional will perform a clinical assessment including an in-depth clinical interview. Occasionally, standardized questionnaires will be used to determine a diagnosis. The mental health professional may speak to previous health care providers, friends and family and review previous psychological records.

It is important to note that BPD should not be diagnosed quickly. A true diagnosis usually takes lengthier periods of observation and/or gathering data from different sources of information to ensure that a personality disorder diagnosis such as BPD is warranted and accurate.

There is no way to prevent borderline personality disorder. However, early diagnosis and treatment may help to reduce the severity of symptoms. Because diagnosis for BPD typically occurs in early adulthood, screening an individual when they first display symptoms that meet the DSM-5 criteria for the condition and seeking appropriate treatment may help to prevent symptoms from worsening.

Anyone showing signs of BPD should see a mental health professional, such as a psychologist or a psychiatrist. Mental health professionals use specific diagnostic criteria to determine if an individual has this condition.

Effective BPD treatment depends on the needs of the individual but may include the following:

• Psychotherapy (or talk therapy) has been proven to reduce symptom severity, incidence of self-harm and suicidal outcomes in people with BPD, and may improve psychosocial function and depression^[3]Storebø OJ, Stoffers-Winterling JM, Völlm, BA, et el. Psychological therapies for people with borderline personality disorder . Cochrane Database of Systematic Reviews. 2020. . Dialectical behavioral therapy in particular is a type of therapy developed to treat people with personality disorders.
• Medications, although there is not a specific one identified to treat BPD. BPD medication options depend on the individual and include antidepressants, mood stabilizers and atypical antipsychotics. Medication should be used in conjunction with psychotherapy, and isn’t always necessary for the successful treatment of BPD.

Additionally, short-term hospitalization may be warranted if a person with BPD is determined to be an immediate danger to themselves or others or if they cannot take care of themselves or tend to activities of daily living.

Online Therapy for Borderline Personality Disorder

Research indicates that online therapy may be as effective in treating certain behavioral conditions as in-person therapy. Many virtual therapy platforms, such as BetterHelp and Talkspace, offer dialectical behavior therapy (DBT), which is an effective, evidence-based treatment for individuals with borderline personality disorder.

However, individual experience with online therapy may vary. Not all conditions can be best treated through online therapy, and some individuals with borderline personality disorder may benefit from the advantages offered by in-person therapy sessions.

How Can I Help Someone with Borderline Personality Disorder?

If you suspect that someone you love may be experiencing symptoms of borderline personality disorder, there are many ways you can offer support.

For example, it may be beneficial to educate yourself about BPD and encourage treatment. Do not suggest to the individual that they may meet criteria for BPD or attempt to diagnose them yourself. Instead, focus on helping your loved one find or maintain treatment. You can equip yourself with tools to help manage the condition and demonstrate your emotional support by attending psychotherapy sessions along with them (if they invite you to) or going to a support group for individuals who are in close relationships with people with BPD.

Additionally, communicating honest love and validation may be helpful for an individual experiencing the symptoms of BPD. Though individuals with this condition may have turbulent relationships marked by intense feelings of love and devaluation, providing comfort with reassurance may ease fears of abandonment and feelings of guilt.

Finally, it’s important to approach a relationship with an individual diagnosed with BPD with a sense of understanding. Borderline personality disorder is a condition marked by emotional dysregulation, meaning it may be challenging for individuals to manage their symptoms. Offering support through encouraging treatment and open communication along with setting healthy boundaries with the person with BPD may help to improve symptoms.

Explore Our Featured Online Therapy Sponsors

Company Logo	Forbes Health Ratings	View More	learn_more_cta_below_text	Learn More
	Achieve your potential with Talkspace online therapy Thousands of licensed therapists Message your therapist 24/7 Insured members on average pay a $20 copay or less Get $85 Off Your First Month At Talkspace! Using FORBES85 at checkout	Learn More	On Talkspace's Website	https://talkspace.pxf.io/c/1955282/1374290/14729" rel="nofollow"
	Convenient and affordable online therapy with Betterhelp Prices vary and start at $65/week Users can be matched with a therapist within 48 hours Communicate via phone, video, or messaging whenever you feel it's needed Enjoy 20% Off Your First Month	Learn More	On BetterHelp's Website	https://hasofferstracking.betterhelp.com/aff_c?offer_id=2&aff_id=3811&source=forbeshealth" rel="nofollow"
	Human, virtual mental health care from doctors who take insurance Adheres to the highest standards of care Represents a diverse range of specialties and identities Offers virtual visits, flexible scheduling, medication management and therapist matching	Learn More	On Talkiatry's Website	https://www.trv6hh.com/4RQSJ/2CTPL/" rel="nofollow"
	Mental health support for your whole being Meet virtually with a therapist, prescriber, or both Custom treatment plans created with your therapist Treatment available for anxiety, depression, insomnia, stress, PTSD, and more  Get 50% Off For The First Month Of Any Plan using code FORBES50	Learn More	On Cerebral's Website	https://cerebral.sjv.io/c/1955282/999612/12128" rel="nofollow"

If you’ve been diagnosed with borderline personality disorder, there are many avenues you can take to alleviate symptoms.

Find a therapist

Research indicates that dialectical behavior therapy (DBT) is an effective treatment for individuals who experience the symptoms of borderline personality disorder. DBT emphasizes teaching individuals mindfulness, emotional regulation, interpersonal effectiveness and distress tolerance. It can be practiced in individual or group settings.

Additionally, individuals with borderline personality disorder may benefit from consulting a psychiatrist about prescription medication to manage symptoms. Research indicates that antidepressants, mood stabilizers and antipsychotics may be successful in controlling the symptoms associated with BPD.

Learn coping skills

During feelings of stress or anxiety, self-soothing coping skills may be able to help an individual feel grounded and more at ease.

Self-soothing coping skills may include:

• Going for a walk
• Going to a museum
• Watching a favorite movie
• Listening to music
• Lighting a scented candle
• Eating your favorite meal
• Petting an animal
• Taking a shower or bath

Other avenues for coping with borderline personality disorder involve maintaining a healthy lifestyle. If you’re experiencing symptoms of BPD, maintaining the following habits may be helpful:

• Eat a healthy diet
• Exercise to reduce stress and improve mood
• Keep track of people, places or situations that may trigger symptoms
• Get enough sleep and speak to your doctor if sleep problems arise

Find a BPD support group

Connecting with others who have experienced symptoms of borderline personality disorder to share thoughts, feelings and questions may offer emotional support. Additionally, consider spending time with others in your community to help alleviate feelings of isolation.

If you’ve experienced symptoms of borderline personality disorder, it may be beneficial to see a mental health profession to get an official diagnosis in order to seek proper treatment. If symptoms begin to interfere with your ability to function in daily life or perform ordinary tasks, seek a therapist before it becomes debilitating.

If you’ve already received a BPD diagnosis, tell your healthcare provider if your symptoms worsen or new symptoms arise.