Borderline Personality Disorder

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Borderline Personality Disorder

Topic Overview

What is borderline personality disorder?

Borderline personality disorder is a mental illness that causes intense mood swings, impulsive behaviours, and severe problems with relationships and self-worth. People with this disorder often have other problems such as depression, eating disorders, or substance abuse.

Most of the time, signs of the disorder first appear in childhood. But problems often don't start until early adulthood. Treatment can be very hard, and getting better can take years. This is because problems with emotions and behaviours are hard to improve. But treatment may work better than experts used to think. Most people with severe symptoms get better over time.

What are the symptoms?

Everyone has problems with emotions or behaviours sometimes. But if you have borderline personality disorder, the problems are severe, repeat over a long time, and disrupt your life. The most common symptoms include:

  • Intense emotions and mood swings.
  • Impulsive behaviours that are self-damaging, such as substance abuse, binge eating, and reckless driving.
  • Relationship problems.
  • Low self-worth.
  • A frantic fear of being left alone (abandoned).
  • Aggressive behaviour.

Other symptoms may include:

  • Feeling empty inside.
  • Problems with anger, such as violent temper tantrums.
  • Hurting yourself, such as cutting or burning yourself.
  • Suicide attempts and suicidal thoughts.
  • Feeling suspicious of others for no reason (feeling paranoid) or losing a sense of reality.

It is easy to confuse this disorder with other mental illnesses such as antisocial personality disorder. So if you think that you or someone you know may have borderline personality disorder, see a doctor. Don't try to diagnose yourself.

What causes borderline personality disorder?

About 2 out of 100 people have borderline personality disorder. But experts don't know exactly what causes it. Problems with chemicals in the brain that help control moods may play a role. The disorder also seems to run in families.

Often people who get it faced some kind of childhood trauma such as abuse, neglect, or the death of a parent. The risk for getting the disorder is higher when people who had childhood trauma also have problems coping with anxiety or stress.

How is it treated?

The symptoms of borderline personality disorder can be treated, but there is no known cure. Long-term counselling is an important part of treatment, but this can be very challenging. Often, it is hard for people with this disorder to have a good relationship with the counsellor.

There are also medicines that can help you cope with the disorder. These medicines can help treat depression or help control moods.

Treatment can be very hard, and getting better can take years. The return of symptoms is a common problem. This is called a relapse. Treatment is even harder if the person has other problems, such as depression or an eating disorder. But most people who are treated improve over time.

Frequently Asked Questions

Learning about borderline personality disorder:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with borderline personality disorder:

Cause

The cause of borderline personality disorder is not well understood. It may be a result of an imbalance of chemicals in the brain called neurotransmitters, which help regulate mood. Mood is also influenced by genetic and environmental influences.

Borderline personality disorder is five times more common among people whose parents or siblings have the disorder.1 It is also seen more often in families who have other mental health conditions such as antisocial personality disorder, substance abuse problems, and mood disorders like depression.2

People who have this disorder often have experienced significant childhood trauma, such as sexual, physical, or emotional abuse; neglect; or early loss of or separation from a parent. When this trauma is combined with certain personality traits, such as reacting poorly to stress or having problems with anxiety, the risk of borderline personality disorder increases.

Symptoms

A person with borderline personality disorder often has unstable relationships, low self-esteem, and problems with impulsive behaviour, all of which begin by early adulthood.

A common feature of this disorder is fear of being left alone (abandoned), even if the threat of being abandoned is not real. This fear may lead to frantic attempts to hold on to those around you and may cause you to become too dependent on others. Sometimes you may react to the fear of being abandoned by rejecting others first before they can reject you. This erratic behaviour can lead to troubled relationships in every area of your life.

People who are diagnosed with borderline personality disorder have at least five of the following symptoms. They may:1

  • Make frantic efforts to avoid real or imagined abandonment.
  • Have a pattern of difficult relationships caused by alternating between extremes of intense admiration and hatred of others.
  • Have an unstable self-image or be unsure of his or her own identity.
  • Act impulsively in ways that are self-damaging, such as extravagant spending, frequent and unprotected sex with many partners, substance abuse, binge eating, or reckless driving.
  • Have recurring suicidal thoughts, make repeated suicide attempts, or cause self-injury through mutilation, such as cutting or burning himself or herself.
  • Have frequent emotional overreactions or intense mood swings, including feeling depressed, irritable, or anxious. These mood swings usually only last a few hours at a time. In rare cases, they may last a day or two.
  • Have long-term feelings of emptiness.
  • Have inappropriate, fierce anger or problems controlling anger. The person may often display temper tantrums or get into physical fights.
  • Have temporary episodes of feeling suspicious of others without reason (paranoia) or losing a sense of reality.

Not everyone who has five or more of these symptoms is diagnosed with borderline personality disorder. For a person to be diagnosed with any personality disorder, the symptoms must be severe and must go on long enough to cause significant emotional distress or problems functioning in relationships or at work.1

You may have temporary episodes of psychosis (paranoia and a loss of a sense of reality) with borderline personality disorder, especially when you are going through a personal crisis. This psychosis usually does not last very long. But if it continues, your doctor may consider another condition, such as schizophrenia.

Symptoms of borderline personality disorder are not caused by another medical condition or by medicines. And they are not a result of long-term substance abuse problems. Borderline personality disorder may be confused with other conditions with similar symptoms, such as other personality disorders, including antisocial personality disorder and histrionic personality disorder.

Suicidal behaviour

Suicidal behaviour is common in people who have borderline personality disorder, with close to 1 out of 10 of those with the disorder completing suicide.3 Your risk of suicidal thoughts or attempts increases if you have depression along with borderline personality disorder. But you can reduce your risk for suicide by treating symptoms of both conditions.

Other conditions that commonly occur with borderline personality disorder

Other mental health conditions commonly occur with borderline personality disorder and need treatment also. These other conditions can make it hard to distinguish borderline personality and can complicate treatment. Conditions that frequently occur with borderline personality disorder include:2, 1

Other personality disorders can occur in addition to borderline personality disorder. A few of these conditions include:

What Happens

The first signs of borderline personality disorder usually appear by late childhood. The most common early signs are impulsive and reckless behaviour. The disorder often fully develops between the ages of 18 and 25. The risk of suicide associated with borderline personality disorder is greatest in the young adult years and gradually decreases with age.1

In the adult years, the disorder causes intense emotions, impulsive behaviours, and unstable relationships. Uncontrolled emotions and fear of being abandoned often lead to job losses, failed marriages, and uncompleted education.2

Often other disorders occur along with borderline personality disorder and also need treatment.

Treatment can be difficult. And often people with borderline personality disorder have difficult relationships with their doctors. People with the disorder often see others as either "good" or "bad." A shift from one view to the other, called splitting, can occur suddenly in any relationship for minor reasons.

These changes in feeling often are a source of tension between a person with borderline personality disorder and doctors. Splitting is also a common source of tension in relationships with friends and family members.

Severe symptoms such as self-destructive and suicidal behaviour, irrational thinking, and emotional problems related to relationships may improve as you begin treatment. Some symptoms may last longer, such as feelings of anger or emptiness or abandonment, suspiciousness, and difficulty tolerating being alone.

Among people with borderline personality disorder, those who are in their 20s are most likely to have thoughts of suicide. And the risk for completed suicide is highest for people in their 30s.4

But the majority of those with this disorder gain more stable emotions, relationships, and employment during their 30s or 40s. Many people who get treatment for borderline personality disorder do decrease destructive behaviours, often within the first year of treatment.1 Around half of those diagnosed with borderline personality disorder no longer have many of the behaviours associated with the disorder after about 10 years of treatment.1

What Increases Your Risk

Your risk for borderline personality disorder increases if you:

  • Have a family member with the disorder.
  • Have a history of sexual, physical, or emotional abuse during childhood.
  • Have difficulty dealing with stress, anxiety, or worry (neurotic personality).

Your risk for relapse of symptoms of borderline personality disorder is greatest when you feel threatened by being left alone (abandonment).

When To Call a Doctor

Call 911 or other emergency services immediately if:

  • You think you cannot keep from harming yourself or someone else.
  • You hear voices (auditory hallucinations).
  • Someone you know attempts suicide or shows warning signs of suicide, such as talking about suicide.
  • Someone you know talks about harming you or someone else.
  • Someone you know shows signs of detachment from reality (psychosis) or is using alcohol or drugs excessively.

Watchful Waiting

Watchful waiting means taking a wait-and-see approach.

Watchful waiting is not appropriate for borderline personality disorder. If you are concerned about symptoms, contact a doctor.

Who To See

Treatment for borderline personality disorder usually involves professional counselling and sometimes medicine, especially if you have another condition that often responds well to medicine (such as depression). It is important that you establish a long-term and trusting relationship with your doctors for treatment of this disorder.

Professional counselling can be provided by a:

If you need medicine therapy along with professional counselling, it can be prescribed by your:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

If you think you may have symptoms of borderline personality disorder, your doctor will do a thorough evaluation of your symptoms. This may include written or verbal tests, a physical examination, and questions about your medical history, which can help rule out other health conditions that might be causing your symptoms. The evaluation may also include a mental health assessment, which involves an interview with a health professional.

Because borderline personality disorder shares symptoms with many other mental health conditions, your doctor may look for signs of another mental health condition in addition to borderline personality disorder.

Treatment Overview

Borderline personality disorder is hard to treat. Relapse, which is a return of your symptoms, is a common problem. And many people with the disorder have difficult relationships with their counsellors or doctors. But it is possible to recover from the damaging behaviours associated with borderline personality disorder.

Many people find relief from destructive symptoms within the first year of treatment.1 About half of those treated for this condition find that they no longer have most of the behaviours after about 10 years of treatment.1

Consistent, long-term treatment of borderline personality disorder is important in improving your symptoms and the quality of your life.

Initial treatment

Initial treatment depends on how bad your condition is. When borderline personality disorder is diagnosed, you most likely will begin treatment with professional counselling (psychotherapy). The first goal of therapy is to help you control destructive behaviours, especially if you are feeling suicidal or self-destructive. When you are less likely to harm yourself and you are able to function more normally, treatment will focus on managing your emotions, such as controlling feelings of anger or unhappiness.

Types of counselling commonly used to treat the disorder include:

  • Cognitive-behavioural therapy (CBT), which focuses on changing certain thoughts and behaviour patterns to control the symptoms of a condition.
  • Dialectical behaviour therapy, which helps reduce destructive behaviours by teaching healthy ways to adapt to and cope with challenges and feelings of frustration or lack of power.
  • Psychodynamic therapy, which focuses on uncovering or understanding your past to gain insight into your actions and current behaviour. This technique assumes that problems with behaviour are caused by internal conflicts that you are not consciously aware of.
  • Family therapy, which can help educate your family about your condition and provide support to you and to those who care about you and are affected by your condition. For example, it is sometimes hard for a parent with borderline personality disorder to be nurturing, even to his or her own child.
  • Support groups, where you and people you care about are able to meet others who share similar challenges.

Techniques that may help you manage symptoms of borderline personality disorder, such as stress and anxiety, include:

  • Getting enough sleep and going to bed around the same time every night.
  • Eating a balanced diet.
  • Getting regular exercise, such as walking or swimming.
  • Avoiding alcohol, illegal drugs, and medicines that have not been prescribed to you. These may make your symptoms of borderline personality disorder worse and also may interfere with your prescribed medicines.
  • Avoiding any major life decisions (like changing jobs, moving, or getting married or divorced) when you are feeling irritable, anxious, angry, or depressed.
  • Building a strong social support system by developing positive relationships with other people, such as family members, friends, and doctors.

You many need to stay in the hospital if you show warning signs of suicide, such as thoughts or plans of harming yourself or another person, detachment from reality (psychosis), or excessive use of alcohol or drugs.

Any other medical conditions you have may also need to be treated. It is common for other conditions to occur with borderline personality disorder. These may include depression, eating disorders, substance abuse problems, attention deficit hyperactivity disorder (ADHD), or another personality disorder.

Your doctor may prescribe medicines to treat symptoms that can occur with borderline personality disorder, such as impulsive or reckless behaviour, uncontrolled anger, thoughts of self-injury, depression, anxiety, and psychosis. Medicines to treat such symptoms include:

Ongoing treatment

Ongoing treatment for borderline personality disorder includes:

  • Long-term professional counselling such as:
    • Cognitive-behavioural therapy (CBT), which focuses on changing certain thoughts and behaviour patterns to control the symptoms of a condition.
    • Dialectical behaviour therapy, which helps reduce destructive behaviours by teaching healthy ways to adapt to and cope with challenges and feelings of frustration or lack of power.
    • Psychodynamic therapy, which focuses on uncovering or understanding your past to gain insight into your actions and current behaviour. This technique assumes that problems with behaviour are caused by internal conflicts that you are not consciously aware of.
    • Family therapy, which can help educate your family about your condition and provide support to you and to those who care about you and who are affected by your condition. For example, it is sometimes hard for a parent with borderline personality disorder to be nurturing, even to his or her own child.
    • Support groups, where you and people you care about are able to meet others who share similar challenges.
  • Medicines, which may be used to reduce symptoms that can occur with borderline personality disorder, such as impulsive or reckless behaviour, uncontrolled anger, thoughts of self-injury, depression, anxiety, and psychosis. You may have to try several medicines before you find the one or ones that work best for you. Medicines to treat such symptoms include:

Techniques that may help you manage borderline personality disorder include:

  • Getting enough sleep and going to bed around the same time every night.
  • Eating a balanced diet that is low in saturated fat and contains lots of fresh fruits and vegetables.
  • Getting regular exercise, such as walking or swimming.
  • Avoiding alcohol, illegal drugs, and medicines that have not been prescribed to you. These may make your symptoms of borderline personality disorder worse and also may interfere with your prescribed medicines.
  • Avoiding any major life decisions (like changing jobs, moving, or getting married or divorced) when you are feeling irritable, anxious, angry, or depressed.
  • Keeping scheduled counselling appointments and taking your medicines as prescribed.

Treatment if the condition gets worse

If your symptoms associated with borderline personality disorder get worse while you are being treated with professional counselling and medicines, you may need to be hospitalized briefly until serious symptoms (such as intense thoughts of suicide) are reduced.

Your doctor may also prescribe medicines, such as selective serotonin reuptake inhibitors (SSRIs), to help reduce symptoms and prevent relapse (a return of your symptoms). It may take several weeks for these medicines to become effective.

You can help manage symptoms by getting enough sleep regularly, eating a balanced diet, getting regular exercise, avoiding alcohol and medicines not prescribed for you, avoiding big decisions when you are feeling low, keeping scheduled counselling appointments, and taking all of your medicines as prescribed.

Successful treatment for borderline personality disorder is harder if you have:

  • Been abused as a child.
  • Experienced symptoms early in life.
  • Had symptoms over a long period of time.
  • Continued to be unable to control your emotions.
  • Experienced problems with aggression, substance abuse, or other mental health conditions, such as depression.

Prevention

There is no way to prevent borderline personality disorder. But you may be able to prevent a return of your symptoms (relapse) by going to your counselling appointments and taking your medicines as prescribed.

Home Treatment

There are many steps you can take at home to help manage your borderline personality disorder symptoms.

  • Get enough sleep, and go to bed around the same time every night.
  • Eat a balanced diet that is low in saturated fat and contains lots of fresh fruits and vegetables.
  • Get regular exercise, such as walking or swimming.
  • Avoid alcohol, illegal drugs, and medicines that have not been prescribed to you. These may make your symptoms of borderline personality disorder worse and also may interfere with your prescribed medicines.
  • Avoid making any major life decisions (like changing jobs, moving, or getting married or divorced) when you are feeling irritable, anxious, angry, or depressed.
  • Keep scheduled counselling appointments, and take your medicines as prescribed.

If you know someone who has borderline personality disorder, you may want to watch for warning signs of suicide, because suicide attempts are common with this disorder. You also may want to seek support for yourself, because this condition can be demanding for those who care about the affected person.

Medications

Medicines may be used to try to reduce symptoms of borderline personality disorder, such as impulsive behaviour or depression. Often a combination of medicines may be the best treatment.

Medication Choices

The most commonly prescribed medicines for borderline personality disorder are:

What To Think About

It may take several weeks for medicines to become effective. You may need to try more than one medicine before you find the one that is right for you. Your doctor may also prescribe a combination of medicines to reduce your symptoms.

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. It is not recommended that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

Surgery

No surgery is available to treat borderline personality disorder.

Other Treatment

Professional counselling is an important part of treatment for borderline personality disorder. Other therapies, such as relaxation techniques, may also help you recover more quickly and improve your quality of life. Family therapy may help you and those who care about you to deal with borderline personality disorder.

Other Treatment Choices

Borderline personality disorder is often successfully treated with professional counselling such as:

  • Cognitive-behavioural therapy (CBT), which focuses on changing certain thoughts and behaviour patterns to control the symptoms of a condition.
  • Dialectical behaviour therapy, which helps reduce destructive behaviours by teaching healthy ways to adapt to and cope with challenges and feelings of frustration or lack of power.
  • Psychodynamic therapy, which focuses on uncovering or understanding your past to gain insight into your actions and current behaviour. This technique assumes that problems with behaviour are caused by internal conflicts that you are not consciously aware of.
  • Family therapy, which can be helpful in educating your family about your condition and providing support to those who care about you and are also affected by your condition. For example, it is sometimes difficult for a parent with borderline personality disorder to be nurturing, even to his or her own child.
  • Support groups, where you and people you care about are able to meet others who share similar challenges.

What To Think About

A critical part of the treatment of borderline personality disorder is long-term professional counselling. It is important that you build a stable relationship with your counsellor to successfully continue treatment. Your condition may cause you to go from viewing your counsellor as nurturing to cruel, especially when you are asked to try to change a behaviour. Try to find a counsellor who has special training in treating borderline personality disorder.

Unfortunately, many people don't seek treatment for mental health problems. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.

Other Places To Get Help

Organizations

Borderline Personality Disorder Resource Center
New York Presbyterian Hospital—Westchester Division
21 Bloomingdale Road
White Plains, NY  10605
Phone: 1-888-694-2273
Email: bpdresourcecenter@nyp.org
Web Address: www.bpdresourcecenter.org

Canadian Mental Health Association
595 Montreal Road
Suite 303
Ottawa, ON  K1K 4L2
Phone: (613) 745-7750
Fax: (613) 745-5522
Email: info@cmha.ca
Web Address: www.cmha.ca
 

The Canadian Mental Health Association (CMHA) promotes mental health and focuses on combatting mental health problems and emotional disorders. The organization offers workshops, pamphlets, newsletters, and other educational materials.


Canadian Psychiatric Association
141 Laurier Avenue West
Suite 701
Ottawa, ON  K1P 5J3
Phone: (613) 234-2815
Fax: (613) 234-9857
Email: cpa@cpa-apc.org
Web Address: www.cpa-apc.org

Crisis Intervention and Suicide Prevention Centre of British Columbia
763 East Broadway
Vancouver, BC  V5T 1X8
Phone: 1-800-SUICIDE (1-800-784-2433)
TDD: 1-866-872-0113
Email: info@crisiscentre.bc.ca
Web Address: http://www.crisiscentre.bc.ca
 

The Crisis Centre is an independent, non-profit organization that provides three fundamental community services:

  • The 24-Hour Distress Line, a free and confidential hotline offering immediate, non-judgmental support and community resources
  • Community Education, a school-based suicide prevention program for high school students throughout the Lower Mainland of British Columbia
  • Young People Help Line (http://www.youthinbc.com), a Web-based hotline for youth in distress that covers all of BC

The Crisis Centre also provides:

  • After-hours distress line support for other agencies.
  • Stress management and suicide prevention education programs for youth.
  • Volunteer training in crisis intervention and suicide prevention.
  • Professional development workshops for other organizations.
  • Assistance to students on YouthInBC.com through a live chat function, e-mail, and by providing resources and information on youth mental health issues.

National Institute of Mental Health (NIMH)
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD  20892-9663
Phone: 1-866-615-6464 toll-free
(301) 443-4513
Fax: (301) 443-4279
TDD: 1-866-415-8051 toll-free
Email: nimhinfo@nih.gov
Web Address: www.nimh.nih.gov
 

The National Institute of Mental Health (NIMH) provides information to help people better understand mental health, mental disorders, and behavioral problems. NIMH does not provide referrals to mental health professionals or treatment for mental health problems.


References

Citations

  1. American Psychiatric Association (2000). Personality disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 706–710. Washington, DC: American Psychiatric Association.
  2. Cloninger CR, Svrakic DM (2009). Personality disorders. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 2197–2240. Philadelphia: Lippincott Williams and Wilkins.
  3. Janowsky D (2008). Personality disorders. In MH Ebert et al., eds., Current Diagnosis and Treatment in Psychiatry, pp. 513–523. New York: McGraw-Hill.
  4. Paris J (2005). Borderline personality disorder. Canadian Medical Association Journal, 172(12): 1579–1583.

Other Works Consulted

  • Skodol AE, Gunderson JG (2008). Personality disorders. In RE Hales, SC Yudofsky, eds., The American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 821–859. Washington, DC: American Psychiatric Publishing.
  • Gross R, et al. (2002). Borderline personality disorder in primary care. Archives of Internal Medicine, 162(1): 53–60.
  • Gunderson JG (2008). Borderline Personality Disorder: A Clinical Guide, 2nd ed., Washington, DC: American Psychiatric Publishing.
  • Oldham JM (2005). Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder, 2nd ed., pp. 1–9. Arlington, VA: American Psychiatric Association.
  • Sanislow CA, et al. (2002). Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: Findings from the collaborative longitudinal personality disorders study. American Journal of Psychiatry, 159(2): 284–290.

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry
Last Revised May 5, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.