Borderline Personality Disorder (BPD): Types, Symptoms, Causes, and Treatment

A borderline personality disorder is a mental health disorder characterized by constant instability in moods, behavior, self-image, and functioning. Individuals with BPD often experience intense episodes of anger, depression, and anxiety that can last from a few hours to days. BPD is classified as “Cluster B personality disorder” which includes disorders marked by dramatic, overly emotional, or unpredictable thinking and behavior.

The symptoms of BPD include fear of abandonment, unstable relationships, unstable self-image, impulsivity, emotional instability, chronic feelings of emptiness, and intense anger.

The causes of BPD include genetic factors, environmental factors, neurobiological factors, psychological factors, and social factors.

Types of BPD include impulsive BPD, discouraged BPD, self-destructive BPD, and petulant BPD.

Treatment options for BPD include dialectical behavior therapy, cognitive behavioral therapy (CBT), medications, psychodynamic psychotherapy, and schema therapy.

What is Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a complex mental health condition that includes constant instability in mood and actions. People suffering from BPD usually go through severe episodes of anger and depression. These episodes can last for a few hours and even days. This disorder has the potential to impact relationships and daily life. 

As per DSM-5, BPD is defined as constant instability in interpersonal relationships and marked impulsivity. It begins by early adulthood, and is present in a variety of contexts as identified by five or more of these: efforts to avoid real or imagined abandonment, patterns of unstable and intense interpersonal relationships, identity disturbance, impulsivity, recurrent suicidal behavior, chronic feelings of emptiness, and inappropriate intense anger. 

NIMH describes BPD as a serious mental health disorder marked by a pattern of ongoing instability in moods and functioning which usually leads to impulsive actions and unstable relationships. 

A study published in the Journal of Clinical Psychology indicates that at least 1.4% of individuals in New Jersey are diagnosed with BDP. On the other hand, in the United States, up to 5.9% of people have suffered from it.

What are the types of Borderline Personality Disorder?

Types of BPD include impulsive BPD, discouraged BPD, self-destructive BPD, and petulant BPD. 

Some common types of BPD are listed below: 

Impulsive BPD:

Impulsive BPD is characterized by high levels of impulsivity and thrill-seeking behaviors. People suffering from this type of BPD often engage in reckless activities such as substance abuse and overspending. As per NHS, these people might often struggle with boredom and seek new and exciting experiences. They are prone to sudden changes in mood and may have difficulty maintaining long-term relationships due to their unpredictable behavior. 

Discouraged BPD: 

Discouraged BPD resembles dependent personality traits individuals with this type of BPD often suffer from feelings of helplessness, and submissiveness and they are always seeking validation from others. They may have a constant fear of abandonment and struggle with self-identity. These individuals often appear to be clingy and may go to lengths to avoid being alone. They are prone to depressive episodes and may have low self-esteem and feelings of worthlessness. 

Self-destructive BPD: 

Self-destructive BPD is marked by self-harming behaviours including cutting, burning, and other forms of self-injury. As per Harvard Health, these individuals often engage in suicidal thoughts and attempts. Self-destructive behaviors are often used as coping mechanisms to deal with intense pain and feelings of emptiness. They may show a pattern of sabotaging their own success and well-being.

Petulant BPD: 

Petulant BPD involves a combination of irritability, impatience, and difficulty in managing frustration. Individuals with this form of BPD may experience rapid mood swings and show passive-aggressive behavior. These individuals often feel misunderstood and may lash out at others when they feel low. They may alternate between dependence on others and stubborn defiance.

What are the Symptoms of Borderline Personality Disorder?

The symptoms of BPD include fear of abandonment, unstable relationships, unstable self-image, impulsivity, emotional instability, chronic feelings of emptiness, and intense anger.

These common symptoms of BPD are listed below:

Fear of abandonment:

Individuals with BPD often have an intense fear of abandonment or being left alone, even for short periods. This fear can lead to a constant effort to avoid real or imagined abandonment. This symptom can manifest as clinging, frequent texting, or calling and becoming upset on signs of rejection. It is considered among the core symptoms of having BPD.

Unstable relationships: 

People with BPD often experience unstable relationships, swinging between extreme conditions of idealization and devaluation. As per Health Direct, the relationship might start as intense adoration but then move toward anger and dislike if the person feels low and irritated. This cycle can result in a pattern of breaking up and getting back together with a partner, friends, or family. 

Unstable self-image:

People with BPD often have an unstable or distorted self-image, leading to sudden changes in goals, values, opinions, and career decisions. The symptoms can result in feelings of emptiness, identity confusion, and frequent changes in self-perception. People with BPD may suddenly change their views on major life issues. or feel like maybe they don’t know who they are. 

Impulsivity: 

Impulsive behaviors in at least two areas that are potentially self-damaging such as spending, binge-eating, reckless driving, or substance abuse. According to NHS, impulsivity may lead to risky behaviors that can have serious consequences. Individuals might engage in reckless driving or substance abuse, often without considering the long-term consequences. 

Emotional instability: 

Marked mood swings include intense episodes of dysphoria, irritability, or anxiety usually lasting for a few days or hours. As per NHS, emotional irritability in BPD is characterized by rapid shifts in moods and intense emotional reactions. These mood swings can occur without any apparent reason and are often difficult for the individual to control. 

Chronic feelings of emptiness: 

It’s a constant feeling of emptiness and boredom. People with BPD often report feelings of emptiness, boredom, and numbness. As per NIH, they experience a feeling like there’s something in their life. This constant emptiness can lead to a continued need for external validation.

Intense anger: 

It’s having intense anger and difficulty controlling it. People with BPD often experience intense anger that is difficult to control. They might experience frequent temper outbursts, physical fights, or ongoing feelings of anger.

What are the causes of Borderline Personality Disorder?

The causes of BPD include genetic factors, environmental factors, Neurobiological factors, psychological factors, and social factors.

The common causes of BPD are mentioned below.

• Genetic factors: Genetic factors refer to the hereditary aspects that can contribute to the development of BPD. Studies indicate that BPD can run in families suggesting a genetic component. A study published on Science Direct suggests that first-degree relatives of people with BPD are 5 times more likely to have the disorder themselves.

• Environmental factors: Environmental factors include early life experiences such as childhood trauma, abuse, or neglect, that can significantly influence the development of BPD. Emotional and physical abuse, as well as parental neglect, are common among those diagnosed with BPD. As per research gate, up to 70% of patients with BPD have reported childhood sexual abuse.

• Neurobiological factors: Neurobiological factors involve structural and functional abnormalities in the brain region associated with emotion regulation, impulse control, and interpersonal functioning. These abnormalities can affect emotional regulation and stress response contributing to the symptoms of BPD. Research published by the American Psychology Association, suggests the presence of abnormalities in the prefrontal cortex and the limbic region in people with BPD.

• Psychological factors: Psychological factors include personality traits, cognitive patterns, and emotional responses that can lead to individuals developing BPD. People with BPD often show increased sensitivity to emotional stimuli and difficulty returning to a baseline emotional state. A study by APA suggests that BPD occurs after an interaction between biological vulnerabilities and an invalidating environment. 

• Social factors: Social factors include the broader social context and relationships that can impact the development and maintenance of BPD. unstable relationships and lack of support can lead to the development of BPD.

What are the risk factors for developing borderline personality disorder?

The risk factors for developing BPD include a family history of mental disorders, childhood trauma and abuse, early parental loss or separation, personality traits, and sociocultural factors.

Some common risk factors of BPD are listed below:

Family history of mental disorders: A family history of mental disorders or other mental health conditions such as mood disorder or substance abuse can lead to the development of BPD. Genetic factors can be inherited making people more likely to develop BPD. This is often due to shared genetic factors or environmental factors within the family. 

Childhood trauma and abuse: Experiences of physical, emotional, or sexual abuse, as well as neglect during childhood can lead to the development of BPD. Such experiences can disrupt emotional development which can lead to the development of coping mechanisms that are part of BPD.

Early parental loss or separation: Losing a parent or experiencing prolonged separation during childhood can increase the risk of BPD. Early loss or separation can lead to attachment issues, fear of abandonment and difficulty forming stable relationships later in life, all of which are associated with BPD.

Emotional dysregulation: Difficulty in managing and regulating emotions, often seen in childhood can lead to the development of BPD. It can manifest as frequent mood swings. Intense emotions and impulsive behaviors are core symptoms of BPD.

Personality traits: Certain personality traits such as high levels of impulsivity and increased sensitivity are linked with an increased risk of BPD. These traits can lead to intense emotional reactions, unstable relationships, and impulsive behaviors, all of which are linked to the symptoms of BPD.

Sociocultural factors: Socio-cultural factors including societal norms, cultural background, and socioeconomic status, can influence the risk of BPD. These factors can influence how a person experiences and expresses emotions, cope with stress, and relate to others, all leading to BPD.

Who is at risk for Borderline Personality Disorder?

People who are at risk of developing BPD include those with a family history of BPD or other mental health disorders such as depression or substance abuse. Childhood experiences play a major role, specifically for those who have faced trauma, abuse, neglect, or early parental loss. People with certain personality traits such as high impulsivity, emotional sensitivity, and difficulty regulating emotions are at risk of developing BPD. Environmental stressors including unstable living conditions or exposure to chronic stress and conflict can trigger these vulnerabilities. Moreover, cultural and socio-economic factors can influence the likelihood of developing BPD. 

How is BPD diagnosed?

Borderline personality disorder (BPD) is diagnosed through a comprehensive clinical assessment that includes detailed interviews, psychological evaluation, and often the use of standardized diagnostic tools. Clinicians typically diagnose BPD by assessing a person’s long-term patterns of behavior, emotional response, and interpersonal functioning. A main part of this assessment involves understanding the patient’s history and examining the core symptoms, such as emotional instability and impulsive behaviors. The diagnosis is usually made by a mental health professional who conducts a thorough evaluation to differentiate BPD from other mental health disorders. 

According to DSM-5, at least 5 of these symptoms must be present for the diagnosis of BPD including efforts to avoid real or imagined abandonment, a pattern of unstable relationships, identity disturbance, impulsivity, suicidal behavior, feelings of emptiness, and intense anger. 

What are the Treatment Options for Borderline Personality Disorder (BPD)?

Treatment options for BPD include dialectical behavior therapy, cognitive behavioral therapy (CBT), medications, psychodynamic psychotherapy, and schema therapy.

Some of the treatment options for BPD are listed below

• Dialectical behavior therapy: DPT is a type of cognitive-behavioral therapy specially designed for people with BPD. It focuses on teaching skills to manage emotions, improve relationships, and reduce self-destructive behaviors. Recovery can take up to 6 months to a year. While DPT is a widely known treatment for BPD, it can turn out to be intensive.

• Cognitive behavioral therapy (CBT): CBT helps people to identify and change negative thoughts patterns and behaviors that contribute to emotional difficulties and interpersonal problems. A normal course lasts 12-20 weeks. While it may be effective in healing depression and anxiety, it might not address the root cause of BPD.

• Medications: While no medication is specifically approved for BPD, psychiatric medications can help manage symptoms such as depression, anxiety, and mood swings. The effect of medications can be seen in a few weeks. While medications can provide relief from acute symptoms, they might not address the underlying symptoms of BPD.

• Psychodynamic psychotherapy: This therapy focuses on understanding the unconscious process and unresolved conflicts that underline emotional difficulties and behaviors. The results can be seen in a few years. While it is good to address the root cause of BPD, it can be lengthy and intensive. 

• Schema Therapy: Schema therapy combines elements of cognitive-behavioral, experiential, and psychodynamic approaches to address the schemas formed in early life. Treatment often lasts 1-2 years. While it’s effective in addressing deep-seated issues, it can be rather time-consuming. 

Can borderline personality disorders be prevented?

No, BPD can not be entirely prevented, as it is influenced by several genetic, environmental, and psychological factors. However early intervention and support can reduce the severity of symptoms. Promoting a supportive and stable environment in childhood is crucial. Encouraging healthy relationships, teaching emotional regulation skills, and providing adequate mental health resources can help reduce the risk factors associated with BPD.

What is the difference between borderline personality disorder and other mental disorders?

BPD is different from other mental disorders, however, some symptoms can still overlap. Unlike bipolar disorder which involves distinct mood episodes of mania and depression, BPD is characterized by rapid mood swings. In contrast to schizophrenia, which includes symptoms like hallucinations, BPD mainly involves difficulties with emotional regulation. ADHD shares some symptoms with BDP, however, the fear of abandonment and emotional instability is not common in ADHD. 

What is the difference between borderline personality disorder and bipolar disorder?

BPD is characterized by constant instability in mood, behavior, self-image, and functioning often leading to impulsive actions and intense emotional reactions. Bipolar disorder, on the other hand, is a mood disorder characterized by episodes of mania and depression. While both disorders involve mood swings, the fluctuations, and duration differ.

What is the difference between borderline personality disorder and schizophrenia?

BPD is a disorder marked by emotional instability, impulsive behaviors, and unstable relationships. Schizophrenia is a severe mental disorder characterized by symptoms such as delusions, and impaired reality testing. While both disorders include episodes of distorted thinking, they differ in significant ways. BPD might involve stress-related ideation while schizophrenia involves chronic psychotic patterns.

What is the difference between borderline personality disorder and ADHD?

BPD involves intense emotional instability and impulsive behaviors. ADHD, on the other hand, involves constant patterns of inattention and impulsivity.  While both of these disorders involve difficulty maintaining attention and impulsivity, their core symptoms vary from each other.

What is the difference between borderline personality disorder and depression?

BPD and depression both involve significant mood disturbances but both are different disorders. BPD is characterized by a constant pattern of instability of emotions. Depression, on the other hand, is marked by constant feelings of sadness and loss of interest. 

FAQs

What are the signs of BPD in females?

Common signs of BPD in females include intense emotional reactions, unstable relationships, fear of abandonment, and identity disturbances.

What triggers BPD?

Triggers of BPD typically involve interpersonal stressors such as rejection, abandonment, and criticism.

What happens if BPD is left untreated?

If BPD is left untreated, individuals may experience worsening symptoms which can significantly impair their quality of life.