A Guide to Mental Disorders

Borderline Personality Disorder ☆

Borderline personality disorder is a mental health condition that affects the way people feel about themselves and others, making it hard to function in everyday life. It includes a pattern of unstable, intense relationships, as well as impulsiveness and an unhealthy way of seeing themselves. Impulsiveness involves having extreme emotions and acting or doing things without thinking about them first.

People with borderline personality disorder have a strong fear of abandonment or being left alone. Even though they want to have loving and lasting relationships, the fear of being abandoned often leads to mood swings and anger. It also leads to impulsiveness and self-injury that may push others away.

Borderline personality disorder usually begins by early adulthood. The condition is most serious in young adulthood. Mood swings, anger and impulsiveness often get better with age. But the main issues of self-image and fear of being abandoned, as well as relationship issues, go on.

Borderline personality disorder is one of a group of conditions called "Cluster B" personality disorders, which involve dramatic and erratic behaviors. Personality disorders are chronic (long-term) dysfunctional behavior patterns that are inflexible, prevalent and lead to social issues and distress.

Many people who live with borderline personality disorder don't know they have it and may not realize there's a healthier way to behave and relate to others.

What is the difference between borderline personality disorder and bipolar disorder?
While bipolar disorder is also characterized by wide fluctuations in mood and behavior, it's distinct from borderline personality disorder (BPD).

In BPD, mood and behavior change rapidly in response to significant stress, especially when interacting with other people, whereas in bipolar disorder, moods are more sustained and less reactive. People with bipolar disorder also have significant changes in energy and activity, unlike those with BPD.

Who does borderline personality disorder affect?
Most personality disorders begin in the teen years when your personality further develops and matures. As a result, almost all people diagnosed with borderline personality disorder are above the age of 18.

Although anyone can develop BPD, it's more common if you have a family history of BPD. People with other mental health conditions, such as anxiety, depression or eating disorders, are also at higher risk.

Nearly 75% of people diagnosed with BPD are people assigned female at birth (AFAB). Research suggests that people assigned male at birth (AMAB) may be equally affected by BPD, but they may be misdiagnosed with post-traumatic stress disorder (PTSD) or depression.

How common is borderline personality disorder?
Borderline personality disorder is relatively rare. Approximately 1.4% of the adult U.S. population has BPD.

What are the signs and symptoms of borderline personality disorder (BPD)?
Signs and symptoms of borderline personality disorder usually appear in your late teenage years or early adulthood. A troubling event or stressful experience can trigger symptoms or make them worse.

Over time, symptoms usually decrease and may go away completely.

Symptoms can range from manageable to very severe and can include any combination of the following:
- Fear of abandonment: It's common for people with BPD to feel uncomfortable being alone. When people with BPD feel that they're being abandoned or neglected, they feel intense fear or anger. They might track their loved ones' whereabouts or stop them from leaving. Or they might push people away before getting too close to avoid rejection.
- Unstable, intense relationships: People with BPD find it challenging to keep healthy personal relationships because they tend to change their views of others abruptly and dramatically. They can go from idealizing others to devaluing them quickly and vice versa. Their friendships, marriages and relationships with family members are often chaotic and unstable.
- Unstable self-image or sense of self: People with BPD often have a distorted or unclear self-image and often feel guilty or ashamed and see themselves as "bad." They may also abruptly and dramatically change their self-image, shown by suddenly changing their goals, opinions, careers or friends. They also tend to sabotage their own progress. For instance, they may fail a test on purpose, ruin relationships or get fired from a job.
- Rapid mood changes: People with BPD may experience sudden changes in how they feel about others, themselves and the world around them. Irrational emotions — including uncontrollable anger, fear, anxiety, hatred, sadness and love — change frequently and suddenly. These swings usually only last a few hours and rarely more than a few days.
- Impulsive and dangerous behavior: Episodes of reckless driving, fighting, gambling, substance use, binge eating and/or unsafe sexual activity are common among people with BPD.
- Repeated self-harm or suicidal behavior: People with BPD may cut, burn or injure themselves (self-harm) or threaten to do so. They may also have suicidal thoughts. These self-destructive acts are usually triggered by rejection, possible abandonment or disappointment in a caregiver or lover.
- Persistent feelings of emptiness: Many people with BPD feel sad, bored, unfulfilled or "empty." Feelings of worthlessness and self-loathing are common, too.
- Anger management issues: People with BPD have difficulty controlling their anger and often become intensely angry. They may express their anger with biting sarcasm, bitterness or angry tirades. These episodes are often followed by shame and guilt.
- Temporary paranoid thoughts: Dissociative episodes, paranoid thoughts and sometimes hallucinations may be triggered by extreme stress, usually fear of abandonment. These symptoms are temporary and usually not severe enough to be considered a separate disorder.