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Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health condition that impacts how you feel about yourself and others, significantly affecting your ability to function in everyday life. BPD can manifest differently in each person, with symptoms and severity varying. With effective treatment, people with BPD can experience improvement in their symptoms and live fulfilling lives.

What Is Borderline Personality Disorder?

Borderline personality disorder is a serious mental illness that impacts the ability to manage emotions effectively. BPD typically starts during adolescence or early adulthood. While the severity can differ, most people with BPD have challenges surrounding emotional regulation, impulsive and reckless behavior, and unstable relationships. 

BPD is characterized by a pattern of instability across several areas: 

  • Relationships: People with BPD often experience intense and stormy relationships, swinging between idealizing and then devaluing others. 
  • Self-Image: A shifting or unclear sense of self is common. People with BPD may describe themselves in extremes, feeling very good or very bad about themselves, depending on the situation.
  • Emotions: Rapid mood swings are a hallmark, lasting from a few hours to a few days and triggered by seemingly minor events.
  • Behaviors: Impulsive actions like substance abuse, reckless driving, unsafe sex, or self-harm are used as coping mechanisms for intense emotions.
  • Suicidal Behaviors/Thoughts: Thoughts of suicide or threats of self-harm are common, particularly during emotional distress.

Borderline Personality Disorder vs Bipolar Disorder

Both borderline personality disorder and bipolar disorder are mental health conditions that can cause emotional instability and relationship difficulties, but they are two distinct conditions. They differ in intensity, duration, and underlying causes. 

People with BPD can experience frequent and intense mood swings lasting hours to days, triggered by interpersonal events. In comparison, bipolar disorder causes extreme mood swings lasting weeks or months, with episodes of mania, depression, or both. 

Psychotherapy is often the cornerstone of treatment for borderline personality disorder, whereas bipolar disorder typically involves a combination of medication and psychotherapy. With effective treatment, people with BPD or bipolar disorder can improve and manage their symptoms. Both conditions can be complex and vary significantly from person to person.

Symptoms of Borderline Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR), is the leading resource for diagnosing mental disorders, including BPD. The criteria for BPD include a pattern of instability in three key areas: interpersonal relationships, self-image, and emotions, along with impulsivity starting in early adulthood.

Symptoms of BPD include: 

Emotional Instability:

  • Frequent and intense mood swings lasting from hours to days, often triggered by interpersonal events (like arguments or rejections)
  • Difficulty controlling anger outbursts
  • Rapid shifts between feelings of intense happiness, sadness, anger, emptiness, or irritability

Unstable Relationships:

  • Intense and volatile relationships with family, friends, and romantic partners
  • Fear of abandonment leading to clingy behavior or pushing loved ones away
  • Idealizing people at first, then quickly switching to feeling angry or disappointed

Distorted Self-Image:

  • Unclear or shifting sense of self-identity
  • Feeling very good or very bad about yourself, depending on the situation

Impulsive and Risky Behaviors:

  • Substance abuse
  • Reckless driving
  • Unsafe sex
  • Binge eating
  • Self-harming behavior 

Suicidal Ideation and Self-Harm:

  • Recurrent thoughts of suicide or threats of self-harm, especially during emotional distress
  • Non-suicidal self-harm behaviors like cutting or burning oneself

Chronic Feelings of Emptiness:

  • A persistent sense of inner emptiness or lack of meaning

Other Symptoms:

  • Difficulty trusting others
  • Feeling detached from oneself or surroundings under stress (dissociation)
  • Inappropriate, intense anger or difficulty controlling anger
  • Paranoid thoughts 

Not everyone with BPD will experience all of these symptoms. The way BPD manifests can vary from one person to another. If you suspect that you or someone you know may have BPD, it’s essential to seek help from a mental health professional who can assess, diagnose, and formulate a treatment plan. 

What Triggers Borderline Personality Disorder?

BPD is a complex condition with various contributing factors. Stressful events, relationship issues, or reminders of past trauma can trigger BPD episodes. These act like emotional storms that intensify existing vulnerabilities. Underlying vulnerabilities in BPD might include emotional dysregulation, fear of abandonment, or unstable self-image.

Triggers can include: 

  • Perceived or real abandonment
  • Unstable or chaotic relationships
  • Stressful events
  • Feeling overwhelmed
  • Rejection or criticism
  • Unstable self-image
  • Boredom
  • Reminders of trauma

Living a Normal Life With Borderline Personality Disorder

Living with BPD may involve navigating challenges, but with treatment, you can build a meaningful life. People with borderline personality disorder can lead fulfilling and productive lives with the right care and support, which can include: 

  • Therapy: Therapy for BPD can be a powerful tool for managing BPD symptoms, improving communication, building healthy relationships, and regulating emotions. 
  • Education: Learning about BPD can be incredibly empowering. It can equip you to challenge negative thinking patterns and become your own advocate. 
  • Self-Care: Prioritizing your physical and mental health is vital for managing BPD.

Treatments for Borderline Personality Disorder

If you have been diagnosed with BPD or have any concerns about yourself or someone you love, speaking to a mental health professional is an important step in getting the treatment you need. 

Treatments for BPD include:

  • Psychotherapy: Talk therapy is a cornerstone of treatment for borderline personality disorder. It provides a safe space for individuals with BPD to explore their emotions, thoughts, and behaviors with a trained mental health professional. 
  • Medication: While there is no medication specifically for BPD, some medications can help with conditions that happen with BPD, like anxiety or depression. 
  • Hospitalization: In certain situations, staying in a hospital may be necessary to keep you safe from harming yourself and help you work through suicidal thoughts or behaviors. 

Comorbidity is common with BPD, meaning it frequently occurs with other mental health conditions, including mood disorders, anxiety disorders, and substance use disorders. This is not an exhaustive list, and speaking with a mental health professional is essential for diagnosing and treating any co-existing conditions. 

In times of crisis, it’s important to seek emergency help if you or someone you know with BPD is experiencing suicidal thoughts or urges, self-harm, severe emotional turmoil, or psychosis. You can also contact the National Suicide Prevention Lifeline at 988.

How a Therapist Can Help With Borderline Personality Disorder

Therapy aims to equip people with the tools and strategies they need to manage symptoms of borderline personality disorder and improve their overall well-being. Therapeutic approaches that are often used to treat BPD include: 

  • Dialectical Behavior Therapy (DBT): Teaches practical skills in emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
  • Cognitive Behavioral Therapy (CBT): Helps identify and challenge negative thought patterns.
  • Mentalization-Based Therapy (MBT): Develops a person’s ability to understand their own and others’ mental states.

People with BPD experience the disorder differently, and a tailored approach to individual needs is crucial for treatment and symptom management. Therapy for BPD can help individuals gain self-understanding, cultivate healthier coping mechanisms, and build a more fulfilling life. 

Treatment for BPD can also involve family members, if appropriate, to help families understand BPD, improve communication, and develop healthier ways to interact with each other. Even without direct involvement in therapy, family members can be supportive and help provide encouragement and a stable environment. 

When to Contact a Qualified Therapist

If you or someone you know has BPD, remember that it’s a treatable condition, and with a long-term commitment to treatment, individuals with BPD can live fulfilling and productive lives. 

If you’re experiencing signs or suspect BPD, contact the mental health experts at Thriving Center of Psych. You don’t need to struggle alone. Our therapists are experienced in treating BPD and can support you in managing symptoms and building a healthier and happier life.