Borderline personality disorder, known short as BPD, is a medical condition affecting one’s mental health mostly by modifying the way feelings are controlled, causing emotional instability. In certain circumstances, especially after triggering events, borderline personality disorder provokes unusually intense emotional responses for an extended amount of time, leading to multiple types of problems in one’s everyday life.

There is a large variety of issues caused by suffering from BPD, including poor self-image, difficulties in emotional management, and impulsive reactions. As these characteristics of borderline personality disorder may strongly affect interactions with other people, another common feature of this condition is having difficulties in forming lasting connections and healthy relationships with the ones around. People who suffer from borderline personality disorder could be overly sensitive, meaning that even the smallest things can trigger these intense reactions. In extreme cases, these self-regulation issues may cause life-threatening behaviors.

Research shows that signs of BPD are usually discovered in early adulthood, slowly improving with age, especially with the right treatment. Even though 75% of adults professionally diagnosed with borderline personality disorder are women, recent studies indicate that men are equally vulnerable to developing this medical condition, but they are mostly misdiagnosed with other mental health conditions such as post-traumatic stress disorder (PTSD) or depression. However, BPD remains the most common type of personality disorder.

 

Causes of borderline personality disorder

Similar to other psychological disorders, the exact causes of BPD development remained unknown, yet mental health professionals confirm that certain factors may strongly influence it. These include:

• Genetics – even though there are no particular genes linked to borderline personality disorder, this condition tends to run in families and therefore could be inherited.
• Environmental and social factors- experiencing traumatic events increases the risk of development, as well as being exposed to unhealthy social relationships. It is not uncommon for someone to start manifesting BPD symptoms a while after going through a traumatic experience such as physical or sexual abuse, neglect, or abandonment, especially when the event took place during childhood.
• Brain factors- research shows that there may be modifications in the specific areas of the brain that control emotions and impulsivity, as well as the decision-making ones. These neurological (functional and structural) abnormalities can lead to miscommunication among these portions of the brain, causing a large variety of symptoms. In addition to that, another brain-related factor is represented by specific chemicals that play an essential role in mood regulation (for example serotonin) not functioning accordingly.

 

Symptoms of borderline personality disorder

Since every human being is unique, not everybody experiences borderline personality disorder the exact same way. Some people only show a few signs, while others manifest almost all of them. According to the Diagnostic and Statistical Manual diagnostic framework, general signs and symptoms of BPD include:

• Intense fear of neglect and abandonment- especially while caused by a traumatic incident regarding these aspects, people with this personality disorder tend to be terrified by the thought of being left alone or rejected by friends and family. Intense emotional responses may be triggered by simple situations such as a family member arriving home later than usual. Even though they want to keep people close and form long-lasting relationships, the uncommon behavior and reactions to different stimulants may push people away. One suffering from BPD can make extreme efforts in order to avoid this real or imagined separation: they may initiate premature intimate relationships, both physical and emotional or they may cut people off when they anticipate abandonment. Other extreme measures taken in certain circumstances are begging, clinging, unexpectedly starting arguments, and even physically blocking people from leaving.
• Not being able to form stable relationships- a pattern of unstable relationships is very common in people with BPD, due to their intense, impulsive reactions. For example, a person suffering from BPD is very likely to fall in love very quickly and have high expectations from the other person, usually leading to severe disappointment. Switching from idealization to devaluation is a very rapid process (known as ‘splitting’) caused by quick opinion shifts. This is also accompanied by difficulties in trusting people around.
• Distorted self-image- with borderline personality disorder, the sense of self is strongly affected, causing fast modifications in self-identity and unclear self-image, including life goals, values and general opinions. It is not uncommon for someone with BPD to frequently change many of these aspects, as well as others: religion, jobs, friends or even sexual identity. Not knowing who they are and having a very blurred sense of self are typical symptoms of BPD.
• Impulsive, risky and dangerous behaviors- self-destructive actions may accompany BPD. These may be gambling, binge eating, consuming certain substances such as drugs or alcohol, shoplifting, engaging in unsafe sex with strangers or driving recklessly. Some of the impulsive decisions may sabotage a successful life- for example, unexpectedly quitting a job or ending a healthy relationship for absolutely no reason at all. These behaviors typically occur when one suffering from BPD is upset and they may have severe outcomes.
• Self-harm- cutting, burning or other types of self-harming behavior as a response to the fear of abandonment or separation are common in people with borderline personality disorder. Threatening and attempting suicide are very serious matters, meaning that once observed, it is strongly recommended to seek help and consult a mental health professional.  
• Emotional swings- unexpected mood swings may occur due to the unstable emotional state. Unlike symptoms of depression or bipolar disorder, these feelings tend to fade away as quickly as they were formed (they may last from a few minutes or a few hours to a few days) despite their high intensity.
• Chronic feelings of emptiness- people that experience BPD tend to describe one of the symptoms as continuously feeling empty inside, with no possible way of being completely satisfied. This is a very uncomfortable feeling, usually accompanied by thinking that they are unreal. In extreme cases, dissociative symptoms may also occur, such as seeing themselves from the outside the body or disconnecting from their own thoughts.
• Paranoia and suspiciousness- especially linked to other people’s intentions.
• Anger issues- short temper and lack of self-control are common signs of BPD. This may lead to behaviors such as yelling or throwing things around due to very intense emotional responses to certain factors. It is often followed by intense feelings of shame and guilt.

 

Types of Borderline Personality Disorder

Based on various criteria and experienced symptoms, there are four main types of borderline personality disorder:

• Impulsive borderline personality disorder

As impulsivity is a main symptom of BPD, people suffering from impulsive borderline personality disorder tend to appear charismatic, flirtatious, and energetic, though their behaviors are dangerous. Without thinking about the possible consequences, they may drive under the influence, do illicit drugs, or frequently have unprotected sex, sometimes with multiple partners. Bingeing behaviors are also common. The impulsivity may lead to aggressive outbursts causing physical fights, yelling and breaking, hitting or throwing objects.

• Discouraged borderline personality disorder

Also called quiet borderline personality disorder, it mainly involves an intense fear of abandonment leading to extreme measures in order to prevent it, as described above. People affected by this type of BPD may be seen as perfectionists and successful, due to their strong desire to feel accepted by their loved ones. They tend to seek social approval, as they usually feel lonely, empty inside or unable to form meaningful relationships with others. They do not express these intense emotions, keeping them to themselves, causing self-harm and possibly suicidal behavior. Main psychological symptoms of discouraged borderline personality disorder include social codependency, neediness, and unexpected mood swings when triggered.

• Self-destructive borderline personality disorder

Common behavior patterns in people with self-destructive BPD involve abusive usage of certain substances and seeking the feeling of adrenaline without considering the risks of the dangerous activities they engage in. These could be accompanied by self-harm behaviors such as cutting, burning or scratching. Symptoms are very similar to those in other mental health conditions, but they may also include increased energy levels, euphoria and others.

• Petulant borderline personality disorder

This sort of borderline personality disorder mostly affects the brain by causing unpredictable mood swings. A person affected by this condition may rapidly change their emotions or perspectives of life, while often feeling unworthy of love. They tend to be very stubborn, easily irritable, impatient, and sometimes aggressive. Their dissatisfaction regarding their difficulties in maintaining healthy relationships with others may lead to self-destructive borderline personality disorder behaviors.

One may be diagnosed with one or multiple types of BPD at the same time, as well as at different times in their lifetime.

 

How does borderline personality disorder affect one’s life?

The wide variety of symptoms related to borderline personality disorder listed above lead to multiple `types of difficulties in one’s everyday life, mostly affecting interactions with other people and their own perspective of their existence.

As a result of emotional instability, relationships with other human beings may be strongly affected. Many negative emotions are involved, including rage, shame, panic, sorrow and others. These could be long term or there could be rapid and unpredictable mood swings, as previously mentioned. For instance, one could feel intensely suicidal and have negative, dark thoughts at a time and after a very short while they could be unexpectedly positive, happy and simply in a good mood, without a specific pattern for these changes.

Issues regarding one’s disturbed thinking processes are also various. These could cause delusions: hearing all sorts of unreal voices in their head giving them certain dangerous instructions or having out-of-body experiences, as well as other types of hallucinating episodes. For example, one could have a strong belief that their families are planning their murder, they could have a distorted sense of self (feeling like they’re unreal and they do not actually exist) or experience self-deprecating emotions and thoughts. They typically believe that they’re terrible people or simply not good enough, resulting in continuously seeking reassurance that this is not true. All these could be considered psychotic beliefs, indicating worsening the severity of the condition.

These behaviors may negatively impact social relationships. Turning calling and texting a loved one in the middle of the night or multiple times a day into a habit is not uncommon for people with borderline personality disorder, causing relationship issues. The intense fear of abandonment usually leads to exaggerated reactions, anxiety, and anger, which might drastically push people away. In severe cases, this is usually followed by suicidal or self-harm threats in case they suspect that the other person might leave them. Being in a relationship with someone that has BPD is very challenging, as they either see things as going perfectly or terribly, no in-between, confusing both themselves and their partner. Unfortunately, this is the main reason why their relationships end, especially when the other person is not aware of them suffering from this mental health disorder. 

 

Borderline personality disorder in children and teenagers

Even though this personality disorder has historically been diagnosed in grown-ups, studies show that children and teenagers are able to develop BPD as well. The signs of borderline personality disorder may be caused by other factors, especially hormonal variations or other mental health conditions that are more specific for young people. When these symptoms persist through adulthood, a BPD diagnosis is considered to be more accurate. However, it is recommended to consult a professional if symptoms are noticeable, as an early diagnosis and treatment may help prevent further evolution of the severity.

As children are still in the process of forming their personalities and identifying themselves, growing up in an inappropriate social and family environment may cause them intense feelings of emptiness, leading to experiencing other symptoms of BPD and depression in their teenage years. Usually, teens suffering from BPD tend to appear angry and impulsive and they have a higher risk of self-harm and suicide.

 

Testing and diagnosing borderline personality disorder

As it is a complex neurological disorder, there is no single test designed to diagnose BPD. When symptoms are experienced, it is strongly recommended to consult a mental health specialist (could be a psychologist, a psychiatrist, or a clinical social worker) regarding the situation. In order to give a certain diagnosis, licensed professionals may combine multiple testing methods, including an interview regarding the observed symptoms and family medical history of mental illnesses, as well as a general medical exam searching for other conditions that may possibly cause symptoms.

 

Treatment for borderline personality disorder

There is no universal treatment that helps with borderline personality disorder, as each individual needs an evidence-based, specialized treatment offered by a suitable mental health professional. There are different methods used to reduce the intensity of the symptoms and with the right treatment at the right time, people with BPD may actually live very successful lives.

It is extremely important for individuals affected by this condition to find a therapist they feel comfortable and safe with, making them feel understood and accepted. In order to voluntarily commit to therapy, one might need to try seeing more than one specialist until they find their best option and make progress.

Treatment options that mental health professionals generally consider include psychotherapy, prescription of medications and support groups, as well as environmental support from friends and family members. 

• Psychotherapy

The most effective types of psychotherapy are dialectical behavior therapy, cognitive behavioral therapy, and psychodynamic psychotherapy. These could be very effective, key factors in long-term improvements for patients. They could be done in one-on-one sessions or group settings, as it could be helpful for multiple people suffering from BPD to connect with each other and learn how to properly interact and express their feelings.

On one hand, dialectical behavior therapy (DBT) involves awareness of the emotional state, while encouraging acceptance and mindfulness. It helps the patients learn how to control their feelings, improve social relationships and reduce self-damaging behavior types.

On the other hand, cognitive behavioral therapy (CBT) is designed to change cognitive processes, reducing patients’ negative perceptions of themselves and the ones around them. Similar to DBT, CBT may help with interactions with others, also reducing mood swings and suicidal behaviors. 

• Medication

Although there is no medicinal drug specifically designed for the treatment of borderline personality disorder, some medications could help reduce the intensity of various symptoms. Some of these include mood stabilizers and antidepressant medicines that mostly help improve mood swings. Another symptom, distorted patterns of thinking, could be controlled by administrating low-dose antipsychotic medication.

These drugs must only be taken when a mental health professional recommends them, carefully respecting the dosage, as certain medications may have intense side effects. In extreme cases, short-term hospitalization may also be required in order to ensure safety for patients, especially when severe suicidal behaviors occur.

• Environmental support

In order to record progress and recover from borderline personality disorder, one needs encouragement and emotional support from close friends and family. As interacting with a person with BPD can be stressful, it is recommended to be patient, encouraging and understanding, making it easier for them to get better with time.

 

Complications of borderline personality disorder and other linked medical conditions

Lack of treatment may lead to a wide variety of complications, mostly related to difficulties in the everyday life or the development of other mental health conditions.

Different untreated symptoms could lead to different complication types. Some of these include recurring job changes, inability to successfully complete educational levels, divorces (due to undeveloped communicational skills) or engagement in abusive, unhealthy relationships, unexpected pregnancies, STDs, accidents or legal issues. As mentioned previously, self-harming behaviors are also involved, leading to hospitalizations or, in worst cases, even completed suicides.

Developing other mental health disorders if BPD is not accordingly treated is not uncommon. Medical conditions strongly linked to borderline personality disorder are depression, anxiety, eating disorders, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), substance usage disorders and others. These co-occurring mental health disorders may lead to difficulties in obtaining the right diagnosis, due to overlapping of symptoms.

 

Borderline personality disorder vs. bipolar disorder

Another medical condition that is considered to be linked to BPD is bipolar disorder. Their similarities consist in the symptoms regarding mood swings and emotional instability, as well as impulsive reactions and behaviors.

However, they are two separate, different mental health disorders. For starters, the quality of the unexpected mood changes differs. While people suffering from BPD mostly sense anger, loneliness and emptiness, in bipolar disorder they tend to feel depression symptoms and mania. Compared to borderline personality disorder, these mood swings last longer in bipolar disorder (days, sometimes even weeks). The causes of mood shifts also differ: in bipolar disorder, there is no need for an environmental trigger for them to occur.

Scientifically, there is no strong evidence that the two of these are related, as they are developed fully independently.

 

Famous people with borderline personality disorder

In spite of the daily difficulties produced by having borderline personality disorder, the right treatment could help people become very successful. There are many well-known people that have been diagnosed with this condition, excelling in different domains. These celebrities could be great models for people suffering from BPD, representing hope. Some famous people with BPD are:

• Vincent van Gogh –one of the most recognized painters of all times
• Doug Ferrari- well-known comedian and writer
• Ricky Williams- successful American football player
• Pete Davidson- comedian and actor best known for Saturday Night Live (SNL)
• Mikey Welsh- American musician and artist
• Darrel Hammond- American actor

 

Conclusion

Borderline personality disorder (BPD) is a mental health condition affecting the activity of the brain, mostly by distorting one’s perspective of themselves and others and the way they socially interact. Main symptoms include fear of abandonment, mood swings, impulsive and risky behaviors, weak social skills, as well as self-harm and suicidal behaviors in extreme cases. Treatment options are available as psychotherapy (DBT and CBT) and medications that help reduce some of the symptoms.