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If you have intense mood swings and a sense of loneliness no matter how many relationships you have, you may have a personality disorder. Here we explain what borderline personality disorder (BPD) is and how to get help.
What is borderline?
Borderline personality disorder (BPD) is a mental illness and personality disorder characterized by significant emotional instability, intense relationships with others and a strong fear of abandonment. People with BPD may experience rapid and extreme mood swings, and their self-image may also be unstable.
This is a severe condition that often involves self-harm, suicidal thoughts and substance abuse. If you have these problems, you should primarily seek help through your primary care provider to get a referral to a psychiatrist. In case of severe suicidal thoughts, you can call 911 or go to your nearest emergency room.
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What is a personality disorder?
Personality disorders are complex psychological conditions that affect an individual’s thoughts, feelings and behaviors in a way that often differs significantly from societal norms and expectations.
Why do people get BPD?
The causes of borderline personality disorder are not entirely clear, but may be a combination of genetic, biological and environmental factors, including early trauma such as sexual abuse.
In adolescence, there may be symptoms similar to BPD as teenagers explore their identities and experiment with relationships. If symptoms don’t resolve by the end of adolescence and adults continue to struggle with forming attachments and feeling fulfilled, BPD may be one explanation.
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How common is borderline?
Approximately 1.4% of American adults are diagnosed with BPD (NIMH, 2024).
Symptoms of borderline personality disorder
There are several symptoms of BPD. It is important to note that the severity and prevalence of symptoms can vary greatly between individuals. In addition, there may be co-morbidity with other mental health conditions, such as ADHD, autism, depression, eating disorders and PTSD, which can affect the expression of the profile. Diagnosis and treatment should be done by a licensed psychologist or psychiatrist. Here are some of the main symptoms and characteristics of borderline personality disorder:
- Fear of abandonment: An intense fear of real or imagined abandonment. This can lead to desperate attempts to avoid being abandoned, even through self-harming behavior.
- Unstable relationships: Relationships can be intense and stormy, with periods of idealization followed by devaluation. These swings are often due to black-and-white thinking, with the person with borderline either idealizing others as “perfect” or dismissing them as “terrible”.
- Unstable self-image: A deeply disturbed or changing perception of oneself. People with borderline may have problems with their identity and self-esteem.
- Impulsivity: This can include risky behaviors such as substance abuse, eating disorders, reckless driving, or excessive spending.
- Self-harm: Includes behaviors such as self-harm and suicidal thoughts or attempts.
- Emotional instability: Rapid and intense mood swings that can be difficult to control.
- Feelings of emptiness: A chronic sense of emptiness or meaninglessness.
- Intense anger: Difficulty managing anger, which can lead to temper tantrums or constant irritation.
- Stress-related paranoia or dissociation: During periods of extreme stress, people with borderline may experience paranoia or dissociation from reality.
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Assessment of personality disorders
Personality disorders are diagnosed by licensed mental health professionals. This involves taking an initial medical history to review the background to the symptoms and completing assessment forms. A structured diagnostic interview and an interview with family members are then carried out to see how the symptoms manifest themselves in different areas.
Treatment for borderline personality disorder
Treatment for BPD usually involves a combination of psychotherapy, medication (to manage co-occurring conditions such as depression or anxiety) and self-help strategies. Dialectical behavioral therapy (DBT) is a form of therapy specifically developed to treat borderline and has been shown to be particularly effective.
MBT, short for mentalization-based therapy, is also helpful in treating BPD. An important part of the treatment is mindfulness to manage emotions, but other strategies and tools are also used to increase self-understanding and improve the ability to manage emotions.
Advice for those who know someone with personality disorder
Be careful with boundaries: It is important to set clear boundaries to protect yourself and your own psychological well-being.
Seek professional help: It is not your job to diagnose or treat someone. Let this be handled by qualified health care providers.
Try not to judge: A personality disorder is a medical diagnosis and not a character flaw. It does not always excuse a person’s behavior, but it can explain it. Try to have an empathetic attitude.
Be aware of your own needs: Take care of yourself and seek support, either from friends, family or a professional therapist or psychologist.
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Approaching the topic of a personality disorder can feel overwhelming, but we’re here to make the hard part easier. When you feel it’s time to talk to a psychologist or therapist, you can easily book a session with us. No matter when you take the step, our experienced team is always ready to help you or your loved ones.
12 frequently asked questions about borderline personality disorder
What is a personality disorder?
A personality disorder is an enduring pattern of behavior, worldview and inner experience that is markedly different from what is expected of one’s environment. This is because personality disorders can affect one’s ability to relate to others and function effectively in everyday life.
Is borderline a type of personality disorder?
Yes, borderline personality disorder is one of several types. It is a mental illness characterized by significant emotional instability, intense interpersonal relationships and a strong fear of abandonment.
How is borderline diagnosed?
Diagnosis of narcissism is usually carried out by a psychiatrist or psychologist and involves a detailed diagnostic interview and family interview.
What treatment options are available for borderline?
Treatment usually involves a combination of psychotherapy and medication. Recommended psychotherapy is dialectical behavioral therapy (DBT) and mentalization based therapy (MBT).
Does DBT help with trauma?
If you have experienced trauma and have symptoms of post-traumatic stress disorder (PTSD), it is important to get a thorough assessment and treatment for your PTSD symptoms. DBT may be recommended as part of the treatment.
Is there any way to prevent personality disorders?
Personality disorders are largely caused by environmental influences during childhood, so there are things you can do to prevent unhealthy personality development if you have children.
What is the difference between DBT and cognitive behavioral therapy (CBT)?
DBT is a later development of CBT but they are based on the same foundation of learning theory and thoughts, feelings and behaviors. DBT also includes more mindfulness-based elements that have been inspired by Zen Buddhism.
Are women more likely to attend DBT than men?
It is equally common for men and women to be diagnosed with personality disorders. However, it is much more common for women to seek care and receive DBT, about 75% of patients are women.
Is narcissism a type of personality disorder?
Yes, narcissistic personality disorder is one of several types. Individuals with narcissism have an exaggerated sense of self-importance and a lack of empathy towards other people.
What can I do as a family member?
The most important step is to encourage the person to seek professional help. You can also offer emotional support, but remember that you are not a substitute for qualified care.
Can you force someone to go to therapy?
While therapy may be mandated at times, particularly in the legal system, voluntary treatment typically works better.
Where can I get help?
To get help, you can contact local mental health providers with expertise in treating BPD. If there is a safety risk, call 911 or go to your nearest emergency room.
