- DSM-V Criteria
What Is Borderline Personality Disorder?
Borderline personality disorder (BPD) is an illness marked by an ongoing pattern of extreme moods, fluctuating self-image, and erratic behaviors characterized by impulsive actions, sudden shifts to intense anger or sadness, depression, anxiety, problems in relationships, and even violence.
What Are Symptoms of Borderline Personality Disorder?
Symptoms of borderline personality disorder include:
- Intense mood swings, with each episode lasting from a few hours to a few days
- Distorted and unstable self-image or sense of self
- Rapidly changing interests and values
- Tendency to view things in extremes, such as all good or all bad
- Opinions of other people can change quickly, leading to intense and unstable relationships
- Efforts to avoid real or imagined abandonment
- Rapidly initiating intimate relationships
- Cutting off communication with others in anticipation of being abandoned
- A pattern of intense and unstable relationships, vacillating from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
- Impulsive and often dangerous behaviors
- Self-harming behavior, such as cutting
- Recurring thoughts of suicide, suicidal behaviors, or threats
- People with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away.
- If you or someone you know are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. All calls are confidential. http://www.suicidepreventionlifeline.org
- Chronic feelings of emptiness
- Inappropriate, intense anger or problems controlling anger
- Difficulty trusting, which can be accompanied by irrational fear of other people’s intentions
- Feelings of dissociation
- Feeling cut off from oneself
- Seeing oneself from outside one’s body
- Feelings of unreality
What Causes Borderline Personality Disorder?
The cause of borderline personality disorder is unknown, but it is believed that certain factors may play a role in the development of the condition:
- Genetics: People who have a family history of the disorder have a higher risk of developing it
- Brain structure and function: people with BPD exhibit changes in the brain especially in areas that control impulses and emotions, but is it unclear if these changes are risk factors for the disorder, or if they are caused by the disorder
- Environmental, cultural, and social factors
- Traumatic life events, such as abuse, abandonment, or adversity during childhood
- Exposure to unstable, invalidating relationships
- Exposure to hostile conflicts
How Is Borderline Personality Disorder Diagnosed?
Licensed mental health professionals such as psychiatrists, psychologists, or clinical social workers diagnose borderline personality disorder. Borderline personality disorder often occurs with other mental illnesses such as bipolar disorder, depression, anxiety disorders, substance use disorders, or eating disorders, which can make it harder to diagnose and treat borderline personality disorder, especially when symptoms overlap.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), bases a diagnosis on (1) a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and (2) marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following nine symptoms of borderline personality disorder:
- Frantic efforts to avoid real or imagined abandonment; this does not include suicidal or self-mutilating behavior covered in criterion
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Markedly and persistently unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating); this does not include suicidal or self-mutilating behavior covered in criterion
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, or recurrent physical fights)
- Transient, stress-related paranoid ideation or severe dissociative symptoms
What Is the Treatment for Borderline Personality Disorder?
Treatment for borderline personality disorder can be difficult and usually includes a combination of medications and psychotherapy.
Psychotherapy is the first-line treatment for people with borderline personality disorder. Types of psychotherapies used to treat borderline personality disorder include:
- Dialectical behavior therapy (DBT), which uses concepts of mindfulness and attention to one’s own experience, interpersonal effectiveness, regulating emotions, and stressing tolerance without impulsivity
- Cognitive behavioral therapy (CBT), which helps people identify and change core beliefs and behaviors and may help reduce mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors
Medications used to treat borderline personality disorder are often aimed at treating specific symptoms such as depression, mood swings, and other co-occurring mental disorders.
Medications may include:
- Selective serotonin reuptake inhibitor (SSRI) antidepressants
- Opiate Receptor Antagonists
Families and caregivers of people with borderline personality disorder may also benefit from therapy.