“I feel like I’m always making new friends or falling in love with a new guy, but then something goes really wrong in the relationship and they push me away. The people in my life are always either getting mad at me, breaking up with me or letting me down and I don’t know what is going on, or what I’m doing wrong.” These experiences can be common among people who have an underlying personality disorder. If you have sudden mood swings and experience lots of conflict in your personal relationships, with intense ups and downs that make your life seem unmanageable, these can be hallmark signs of borderline personality disorder, or BPD. A complex and often misunderstood mental health disorder, BPD affects roughly 1.6% of people in the United States. Even the name “borderline personality disorder” is confusing and somewhat misleading, though experts have not yet agreed upon a more appropriate term for this personality disorder. As with many mental health disorders, BPD occurs on a spectrum where there are “low-functioning” and “high-functioning” individuals. A diagnosis can be tricky because the signs and symptoms of BPD can overlap with other disorders. It is important to consult a licensed mental health professional to help determine if you have borderline personality disorder or another condition that presents with similar symptoms. As a preliminary measure to seeking professional help, you can take a quick borderline personality quiz and also review this checklist of signs and symptoms that can indicate BPD.
Signs and Symptoms That Can Indicate BPD
- Chaotic or unstable relationships
- Extreme reactivity/intense reactions
- Severe mood swings; highly changeable moods (each lasting for a few hours or days)
- Problems with self-identity: distorted, unstable self-image or sense of self
- Problems with self-direction: unstable, changing values, goals, aspirations or plans
A BPD diagnosis is more likely if you also have four of these additional symptoms, with at least one of them being uncontrollable anger, impulsivity or risk-taking:
- Intense anxiety or paranoia (often triggered by stress)
- Depression; chronic feelings of emptiness
- Flashes of uncontrollable, inappropriate anger; aggression
- Impulsivity; dangerous behaviors/risk-taking (i.e., substance abuse, unsafe sex, spending sprees)
- Persistent fear of abandonment
- Recurring suicidal thoughts
If you experience a number of signs and symptoms on the BPD checklist, make an appointment with a mental health specialist to get a formal evaluation. Whether it is BPD or something else, getting the correct diagnosis and appropriate treatment will set you on the road to feeling better, managing your moods and finding some balance in your life.
What Causes Borderline Personality Disorder?
Scientists generally agree that genetic, environmental and social influences are likely to be involved. It has also been theorized that brain structure, particularly the brain regions that govern impulsivity and emotion, plays a role. Certain traumatic events in childhood may also play a role in the development of BPD, such as those involving emotional, physical and sexual abuse. Loss, neglect and exposure to conflict may also contribute.
BPD Treatment & Support: Gaining Control of the Chaos
Appropriate treatment for BPD — several different therapies have been found to be effective — can significantly diminish the severity and frequency of symptoms so you can enjoy an improved quality of life. Getting plenty of support throughout treatment is key, so it can be helpful if family members and partners also receive counseling to get guidance on how to provide support, avoid triggers and navigate conflicts. Treatments for BPD include: Transference-focused psychotherapy (TFP) – This is a psychodynamic treatment designed especially for patients with borderline personality disorder. TFP is distinguished from other treatments for BPD by its premise that brain structure plays a role in the disorder. Treatment focuses on a person’s psychological makeup, and their unique ways of experiencing self, others and the environment. TFP helps people with BPD understand their reactivity and how this affects their relationships (how their feelings about one person or situation don’t necessarily apply to another). Cognitive behavioral therapy (CBT) – A goal of this form of therapy is to change unhealthy patterns of thinking and behavior. CBT can help people with BPD identify and change inaccurate beliefs or perceptions of themselves and others that have caused problems in relationships and personal interactions. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors. Dialectical behavior therapy (DBT) – This therapy combines elements of cognitive behavioral therapy with Eastern concepts of acceptance and mindfulness to teach people with BPD good emotion-regulation strategies to improve self-representation and emotional reactivity. People who receive DBT experience decreased emotional reactivity and better emotion management. Schema-focused therapy – This therapy combines elements of CBT with other types of psychotherapy to focus on reframing how people view themselves — their beliefs or schemas. This approach is based on the idea that a key feature of BPD is a dysfunctional self-image that can affect how a person copes with stress or reacts to others and various situations. In many ways, the various therapies for BPD might be viewed as tools for re-parenting the person with BPD to teach them new ways to respond and react to people and environments in healthier ways. Sometimes, though not always, medications are used in conjunction with psychotherapy to treat people with BPD to further help reduce symptoms. Medical therapies might include mood stabilizers, antidepressants and antipsychotics. Sources: Borderline Personality Disorder. National Institute of Mental Health, NIH. Borderline Personality Disorder Gender differences in aggression of borderline personality disorder. Falk Mancke, et al. April 2015. DSM-IV and DSM-5 Criteria for the Personality Disorders. American Psychiatric Association, 2012. Borderline Personality Disorder Statistics. Borderline Personality Disorder is More Common Than You Think. Kristalyn Salters-Pedneault, PhD. January, 2017 Supporting Someone with Borderline Personality Disorder. Laura Greenstein. NAMI, June 2017. Borderline Personality Disorder: Big Changes in the DSM-5. Stephanie Sarkis, PhD. December, 2011. 6 Signs Of Borderline Personality Disorder I Have Borderline Personality Disorder, And I Am Not Crazy. Risa Sugarman. The Blog, Huffington Post, June 2016.