Table of Contents

Understanding and Describing Borderline Personality Disorder

Borderline Personality Disorder

Clinically Reviewed by: Dr. Robin Campbell, LMFT, PHD

How to Describe Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a complex mental illness often misunderstood by many. Unlike other mental disorders such as bipolar disorder or post-traumatic stress disorder, BPD is characterized by extreme emotions, intense and unstable relationships, and severe symptoms that can deeply affect an individual’s life. Recognizing borderline personality disorder and understanding how it can be treated is crucial for those who wish to provide support to their loved ones. This blog aims to demystify BPD by offering a clear explanation for those who may not be familiar with this condition. We will explore how BPD, also known as emotionally unstable personality disorder, differs from other personality disorders and mood disorders, and how it can be effectively managed with the help of a licensed mental health professional. By understanding the risks, including substance misuse and dangerous behaviors, and the importance of treatment, we can offer better emotional support to those affected by BPD. Borderline personality disorder treated through various approaches, including psychotherapy such as cognitive behavioral therapy, dialectical behavior therapy, schema-focused therapy, and Systems Training for Emotional Predictability and Problem Solving, as well as medicines like neuroleptic and atypical antipsychotic medicine, and antidepressant and anti-anxiety medicine for specific symptoms, can significantly improve the quality of life for those affected.

 

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is a mental health condition characterized by intense emotional instability, impulsive behaviors, and severe difficulties in maintaining interpersonal relationships. Individuals with BPD often experience rapid mood swings, fear of abandonment, and a distorted self-image. They may struggle with feelings of emptiness, engage in self-harming behaviors, and have episodes of intense anger or depression. The disorder can lead to tumultuous relationships and challenges in social and occupational functioning. Effective treatment often involves a combination of psychotherapy, medication, and support to help manage symptoms and improve quality of life.

 

How to Describe Borderline Personality Disorder to Others

Borderline Personality Disorder (BPD) is a mental health condition that affects how a person thinks and feels about themselves and others. This can make everyday life and relationships very challenging. Here’s a simple and thorough explanation:

  1. Intense Emotions: People with BPD feel emotions very strongly and quickly. They might go from feeling extremely happy to very sad or angry in a short amount of time.

  2. Fear of Abandonment: They often have a deep fear of being left alone or abandoned, even if there’s no real reason to think this will happen. This fear can make them very anxious and can affect their behavior in relationships.

  3. Unstable Relationships: Their relationships can be intense but unstable. They might idealize someone one moment (seeing them as perfect) and then suddenly believe that person doesn’t care about them at all.

  4. Impulsive Behaviors: They might act impulsively in ways that are risky or self-damaging, such as spending money recklessly, engaging in unsafe sex, substance abuse, or binge eating.

  5. Self-Image Issues: People with BPD often have an unstable self-image. They may feel very good about themselves at one moment and then feel they are worthless or bad at another.

  6. Feelings of Emptiness: They often feel empty or like there’s something missing inside them, which can be very distressing.

  7. Anger: They might have intense anger or difficulty controlling their anger, which can lead to frequent arguments or physical fights.

  8. Stress-Related Paranoia or Dissociation: Under stress, some people with BPD might feel paranoid or disconnected from reality, as if they are outside their own body.

BPD is a serious condition, but with understanding, support, and proper treatment like therapy and sometimes medication, people with BPD can improve and lead fulfilling lives. It’s important to approach them with empathy and patience.

 

What Causes Borderline Personality Disorder?

The exact cause of Borderline Personality Disorder (BPD) is not fully understood, but it is believed to result from a combination of genetic, environmental, and brain-related factors. Here are the main contributing factors:

  1. Genetics: BPD can run in families. People who have a close family member with the disorder are more likely to develop it themselves, suggesting a genetic component.

  2. Environmental Factors: Traumatic life events, especially during childhood, are strongly linked to BPD. This includes experiences such as physical or emotional abuse, neglect, separation from parents, or other forms of early trauma.

  3. Brain Function: Research has shown that people with BPD may have differences in their brain structure and function, particularly in areas that control emotions and behavior. For example, the amygdala (which helps regulate emotions) and the prefrontal cortex (which helps control decision-making and behavior) may function differently in individuals with BPD.

  4. Personality and Temperament: Some people may have a natural tendency to be more emotionally sensitive or impulsive, which can increase the likelihood of developing BPD when combined with other risk factors.

  5. Biochemical Factors: Imbalances in neurotransmitters, the chemicals in the brain that help regulate mood, can also play a role in the development of BPD.

 

Can Borderline Personality Disorder Be Cured?

Borderline Personality Disorder (BPD) is considered a chronic condition, meaning it often persists over a long period. Borderline personality disorder is treatable with the right specialized approach and support. However, with appropriate treatment and support, many individuals with BPD can experience significant improvement in their symptoms and lead fulfilling lives. While BPD may not be “cured” in the traditional sense, it is highly treatable. Here are some key points regarding treatment and management:

  1. Psychotherapy: This is the cornerstone of treatment for BPD. Dialectical Behavior Therapy (DBT) is particularly effective. DBT focuses on teaching skills to manage emotions, reduce self-destructive behaviors, and improve relationships. Other forms of therapy, such as Cognitive Behavioral Therapy (CBT) and Schema Therapy, can also be beneficial.

  2. Medication: While there is no specific medication approved to treat BPD, medications can help manage specific symptoms such as depression, anxiety, or mood swings. These might include antidepressants, antipsychotics, or mood stabilizers.

  3. Support Groups: Participating in support groups can provide individuals with BPD a sense of community and understanding, helping them to feel less isolated and more supported.

  4. Self-Care and Lifestyle Changes: Regular exercise, a healthy diet, sufficient sleep, and stress management techniques can help improve overall well-being and reduce symptom severity.

  5. Education and Support for Loved Ones: Educating family members and friends about BPD can help create a supportive environment and improve relationships. Family therapy can also be beneficial.

  6. Long-Term Outlook: Many people with BPD see significant improvements in their symptoms over time, especially with consistent treatment. Studies show that with appropriate therapy, many individuals no longer meet the criteria for BPD after several years.

While BPD can be challenging, it is important to remain hopeful. With the right treatment and support, individuals with BPD can make substantial progress and lead meaningful, productive lives.

 

Is Borderline Personality Disorder Hereditary?

Borderline Personality Disorder (BPD) does have a hereditary component, but it is not solely determined by genetics. Here’s a breakdown of the hereditary aspects and other contributing factors:

  1. Genetics: Research suggests that BPD can run in families. Individuals who have a first-degree relative (such as a parent or sibling) with BPD are at a higher risk of developing the disorder themselves. This indicates that there is a genetic predisposition to BPD.

  2. Environmental Influences: Although genetics play a role, environmental factors are also significant. Traumatic experiences, especially during childhood, such as abuse, neglect, or separation from caregivers, are strongly linked to the development of BPD. These environmental factors interact with genetic vulnerabilities.

  3. Gene-Environment Interaction: The interaction between genetic predisposition and environmental factors is complex. A person may have a genetic tendency towards emotional sensitivity or impulsivity, which, when combined with a stressful or traumatic environment, increases the likelihood of developing BPD.

  4. Biological Factors: There may also be biological factors related to brain structure and function that contribute to the disorder. Differences in areas of the brain that regulate emotions and impulses can be influenced by both genetic and environmental factors.

In summary, while BPD has a hereditary component, it is not purely hereditary. It results from a combination of genetic predisposition, environmental factors, and the interaction between these elements. Understanding this complex interplay can help in providing effective treatment and support for individuals with BPD.

 

Borderline Personality Disorder Prognosis

The prognosis for Borderline Personality Disorder (BPD) has significantly improved over the years with advances in treatment and a better understanding of the disorder. While BPD is a chronic condition, many individuals experience substantial improvement over time. Here are key points about the prognosis:

  1. Symptom Improvement: Many people with BPD see a reduction in the intensity and frequency of their symptoms with appropriate treatment. Studies show that with consistent therapy, a significant number of individuals no longer meet the diagnostic criteria for BPD after several years.

  2. Therapy Effectiveness: Evidence-based therapies, such as Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT), have been shown to be particularly effective in helping individuals manage their emotions, reduce self-destructive behaviors, and improve relationships.

  3. Functional Improvement: With treatment, many individuals with BPD can achieve a better quality of life, including improved social and occupational functioning. They can build healthier relationships, maintain employment, and engage in fulfilling activities.

  4. Long-Term Outlook: The long-term outlook for individuals with BPD is generally positive. Many people experience sustained periods of stability and symptom remission. However, some individuals may continue to struggle with certain symptoms, requiring ongoing support and management.

  5. Factors Influencing Prognosis: Several factors can influence the prognosis of BPD, including the severity of symptoms, the presence of co-occurring mental health conditions, the individual’s support system, and their commitment to treatment. Early intervention and consistent therapy are associated with better outcomes.

  6. Relapse and Recovery: Like many chronic conditions, BPD can involve periods of relapse and recovery. It is important for individuals to have access to ongoing support and to develop coping strategies to manage stress and prevent relapse.

  7. Hope and Resilience: With the right treatment and support, individuals with BPD can lead fulfilling and productive lives. Developing skills to manage emotions, building a strong support network, and engaging in self-care are crucial components of recovery.

 

Types of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is typically classified as a single diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, clinicians and researchers have noted that individuals with BPD can present with different patterns of symptoms. Some professionals use subtypes or classifications to better understand and treat these patterns, even though they are not formally recognized in the DSM-5. Here are some commonly referenced subtypes or patterns of BPD:

  1. Discouraged Borderline: This subtype is characterized by a pervasive sense of dependency, helplessness, and submissiveness. Individuals may appear clingy and overly reliant on others for validation and support. They often struggle with low self-esteem and may exhibit depressive symptoms.

  2. Impulsive Borderline: Individuals with this subtype tend to engage in high-risk, impulsive behaviors such as substance abuse, reckless driving, or promiscuity. They may have difficulty controlling their impulses and often seek excitement or novelty. This subtype is associated with a greater likelihood of acting out and engaging in self-harm or suicidal behaviors.

  3. Petulant Borderline: This subtype is marked by moodiness, irritability, and a tendency to become easily frustrated or disappointed. Individuals may have difficulty expressing their emotions in healthy ways and often display passive-aggressive behavior. They might have a tumultuous relationship with authority figures and can be unpredictable in their reactions.

  4. Self-Destructive Borderline: Individuals with this subtype often engage in self-harming behaviors, such as cutting, burning, or other forms of self-injury. They may struggle with chronic feelings of emptiness and worthlessness and have a high risk of suicidal ideation and attempts. Their actions are often driven by a need to alleviate emotional pain or to punish themselves.

It’s important to note that these subtypes are not officially recognized diagnostic categories but rather descriptive patterns that some clinicians find useful for understanding and treating BPD. Each person with BPD is unique, and their symptoms can vary widely. Comprehensive assessment and individualized treatment planning are essential for effectively managing BPD.

 

Effects of Borderline Personality Disorder

Borderline Personality Disorder (BPD) can have widespread and profound effects on various aspects of an individual’s life, affecting their emotions, behavior, relationships, and overall functioning. Here are some of the primary effects:

  1. Emotional Instability: Individuals with BPD experience intense and rapidly changing emotions, often feeling extreme sadness, anger, anxiety, or euphoria within short periods. This emotional volatility can be overwhelming and difficult to manage.

  2. Interpersonal Relationships: BPD often leads to unstable and intense relationships. Individuals may swing between idealizing and devaluing others, leading to conflicts and misunderstandings. Fear of abandonment can result in clingy or overly dependent behavior, which can strain relationships with family, friends, and partners.

  3. Self-Image and Identity Issues: People with BPD frequently struggle with a fluctuating sense of self. They may experience sudden shifts in how they see themselves, leading to confusion about their goals, values, and career aspirations. This unstable self-image can affect their confidence and decision-making.

  4. Impulsive Behaviors: Impulsivity is a hallmark of BPD. Individuals may engage in risky activities such as substance abuse, reckless driving, binge eating, or unsafe sexual practices. These behaviors can have serious physical, legal, and financial consequences.

  5. Self-Harm and Suicidal Behavior: Many people with BPD engage in self-injurious behaviors like cutting, burning, or other forms of self-harm. They also have a high risk of suicidal thoughts and attempts. These behaviors often serve as coping mechanisms for intense emotional pain.

  6. Chronic Feelings of Emptiness: Individuals with BPD often report feeling empty or bored. This persistent sense of inner void can contribute to depression and a lack of fulfillment in life.

  7. Anger and Aggression: Intense and inappropriate anger is common in BPD. Individuals may have frequent outbursts or become involved in physical fights. This anger can damage relationships and create additional stress.

  8. Paranoia and Dissociation: Under stress, individuals with BPD may experience transient paranoia or dissociation, feeling disconnected from reality or as if they are outside their own body. These episodes can be disorienting and frightening.

  9. Impact on Daily Functioning: The symptoms of BPD can significantly impair daily functioning. Individuals may struggle to maintain stable employment, complete education, or engage in consistent social activities. This can lead to economic hardships and social isolation.

  10. Co-Occurring Disorders: BPD often coexists with other mental health conditions, such as depression, anxiety disorders, eating disorders, and substance use disorders. The presence of these additional conditions can complicate the diagnosis and treatment of BPD.

 

Risks of Borderline Personality Disorder

Short-Term Risks of Borderline Personality Disorder

  1. Self-Harm: Immediate risk of self-injury, such as cutting or burning.

  2. Suicidal Behavior: Increased likelihood of suicide attempts.

  3. Impulsive Actions: Engagement in risky behaviors like substance abuse or reckless driving.

  4. Emotional Distress: Intense and frequent mood swings leading to significant emotional pain.

  5. Relationship Conflicts: Frequent arguments and instability in personal relationships.

Long-Term Risks of Borderline Personality Disorder

  1. Chronic Suicidality: Persistent risk of suicide over time.

  2. Unstable Relationships: Long-term difficulties in maintaining stable, healthy relationships.

  3. Economic Instability: Job loss and financial problems due to impulsive spending and difficulty maintaining employment.

  4. Co-Occurring Disorders: Development or exacerbation of other mental health conditions, such as depression, anxiety, or substance use disorders.

  5. Poor Physical Health: Long-term health issues resulting from chronic stress, poor self-care, and risky behaviors.

  6. Social Isolation: Long-term social withdrawal and lack of support due to relationship difficulties and stigma.

 

Borderline Personality Disorder Prevalence

Borderline Personality Disorder (BPD) is relatively common, affecting approximately 1.6% to 5.9% of the general population. It is more frequently diagnosed in women than in men and often emerges in adolescence or early adulthood. The prevalence can vary across different studies and populations.

 

How is Borderline Personality Disorder Diagnosed?

  1. Clinical Interview: The mental health professional will conduct a detailed interview to gather information about the individual’s symptoms, emotional patterns, behaviors, and personal history.

  2. Diagnostic Criteria: The professional will use the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed with BPD, an individual must meet at least five of the following nine criteria:

    • Intense fear of abandonment

    • Unstable and intense interpersonal relationships

    • Identity disturbance or unstable self-image

    • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse)

    • Recurrent suicidal behavior, gestures, or threats, or self-harming behavior

    • Emotional instability due to significant mood reactivity

    • Chronic feelings of emptiness

    • Inappropriate, intense anger or difficulty controlling anger

    • Transient, stress-related paranoid thoughts or severe dissociative symptoms

  3. Self-Report Questionnaires: The professional may use standardized self-report questionnaires or assessment tools to help identify BPD symptoms and assess their severity.

  4. Medical Evaluation: A medical evaluation might be conducted to rule out other medical conditions or substance use issues that could be contributing to the symptoms.

  5. Collateral Information: With the individual’s consent, information from family members, partners, or close friends may be gathered to provide additional context about the individual’s behavior and symptoms.

 

Signs and Symptoms of Borderline Personality Disorder

  1. Intense fear of abandonment

  2. Unstable and intense relationships

  3. Unclear or shifting self-image

  4. Impulsive, self-destructive behaviors

  5. Self-harming behaviors

  6. Extreme emotional swings

  7. Chronic feelings of emptiness

  8. Explosive anger

  9. Paranoia or feeling disconnected from reality under stress

These symptoms can vary in intensity and duration, affecting various aspects of an individual’s life, including their relationships, work, and self-esteem.

 

How Do You Help a Loved One with Borderline Personality Disorder?

Educate Yourself: Learn about BPD to understand their experiences and challenges.

Encourage Treatment: Support them in seeking professional help, such as therapy and medication.

Be Patient and Empathetic: Show understanding and patience during their emotional episodes.

Set Boundaries: Establish healthy boundaries to protect your own well-being.

Offer Consistent Support: Be reliable and consistent in your support and presence.

Listen Without Judgment: Provide a safe space for them to express their feelings.

Encourage Healthy Coping Strategies: Help them find and practice positive coping mechanisms.

Take Care of Yourself: Ensure you also have support and self-care to manage the stress.

 

Borderline Personality Disorder Treatment Options

Psychotherapy: The cornerstone of BPD treatment, with types including:

  • Dialectical Behavior Therapy (DBT): Focuses on teaching skills to manage emotions, reduce self-destructive behaviors, and improve relationships.

  • Cognitive Behavioral Therapy (CBT): Helps change negative thought patterns and behaviors.

  • Schema Therapy: Combines elements of CBT with other therapeutic approaches to address deeply ingrained patterns.

Medication: While no specific medication is approved for BPD, medications can help manage symptoms such as:

  • Antidepressants: For mood swings and depression.

  • Antipsychotics: For severe mood instability and psychotic symptoms.

  • Mood Stabilizers: To reduce mood swings and impulsivity.

Support Groups: Participation in support groups provides a sense of community and understanding.

Hospitalization: In severe cases, short-term hospitalization may be necessary to ensure safety and stabilize symptoms.

Self-Care and Lifestyle Changes: Encouraging regular exercise, a healthy diet, adequate sleep, and stress management techniques can support overall well-being.

Education for Loved Ones: Family therapy and education can help improve understanding and support within the family.

 

Inpatient and Outpatient Treatment Options 

Inpatient Treatment Options:

  1. Hospitalization: For severe cases, short-term hospital stays provide intensive treatment and ensure safety during crises.

  2. Residential Treatment Centers: Long-term, structured environments where individuals receive comprehensive therapy, skills training, and support.

Outpatient Treatment Options:

  1. Therapy Sessions: Regular sessions with a therapist, such as DBT, CBT, or schema therapy.

  2. Medication Management: Ongoing supervision and adjustment of medications by a psychiatrist.

  3. Day Programs: Partial hospitalization or intensive outpatient programs offering structured therapy and support during the day while allowing individuals to return home at night.

  4. Support Groups: Group therapy or peer support groups providing community and shared experiences.

  5. Individual Support: Regular check-ins with mental health professionals to monitor progress and provide guidance.

Common Prescription Medications for Borderline Personality Disorder and Typical Dosages:

  1. Antidepressants:

    • Selective Serotonin Reuptake Inhibitors (SSRIs):

      • Fluoxetine (Prozac): 20-60 mg daily

      • Sertraline (Zoloft): 50-200 mg daily

  2. Mood Stabilizers:

    • Lamotrigine (Lamictal): 25-200 mg daily

    • Valproate (Depakote): 250-1500 mg daily, depending on blood levels and response

  3. Antipsychotics:

    • Quetiapine (Seroquel): 150-800 mg daily

    • Aripiprazole (Abilify): 10-30 mg daily

  4. Anti-Anxiety Medications:

    • Buspirone (Buspar): 15-60 mg daily, divided into 2-3 doses

Dosages can vary based on individual needs and responses, so it’s important for a healthcare provider to tailor the prescription accordingly.

 

Does Insurance Cover Borderline Personality Disorder Treatment?

Yes, most health insurance plans cover treatment for Borderline Personality Disorder (BPD), including psychotherapy, medications, and sometimes inpatient or residential treatment. Coverage specifics can vary based on the insurance provider and plan. It’s important to check with your insurance company to understand the details of your coverage, including any copayments, deductibles, and prior authorization requirements.

 

Common Insurance Plans

  1. Employer-Sponsored Health Insurance: Plans provided by employers, often covering mental health services.

  2. Medicare: Federal insurance for people over 65 or with certain disabilities, includes mental health coverage.

  3. Medicaid: State and federal program for low-income individuals, covers a range of mental health services.

  4. Affordable Care Act (ACA) Plans: Marketplace plans that include mental health coverage as an essential benefit.

  5. Private Health Insurance: Plans purchased individually, typically offering mental health benefits.

  6. Military Insurance (TRICARE): Coverage for military personnel and their families, includes mental health services.

 

Is Borderline Personality Disorder (BPD) Treatment Right for Me?

Consider treatment if you:

  1. Experience Symptoms: Intense emotions, unstable relationships, impulsive behaviors, or self-harm.

  2. Receive a Diagnosis: A mental health professional diagnoses you with BPD.

  3. Struggle Daily: Symptoms significantly impact your daily life and relationships.

  4. Are Ready to Engage: Willing to commit to therapy and lifestyle changes.

  5. Have Support: Access to a supportive network of family or friends.

 

Conclusion

In conclusion, understanding Borderline Personality Disorder (BPD) is essential for providing meaningful support to those who struggle with this challenging mental illness. Recognizing borderline personality disorder involves identifying the intense and unstable relationships, extreme emotions, and ongoing feelings of emptiness that characterize it. Treatment for BPD, which includes therapies aimed at emotional balance and skill development, can help manage severe symptoms and dangerous behaviors. By distinguishing BPD from other mental disorders like bipolar disorder and post-traumatic stress disorder, and addressing specific symptoms such as risky behavior and substance misuse, a licensed mental health professional can offer targeted interventions. With the right support from mental health providers and awareness of resources like the crisis lifeline, individuals with BPD can work towards emotional predictability and stability. It is vital to understand that BPD is treatable, and with the proper care and support, those affected can lead healthier, more balanced lives.

 

Seeking Treatment? We Can Help!

At New Hope Healthcare, as an in-network provider we work with most insurance plans, such as:

If you or a loved one are struggling with mental health challenges or substance abuse, reach out to New Hope Healthcare today. Our team of compassionate professionals is here to support your journey towards lasting well-being. Give us a call at 866-799-0806

Frequently Asked Questions

Intense mood swings, fear of abandonment, unstable relationships, impulsive behaviors, self-harm, chronic feelings of emptiness, and intense anger.
BPD is believed to result from a combination of genetic, environmental, and brain-related factors, including childhood trauma, abuse, and neglect.
Yes, BPD can be effectively treated with psychotherapy (such as Dialectical Behavior Therapy), medications to manage specific symptoms, and support from loved ones and support groups.
BPD is diagnosed more frequently in women, but it can affect individuals of any gender. Some studies suggest that men may be underdiagnosed or misdiagnosed with other disorders.
With appropriate treatment and support, many people with BPD can manage their symptoms, improve their relationships, and lead fulfilling lives. Long-term prognosis is generally positive with consistent treatment.

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