Borderline Personality Disorder (BPD)

Borderline personality disorder (BPD) is a mental illness that causes intense mood swings, impulsive behaviors, severe difficulties with relationships, and poor feelings of self-worth. People with this disorder often have other challenges in their lives, such as depression, eating disorders, self-harm, or substance abuse, and are at high risk for suicide.

Sometimes, signs of the disorder first appear in childhood, but significant problems often don’t start until early adulthood, when a person is diagnosed with BPD. BPD can be diagnosed as mild, moderate, or severe.

While the mood of a person with depression or bipolar disorder typically stays consistent for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that last only for an hour of two, or at most a day. Also, people struggling with BPD harbor feelings of emptiness.

People with BPD often have very unstable social relationship patterns. They can develop intense but fragile attachments to others, but their attitudes towards loved ones are liable to suddenly shift from great admiration to intense anger and dislike.

Indicators of BPD include:

• Concerns with abandonment
• Idealizing people
• Devaluing people (often switching back and fourth from idealizing them)
• Disturbance about self-image
• Lack of sense of boundaries
• Impulsive behavior (for example, binge eating and substance abuse
• Inappropriate anger
• Paranoid ideation (think someone’s after them)
• Dissociative feelings (feeling like they are not present in their body)

To be diagnosed with BPD, a person must have at least five of the above indicators.

Managing BPD

Upon being diagnosed with BPD, most patients start psychotherapy, or “talk” therapy. The first goal of psychotherapy is to help patients learn to control destructive behaviors, such as self-injury or binge eating.

Once the person is able to function normally, the psychotherapy begins to focus more on managing emotions, to help keep feelings of anger and sadness under control.

There are several types of therapy commonly used to treat BPD, including:

• Cognitive-behavioral therapy (CBT), which focuses on changing certain thoughts or behaviors in order to control the symptoms of a condition. In CBT, a counselor teaches the patient self-counseling skills. Once the patient learns how to change his/her own way of thinking, they can achieve long-term, effective results.
• Dialectical behavior therapy (DBT), which reduces destructive behavior by teaching healthy ways of coping with challenges and feelings of anger and frustration. DBT involves two components: an individual component and a group component. During individual therapy, the patient and therapist discuss upcoming events during the week, recorded on diary cards, as well as focus on improving the quality of the patient's life in general by focusing on skill improvement. During group therapy, patients meet once a week for several hours to learn several skills: core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills.
• Psychodynamic therapy, which focuses on discovering the patients past to discover the cause of certain symptoms. This method of therapy is based on the belief that the symptoms are caused by something internal that the patient is not consciously aware of.

Last Reviewed: October 2013