Borderline Personality Disorder | Definition, Symptoms, Treatments

Teodora Stojmenovic, MSc
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Borderline Personality Disorder (BPD) is a very complex mental health condition marked by emotional turmoil, unstable relationships, and a fragile sense of self. It often leads to fear of abandonment, impulsive and risky behavior, and intense mood swings, which severely impact an individual’s life.

The causes of BPD are complex and not yet fully understood. Current research points toward genetic and environmental factors (early childhood experiences such as trauma) and brain abnormalities as potential causal factors.

Although BPD is widely recognized as one of the most difficult mental health disorders to live with, it is treatable, and many people achieve lasting recovery with the right treatment plan.

DSM-5 criteria

The DSM-5 characterizes Borderline Personality Disorder as a chronic pattern of unstable interpersonal relationships, fluctuations in self-image, and impulsive behavior, beginning in early adulthood. In order to be diagnosed, five or more of the following criteria need to be present:

  • Frantic efforts to avoid real or imagined abandonment.
  • A pattern of unstable and intense relationships with extreme fluctuations between idealizing and devaluing people.
  • Unstable self-image characterized by frequent changes in how the patient perceives themself.
  • Impulsive or harmful behaviors.
  • Self-harm or suicidal behavior.
  • Emotional instability—mood swings in the form of intense episodic dysphoria, anxiety, or irritability, usually lasting a few hours and sometimes more than a few days.
  • Chronic feelings of emptiness.
  • Intense anger manifested through frequent outbursts or difficulty controlling temper.
  • Stress-related paranoia or dissociation.

It is important to note that professionals don’t usually diagnose Borderline Personality Disorder in people under the age of 18, as personality is still developing at this age. However, exceptions can be made if the symptoms are extreme and last for at least a year.

Symptoms

Woman suffering from anger symptoms as a result of BPD.

BPD symptoms can have an overwhelming effect on an individual’s life, preventing them from keeping a stable job or maintaining a relationship. In addition, they often intensify in times of stress or perceived rejection.

While each person’s experience with BPD is unique, there are some common patterns to this condition.

  • Extreme fear of abandonment usually displays in the form of panic and desperation in situations where availability or attention from loved ones changes. Example: a partner taking longer than usual to reply to a message can lead to frantic calls, accusations, or emotional withdrawal.
  • Unstable relationships are characterized by a sudden change from admiration and love to distrust and anger. Example: one week, a friend or partner is seen as honest, perfect, and irreplaceable, the next they’re viewed as untrustworthy and hurtful as a result of a minor conflict.
  • A shifting self-image underpins a fragile sense of identity that changes quickly, leaving the individual unsure of who they are or what they want. Some people may change friend groups, career goals, and personal values in a short period of time, feeling with each shift as though this time it will be final.
  • Intense emotional swings can include going from joy to despair or calm to angry within the space of a few hours, as a reaction to external events. Example: a small disagreement at work can make a good day turn into one filled with extreme sadness or explosive anger.
  • Impulsive behaviors are defined as choices made without considering their consequences, often as a coping mechanism. This usually involves impulses to hurt oneself (can lead to suicide attempts) or engaging in risky behavior (ex. going on a spending spree, binge eating, risky sexual behavior).
  • Persistent feelings of emptiness or a lack of meaning remain even when everything seems to be going well in an individual’s life. Example: feeling numb or detached while celebrating an important achievement.
  • Difficulty managing anger, which may feel sudden and overwhelming, often leading to verbal or physical confrontations. Example: yelling or slamming doors over something small, such as a misplaced item.
  • Episodes of paranoia or dissociation following an overwhelming event. Example: during an argument, a person may feel like the situation is not real, or they may become paranoid or suspicious of that person.

Treatment methods

The treatment of BPD predominantly involves psychotherapy, with several approaches showing strong evidence when used to help with this condition.

  • Dialectical Behavior Therapy (DBT) is focused on helping individuals build new skills in managing their emotions by understanding and accepting them, while at the same time improving their behavior.
  • Mentalization-Based Therapy (MBT) mainly aims to help individuals understand their own and others’ mental states (thoughts, feelings, intentions). This way, individuals can develop empathy and learn to respond appropriately to others, therefore improving their emotional regulation as well as their relationships.
  • Schema Therapy is a bit different than MBT and DBT, in that it focuses on maladaptive patterns formed early in life. It involves identifying these patterns, exploring an individual’s childhood experience, and addressing unmet needs that led to these issues.
  • Transference-Focused Therapy (TFT) looks at how the feelings and habits you picked up in past relationships show up in conversation between you and your therapist. By noticing these patterns in real time, your therapist can understand them and help you to change them.

Medication

While medication is not the primary focus of treatment for Borderline Personality Disorder, some prescription drugs can help with co-occurring symptoms such as depression, anxiety, and mood swings:

  • Antidepressants (SNRIs and SSRIs) can help with depression and anxiety.
  • Mood stabilizers can help with frequent mood changes, reducing impulsivity and emotional reactivity.
  • Atypical antipsychotics can be used for anger management, impulsivity, or transient psychotic-like symptoms (paranoid thoughts).

Crisis planning

Because BPD can lead to suicidal thoughts and behaviors, having a crisis plan can be essential in maintaining stability and safety.

Many people with BPD find it helpful to closely monitor for early warning signs of potential self-harm, and keep a ready list of coping strategies, supportive family/friends, and helpline numbers available.

Further resources and hotlines

Teodora Stojmenovic, MSc

Teodora is a psychology graduate from the University of Sheffield and holds a MSc in Clinical Psychology with Distinction from the University of York. She has worked across psychotherapy centers and psychiatric hospitals, providing counseling and participating in clinical assessments for individuals facing a range of mental health challenges, including PTSD, anxiety, depression, schizophrenia and borderline personality disorder. Currently, Teodora is completing advanced training in Systemic Family Therapy, focusing on relational approaches to mental well-being.

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