Borderline personality disorder

Overview

Borderline personality disorder is a mental health condition that affects the way people feel about themselves and others, making it hard to function in everyday life. It includes a pattern of unstable, intense relationships, as well as impulsiveness and an unhealthy way of seeing themselves. Impulsiveness involves having extreme emotions and acting or doing things without thinking about them first.

People with borderline personality disorder have a strong fear of abandonment or being left alone. Even though they want to have loving and lasting relationships, the fear of being abandoned often leads to mood swings and anger. It also leads to impulsiveness and self-injury that may push others away.

Borderline personality disorder usually begins by early adulthood. The condition is most serious in young adulthood. Mood swings, anger and impulsiveness often get better with age. But the main issues of self-image and fear of being abandoned, as well as relationship issues, go on.

If you have borderline personality disorder, know that many people with this condition get better with treatment. They can learn to live stabler, more-fulfilling lives.

Symptoms

Borderline personality disorder affects how you feel about yourself, relate to others and behave.

Symptoms may include:

• A strong fear of abandonment. This includes going to extreme measures so you're not separated or rejected, even if these fears are made up.
• A pattern of unstable, intense relationships, such as believing someone is perfect one moment and then suddenly believing the person doesn't care enough or is cruel.
• Quick changes in how you see yourself. This includes shifting goals and values, as well as seeing yourself as bad or as if you don't exist.
• Periods of stress-related paranoia and loss of contact with reality. These periods can last from a few minutes to a few hours.
• Impulsive and risky behavior, such as gambling, dangerous driving, unsafe sex, spending sprees, binge eating, drug misuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship.
• Threats of suicide or self-injury, often in response to fears of separation or rejection.
• Wide mood swings that last from a few hours to a few days. These mood swings can include periods of being very happy, irritable or anxious, or feeling shame.
• Ongoing feelings of emptiness.
• Inappropriate, strong anger, such as losing your temper often, being sarcastic or bitter, or physically fighting.

When to see a doctor

If you're aware that you have any of the symptoms above, talk to your doctor or other regular healthcare professional or see a mental health professional.

If you have thoughts about suicide

If you have fantasies or mental images about hurting yourself, or you have thoughts about suicide, get help right away by taking one of these actions:

• Call 911 or your local emergency number right away.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.
• U.S. veterans or service members who are in crisis can call 988 and then press "1" for the Veterans Crisis Line. Or text 838255. Or chat online.
• The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Call your mental health professional, doctor or another member of your healthcare team.
• Reach out to a loved one, close friend, trusted peer or co-worker.
• Contact someone from your faith community.

If you notice symptoms in a family member or friend, talk to that person about seeing a doctor or mental health professional. But you can't force someone to change. If the relationship causes you a lot of stress, you may find it helpful to see a therapist.

Causes

As with other mental health conditions, the causes of borderline personality disorder aren't fully known. In addition to environmental factors — such as a history of child abuse or neglect — borderline personality disorder may be linked to:

• Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly related to other mental health conditions among family members.
• Changes in the brain. Some research has shown that changes in certain areas of the brain affect emotions, impulsiveness and aggression.

Risk factors

Factors related to personality development that can raise the risk of getting borderline personality disorder include:

• Hereditary predisposition. You may be at a higher risk if a blood relative — your mother, father, brother or sister — has the same or a like condition.
• Stressful childhood. Many people with the condition report being sexually or physically abused or neglected during childhood. Some people have lost or were separated from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health issues. Others have been exposed to hostile conflict and unstable family relationships.

Complications

Borderline personality disorder can damage many areas of your life. It can negatively affect close relationships, jobs, school, social activities and how you see yourself.

This can result in:

• Repeated job changes or losses.
• Not finishing an education.
• Multiple legal issues, such as jail time.
• Conflict-filled relationships, marital stress or divorce.
• Injuring yourself, such as by cutting or burning, and frequent stays in the hospital.
• Abusive relationships.
• Unplanned pregnancies, sexually transmitted infections, motor vehicle accidents, and physical fights due to impulsive and risky behavior.
• Attempted suicide or death due to suicide.

Also, you may have other mental health conditions, such as:

• Depression.
• Alcohol or other substance misuse.
• Anxiety disorders.
• Eating disorders.
• Bipolar disorder.
• Post-traumatic stress disorder (PTSD).
• Attention-deficit/hyperactivity disorder (ADHD).
• Other personality disorders.

Diagnosis

Personality disorders, including borderline personality disorder, are diagnosed based on a:

• Detailed interview with your doctor or a mental health professional.
• Mental health evaluation that may include completing a series of questions.
• Medical history and exam.
• Discussion of your symptoms.

A diagnosis of borderline personality disorder usually is made in adults — not in children or teenagers. That's because what may appear to be symptoms of borderline personality disorder in children or teenagers may go away as they get older and mature.

Treatment

Borderline personality disorder is mainly treated using psychotherapy, which also is known as talk therapy. But medicine may be added. Your doctor also may recommend that you stay in the hospital if your safety is at risk.

Treatment can help you learn skills to manage and cope with your condition. You also should be treated for any other mental health conditions that often occur along with borderline personality disorder, such as depression or substance misuse. With treatment, you can feel better about yourself and have a stabler, more fulfilling life.

Talk therapy

Talk therapy is a basic treatment approach for borderline personality disorder. Your mental health professional may adjust the type of therapy to best meet your needs.

Talk therapy seeks to help you:

• Focus on your ability to function.
• Learn to manage emotions that feel uncomfortable.
• Reduce your impulsiveness by helping you note feelings rather than act on them.
• Work on making relationships better by being aware of your feelings and those of others.
• Learn about borderline personality disorder.

Management of borderline personality disorder mainly focuses on making sense of moments that are emotionally hard by thinking about what happened in your relationships that led to those moments. Good mental health management tends to include a combination of individual therapy, group therapy, family education and medicines for related conditions.

Types of talk therapy that have been found to be effective include:

• Dialectical behavior therapy (DBT). DBT includes group and individual therapy designed to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, handle distress and understand relationships better.
• Cognitive behavioral therapy (CBT). CBT helps you change your beliefs that come from distorted ways of seeing things. It also can help with relationship issues. The goal is to learn to pinpoint negative thoughts and cope with those thoughts. This treatment can reduce mood swings and make you less anxious. It also can make it less likely that you'll harm yourself or attempt suicide.
• Schema-focused therapy. Schema-focused therapy focuses on changing negative thought patterns.
• Mentalization-based therapy (MBT). MBT helps you note your thoughts and feelings and see things differently. MBT stresses thinking before reacting.
• Systems Training for Emotional Predictability and Problem-Solving (STEPPS). STEPPS is a 20-week treatment program where you work in groups that include your family members, caregivers, friends or significant others. STEPPS is used in addition to other types of talk therapy.
• Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you learn about your emotions and issues relating to others by creating a relationship between you and your therapist. You then apply what you learn to other situations.

Medicines

The Food and Drug Administration hasn't approved any drugs specifically to treat borderline personality disorder. But some medicines may help with symptoms. And some medicines can help with conditions that occur with borderline personality disorder, such as depression, impulsiveness, aggression or anxiety. Medicines used to treat these conditions may include antidepressants, antipsychotics or mood-stabilizing drugs.

Talk to your doctor or mental health professional about the benefits and side effects of medicines.

Hospitalization

At times, you may need to be treated in a psychiatric hospital or clinic. Staying in the hospital also may keep you safe from harming yourself or help you talk about thoughts or behaviors related to suicide.

Recovery takes time

Learning to manage your emotions, thoughts and behaviors takes time. Most people improve greatly, but some people always struggle with some symptoms of borderline personality disorder. You may have times when your symptoms are better or worse. But treatment can make it easier to function and help you feel better about yourself.

You have the best chance for success when you work with a mental health professional who has experience treating borderline personality disorder.

Coping and support

Symptoms related to borderline personality disorder can be stressful and challenging for you and those around you. You may be aware that your emotions, thoughts and behaviors are harmful to yourself. But you may feel that you don't know how to manage them.

In addition to getting professional treatment, you can help manage and cope with your condition if you:

• Learn about the condition so that you understand its causes and treatments.
• Know what may make you angry or impulsive.
• Seek professional help and stick to your treatment plan. Attend all therapy sessions and take medicines as directed.
• Work with your mental health professional to create a plan for what to do the next time a crisis occurs.
• Stay away from drugs and alcohol.
• Consider involving people close to you in your treatment to help them understand and support you.
• Manage strong emotions by practicing coping skills, such as the use of breathing techniques and mindfulness meditation.
• Set limits for yourself and others by learning how to express emotions in a manner that doesn't push others away or make you feel abandoned or unstable.
• Don't assume what people are feeling or thinking about you.
• Reach out to others with borderline personality disorder to share your experiences and what you've learned.
• Build a support system of people who can understand and respect you.
• Keep up a healthy lifestyle, such as eating a healthy diet, being physically active and taking part in social activities.
• Don't blame yourself for the condition. But take responsibility for treating it.

Preparing for an appointment

You may start by seeing your primary care doctor or other healthcare professional. After the first appointment, your doctor may refer you to a mental health professional, such as a psychologist or psychiatrist. Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you or people close to you have noticed, and for how long.
• Key personal information, including traumatic events in your past and any current major stressors.
• Your medical information, including other physical or mental health conditions.
• All medicines you take, including prescription medicines, medicines available without a prescription, vitamins and other supplements — and the doses.
• Questions you want to ask so that you can make the most of your appointment.

Take a family member or friend along, if possible. Someone who has known you for a long time may be able to share important information with the doctor or mental health professional, with your permission.

Basic questions to ask at the appointment include:

• What's causing my symptoms or condition?
• What treatments are most likely to be effective?
• Will my symptoms get better with treatment?
• How often will I need therapy sessions and for how long?
• Are there medicines that can help?
• What are the possible side effects of the medicines you may prescribe?
• Do I need to take any precautions or follow any restrictions?
• I have other health conditions. How can I best manage them together?
• How can my family or close friends help me in my treatment?
• Do you have any printed material that I can take? What websites do you recommend?

Don't hesitate to ask questions during your appointment.

What to expect from your doctor

A doctor or mental health professional is likely to ask you some questions, such as:

• What are your symptoms? When did you first notice them?
• How are these symptoms affecting your life, including your personal relationships and work?
• How often do you experience a mood swing each day?
• How often have you felt betrayed, victimized or abandoned? Why do you think that happened?
• How well do you manage anger?
• How well do you manage being alone?
• How do you see your value as a human being?
• Have you ever felt you were bad or evil?
• Have you had any issues with behavior that is risky or harmful to yourself?
• Have you ever thought of or tried to harm yourself or attempt suicide?
• Do you use alcohol or recreational drugs or misuse prescription drugs? If so, how often?
• How would you describe your childhood, including your relationship with your parents or caregivers?
• Were you physically or sexually abused, or neglected, as a child?
• Have any of your blood relatives or caregivers been diagnosed with a mental health issue, such as a personality disorder?
• Have you been treated for other mental health issues? If yes, what diagnoses were made, and what treatments were most effective?
• Are you being treated for any other medical conditions?

Be ready to answer questions to make sure there's time to go over any points you want to focus on.