What is the main cause of borderline personality disorder?

Borderline personality disorder (BPD) is a kind of mental health problem. It may also be called emotionally unstable personality disorder. People with BPD have unstable moods and can act recklessly. They also have a hard time managing their emotions. If you have BPD, you may have problems with daily tasks, obligations, and life events. You may have trouble keeping jobs and relationships. And you may use food, alcohol, or other substances to cope.

It's important to get treatment, because you are at higher risk of suicide. You are also at higher risk for depression, anxiety, substance abuse, and self-harm. Experts are still learning about the condition. Certain kinds of treatment can help and are often quite successful.

Mental health experts don't know exactly what causes BPD. Some studies have shown it may be passed down in families. Your social and cultural surroundings may also play a part. For example, you may be at higher risk for BPD if you are part of a community with unstable relationships. People are at a higher risk for getting borderline personality disorder if they have suffered from abuse or neglect. Living with parents or guardians who have a history of substance abuse or criminal activity may increase the risk as well.

What are the symptoms of borderline personality disorder?

The symptoms of BPD often start during the teen years. The symptoms can vary from person to person. But people with BPD will have at least 5 of these symptoms over time:

• A pattern of severe mood changes over hours or days
• Extreme anger and problems controlling anger
• Strong, up-and-down relationships with family and friends that can go quickly from very close to anger and hatred
• Extreme fear of and reactions to abandonment, and extreme behaviors to avoid abandonment
• A rapidly changing sense of self that can cause sudden changes in goals, values, or behaviors
• Feeling disconnected from themselves, their body, or reality, or having paranoid thoughts
• Ongoing feelings of emptiness
• Self-destructive behaviors, such as substance abuse, binge eating, unsafe sex with multiple partners, unsafe driving, or reckless spending
• Suicide attempts or self-harming behavior, such as cutting, hair pulling, or burning

The symptoms of BPD may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is borderline personality disorder diagnosed?

If you have BPD symptoms, you can be diagnosed by a mental health provider. This type of specialist can include a psychiatrist or a psychologist. Or you may be seen by a clinical social worker or psychiatric nurse practitioner.

The mental health provider will ask about your medical history and your symptoms. You may be asked about your family's history of mental health conditions. You may also have a physical exam. This can rule out other illness. Make sure to tell the mental health provider about any health problems you have and any medicines you take.

How is borderline personality disorder treated?

Your healthcare provider will figure out your specific treatment for BFP based on the following:

• The extent of the problem
• Your age, overall health, and medical history
• Your tolerance for specific medicines, procedures, or therapies
• Expectations for the course of the disorder
• The opinion of the healthcare providers involved in your care
• Your opinion and preference

Many people with BPD respond well to treatment and get better. The most common treatment for BPD is psychotherapy. It can be done one-on-one or in a group setting. It may also be helpful if your family is part of the treatment. A trained psychotherapist may use one or more of these methods:

• Cognitive behavioral therapy. This gives you tools to help change your thoughts and actions.
• Dialectical behavior therapy. This helps you to be more aware of the current moment. It teaches you how to reduce extreme emotions and actions.
• Schema-focused therapy. This helps you change how you see yourself. It helps you turn negative views into more positive ones.
• Systems Training for Emotional Predictability and Problem Solving, or STEPPS. This trains you to use tools to manage your reactions to certain situations. Family and friends are also trained.

Medicines can also help some people with BPD. Neuroleptic and atypical antipsychotic medicine can help with some symptoms. Antidepressant and antianxiety medicine can be used to treat symptoms of depression or anxiety that may happen at the same time as BPD.

If you have severe symptoms, you may need hospital care for a time.

What are the complications of borderline personality disorder?

BPD may seriously affect a person's ability to cope and function in a job or in school. Other common problems that affect people with BPD include getting other mood disorders such as anxiety, depression, bipolar, substance abuse, eating disorders, and other psychiatric conditions. The person may have repeated hospitalizations due to repeated suicide attempts, self-mutilation, and disruptive behaviors. It can even lead to multiple prison sentences.

Living with borderline personality disorder

If you have BPD:

• See your healthcare provider or therapist on schedule. Don't skip appointments.
• Make sure to get enough sleep. Tell your healthcare provider if you're having trouble sleeping.
• Keep a healthy diet, and eat at regular meal times.
• Be physically active to help reduce stress and boost mood.
• Keep track of people, places, or situations that trigger your symptoms.
• Talk with your healthcare provider right away if your symptoms get worse, or if you feel suicidal.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, tell your healthcare provider.

Key points about borderline personality disorder

• Borderline personality disorder is a mental health problem. It can cause you to feel impulsive, reckless, moody, and emotionally unstable.
• BPD can be caused by living in a disruptive environment with unstable family support.
• People often seek medical help after attempting self-harm including cutting, self-mutilation, and suicide.
• People with BPD generally do very well with medical and cognitive therapy treatment.
• Early diagnosis can improve the person's long-term quality of life. It can also help the person form stable relationships. And help prevent violent disruptions in the life of the individual and his or her peers.
• Symptoms tend to be chronic and lifelong.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Borderline personality disorder (BPD) is a type of personality disorder in which a person has difficulty processing or managing their emotions. It often involves self-image issues, varying moods, and behavioral changes. In addition, it can cause a sense of instability and insecurity.

These symptoms can cause a person to engage in impulsive behaviors and develop strained relationships with family members, significant others, friends, and acquaintances.

About 1.4 percent of the population in the United States is living with BPD. Around 75 percent of diagnosed cases involve women, according to the National Alliance of Mental Illness (NAMI). But some experts believe BPD may be just as common in men. It’s often misdiagnosed as post-traumatic stress disorder (PTSD) or depression.

Living with BPD can look slightly different for everyone. However, there are certain signs and symptoms that can indicate borderline personality disorder may be present.

Some common signs and symptoms include:

• self-harming behaviors, such as cutting
• pattern of intense and unstable relationships with family, friends, significant others, and other loved ones
• efforts to avoid abandonment, which can include leaving someone first or rushing into emotional or physical relationships with others
• unstable and distorted self-image
• impulsive behaviors, including spending sprees, unsafe sexual intercourse, binge eating or drinking, reckless driving, or others
• feeling of emptiness that doesn’t go away
• trouble trusting others and irrational fear of what other people are intending
• anger issues, which can include irrational, intense anger or issues with controlling anger
• feeling dissociated from your body
• intense and quickly changing moods
• suicidal thoughts or threats

You may experience all, some, or only a few of the signs and symptoms if you’re living with BPD. Certain events or people may trigger some of the symptoms.

Many of the symptoms of BPD can overlap with other mental health conditions, such as PTSD or depression. It’s important to talk with a mental health professional if you or someone you care about seems to be dealing with new or worsening mental health issues.

A diagnosis from a professional is often the first step toward proper treatment.

Several factors may influence the development of BPD, but researchers still don’t know the exact causes. Some think that genetic predisposition combined with environmental factors may be involved.

The most likely causes include:

• genetics
• environmental factors
• changes in brain chemistry

It’s important to note that you may have exposure to one or more of the causes and never develop BPD.

Genetics

Research suggests that genetics, such as having a close family relative living with BPD, may increase your risk of developing the condition. But scientists haven’t found a specific gene or profile related to the development of BPD.

Environmental factors

Your environment may increase your risk of developing BPD.

According to a 2021 review, the effects of traumatic experiences in childhood are enhanced when “the dysfunctional familial environment that produces traumas interacts with the child’s innate temperamental traits or specific genetic polymorphisms.”

In other words, when combined with a prolonged stressful environment and other genetic risk factors, trauma from abuse, sexual assault, bullying, or other stressors in your childhood may cause the development of BPD.

Changes in brain function structure

Some research suggests that changes in how your brain functions and structure may increase your risk of developing BPD. The changes may influence impulsive behaviors and make it difficult to regulate emotions.

However, it’s not clear if the changes occur as a potential cause or risk factor, or if they occur as a result of living with BPD.

You may be at risk of developing BPD if:

• you have a family member living with BPD
• you experienced emotional, sexual, or physical abuse, bullying, attachment issues, social issues, or other traumatic events during your childhood

People living with BPD may not always receive a correct diagnosis.

For example, there’s a large discrepancy between the number of women who are living with BPD and the number of men who are living with it. An estimated 75 percent of diagnosed cases involve women, which leads some to believe that doctors may misdiagnose BPD in men.

A primary care doctor typically can’t diagnose BPD, but they may be able to refer you or a loved one to a licensed mental health professional. Some professionals who can diagnose the condition include:

• psychiatrist
• psychologist
• clinical social worker

In order to diagnose BPD, a mental health professional will typically need to:

• interview you about your symptoms and other topics pertinent to your mental and emotional health
• ask about your family’s medical history and history of mental health issues

Diagnosing BPD can be challenging because it can often occur along with other mental health conditions, such as anxiety or depression.

That is, you may be dealing with symptoms of depression that may mask or overshadow symptoms of BPD, which can lead to a misdiagnosis of BPD.

Your mental health professional may recommend one or more treatments for BPD, including psychotherapy, medication, or hospitalization.

Psychotherapy

Psychotherapy is typically the main treatment for BPD. Your mental health professional may recommend one of the following types:

Cognitive behavioral therapy (CBT)

CBT helps you to identify and change unhealthy beliefs, behaviors, and inaccurate perceptions you may have about yourself or others. It teaches you better ways to react when you feel angry, insecure, anxious, or have suicidal thoughts.

Dialectical behavior therapy (DBT)

DBT teaches you how to recognize, be aware of, and accept your beliefs and behaviors. You can also learn more balanced responses to the behaviors of others.

Schema-focused therapy

Schema-focused therapy helps you to view yourself and the world in a more positive way.

Medication

Medication doesn’t cure BPD, but it can relieve symptoms. Your doctor may prescribe medication in addition to psychotherapy treatment to help with changes in mood or depression. For example, they may prescribe:

• antidepressants to treat depression
• antipsychotics to treat aggressive symptoms
• antianxiety medications to treat anxiety

If you experience side effects from your medication, you should talk with your doctor. They may be able to recommend different medication or treatment options.

Hospitalization

If your symptoms are severe, your doctor may recommend that you temporarily stay in a hospital for treatment.

It’s important to remember not to feel shame or embarrassment regarding a hospital stay. Getting the treatment you or a loved one needs is an important part of self-care.

Therapy for family members

Family members may also benefit from therapy. In some cases, therapies may involve family members during one or more sessions. This may help them to both understand the condition better and help provide support.

BPD may raise your risk of developing other conditions, such as:

• depression
• anxiety disorders
• eating disorders
• bipolar disorder
• substance abuse

Your BPD symptoms can also increase your risk of:

• work issues
• relationship issues
• being in an abusive relationship, as the abused or the abuser
• sexually transmitted infections
• self-injury
• suicidal ideation
• getting in a motor vehicle accident
• getting in physical fights
• becoming the victim of violent crimes

Living with BPD doesn’t mean you can’t live a full, happy life surrounded by loved ones. In fact, many treatments can help you and your family successfully manage the condition.

You also may find that, with proper treatment, your symptoms may become less severe. This doesn’t mean you may never experience symptoms again, but treatment can help you become better equipped to handle them.

One of the most important steps you can take is to seek and stick with your treatment. If you find that a particular type of treatment isn’t working for you, talk with your doctor about other potential options.