Borderline personality disorder is a mental illness that causes intense mood swings, impulsive behaviors, and severe problems with relationships and self-worth. People with this disorder often have other problems such as depression, eating disorders, or substance abuse.
Most of the time, signs of the disorder first appear in childhood. But problems often don't start until early adulthood. Treatment can be very hard, and getting better can take years. This is because problems with emotions and behaviors are hard to improve. But treatment may work better than experts used to think. Most people with severe symptoms get better over time.
Everyone has problems with emotions or behaviors sometimes. But if you have borderline personality disorder, the problems are severe, repeat over a long time, and disrupt your life. The most common symptoms include:
Other symptoms may include:
It is easy to confuse this disorder with other mental illnesses such as antisocial personality disorder. So if you think that you or someone you know may have borderline personality disorder, see a doctor. Don't try to diagnose yourself.
About 2 out of 100 people have borderline personality disorder. But experts don't know exactly what causes it. Problems with chemicals in the brain that help control moods may play a role. The disorder also seems to run in families.
Often people who get it faced some kind of childhood trauma such as abuse, neglect, or the death of a parent. The risk for getting the disorder is higher when people who had childhood trauma also have problems coping with anxiety or stress.
The symptoms of borderline personality disorder can be treated, but there is no known cure. Long-term counseling is an important part of treatment, but this can be very challenging. Often, it is hard for people with this disorder to have a good relationship with the counselor.
There are also medicines that can help you cope with the disorder. These medicines can help treat depression or help control moods.
Treatment can be very hard, and getting better can take years. The return of symptoms is a common problem. This is called a relapse. Treatment is even harder if the person has other problems, such as depression or an eating disorder. But most people who are treated improve over time.
Frequently Asked Questions
Learning about borderline personality disorder: | |
Being diagnosed: | |
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Ongoing concerns: | |
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The cause of borderline personality disorder is not well understood. It may be a result of an imbalance of chemicals in the brain called neurotransmitters, which help regulate mood. Mood is also influenced by genetic and environmental influences.
Borderline personality disorder is five times more common among people whose parents or siblings have the disorder.1 It is also seen more often in families who have other mental health conditions such as antisocial personality disorder, substance abuse problems, and mood disorders like depression.2
People who have this disorder often have experienced significant childhood trauma, such as sexual, physical, or emotional abuse; neglect; or early loss of or separation from a parent. When this trauma is combined with certain personality traits, such as reacting poorly to stress or having problems with anxiety, the risk of borderline personality disorder increases.
A person with borderline personality disorder often has unstable relationships, low self-esteem, and problems with impulsive behavior, all of which begin by early adulthood.
A common feature of this disorder is fear of being left alone (abandoned), even if the threat of being abandoned is not real. This fear may lead to frantic attempts to hold on to those around you and may cause you to become too dependent on others. Sometimes you may react to the fear of being abandoned by rejecting others first before they can reject you. This erratic behavior can lead to troubled relationships in every area of your life.
People who are diagnosed with borderline personality disorder have at least five of the following symptoms. They may:1
Not everyone who has five or more of these symptoms is diagnosed with borderline personality disorder. For a person to be diagnosed with any personality disorder, the symptoms must be severe and must go on long enough to cause significant emotional distress or problems functioning in relationships or at work.1
You may have temporary episodes of psychosis (paranoia and a loss of a sense of reality) with borderline personality disorder, especially when you are going through a personal crisis. This psychosis usually does not last very long. But if it continues, your doctor may consider another condition, such as schizophrenia.
Symptoms of borderline personality disorder are not caused by another medical condition or by medicines. And they are not a result of long-term substance abuse problems. Borderline personality disorder may be confused with other conditions with similar symptoms, such as other personality disorders, including antisocial personality disorder and histrionic personality disorder.
Suicidal behavior is common in people who have borderline personality disorder, with close to 1 out of 10 of those with the disorder completing suicide.3 Your risk of suicidal thoughts or attempts increases if you have depression along with borderline personality disorder. But you can reduce your risk for suicide by treating symptoms of both conditions.
Other mental health conditions commonly occur with borderline personality disorder and need treatment also. These other conditions can make it hard to distinguish borderline personality and can complicate treatment. Conditions that frequently occur with borderline personality disorder include:2, 1
Other personality disorders can occur in addition to borderline personality disorder. A few of these conditions include:
The first signs of borderline personality disorder usually appear by late childhood. The most common early signs are impulsive and reckless behavior. The disorder often fully develops between the ages of 18 and 25. The risk of suicide associated with borderline personality disorder is greatest in the young adult years and gradually decreases with age.1
In the adult years, the disorder causes intense emotions, impulsive behaviors, and unstable relationships. Uncontrolled emotions and fear of being abandoned often lead to job losses, failed marriages, and uncompleted education.2
Often other disorders occur along with borderline personality disorder and also need treatment.
Treatment can be difficult. And often people with borderline personality disorder have difficult relationships with their doctors. People with the disorder often see others as either "good" or "bad." A shift from one view to the other, called splitting, can occur suddenly in any relationship for minor reasons.
These changes in feeling often are a source of tension between a person with borderline personality disorder and doctors. Splitting is also a common source of tension in relationships with friends and family members.
Severe symptoms such as self-destructive and suicidal behavior, irrational thinking, and emotional problems related to relationships may improve as you begin treatment. Some symptoms may last longer, such as feelings of anger or emptiness or abandonment, suspiciousness, and difficulty tolerating being alone.
Among people with borderline personality disorder, those who are in their 20s are most likely to have thoughts of suicide. And the risk for completed suicide is highest for people in their 30s.4
But the majority of those with this disorder gain more stable emotions, relationships, and employment during their 30s or 40s. Many people who get treatment for borderline personality disorder do decrease destructive behaviors, often within the first year of treatment.1 Around half of those diagnosed with borderline personality disorder no longer have many of the behaviors associated with the disorder after about 10 years of treatment.1
Your risk for borderline personality disorder increases if you:
Your risk for relapse of symptoms of borderline personality disorder is greatest when you feel threatened by being left alone (abandonment).
Call 911 or other emergency services immediately if:
Watchful waiting means taking a wait-and-see approach.
Watchful waiting is not appropriate for borderline personality disorder. If you are concerned about symptoms, contact a doctor.
Treatment for borderline personality disorder usually involves professional counseling and sometimes medicine, especially if you have another condition that often responds well to medicine (such as depression). It is important that you establish a long-term and trusting relationship with your doctors for treatment of this disorder.
Professional counseling can be provided by a:
If you need medicine therapy along with professional counseling, it can be prescribed by your:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
If you think you may have symptoms of borderline personality disorder, your doctor will do a thorough evaluation of your symptoms. This may include written or verbal tests, a physical exam, and questions about your medical history, which can help rule out other health conditions that might be causing your symptoms. The evaluation may also include a mental health assessment, which involves an interview with a health professional.
Because borderline personality disorder shares symptoms with many other mental health conditions, your doctor may look for signs of another mental health condition in addition to borderline personality disorder.
Borderline personality disorder is hard to treat. Relapse, which is a return of your symptoms, is a common problem. And many people with the disorder have difficult relationships with their counselors or doctors. But it is possible to recover from the damaging behaviors associated with borderline personality disorder.
Many people find relief from destructive symptoms within the first year of treatment.1 About half of those treated for this condition find that they no longer have most of the behaviors after about 10 years of treatment.1
Consistent, long-term treatment of borderline personality disorder is important in improving your symptoms and the quality of your life.
Initial treatment depends on how bad your condition is. When borderline personality disorder is diagnosed, you most likely will begin treatment with professional counseling (psychotherapy). The first goal of therapy is to help you control destructive behaviors, especially if you are feeling suicidal or self-destructive. When you are less likely to harm yourself and you are able to function more normally, treatment will focus on managing your emotions, such as controlling feelings of anger or unhappiness.
Types of counseling commonly used to treat the disorder include:
Techniques that may help you manage symptoms of borderline personality disorder, such as stress and anxiety, include:
You many need to stay in the hospital if you show warning signs of suicide, such as thoughts or plans of harming yourself or another person, detachment from reality (psychosis), or excessive use of alcohol or drugs.
Any other medical conditions you have may also need to be treated. It is common for other conditions to occur with borderline personality disorder. These may include depression, eating disorders, substance abuse problems, attention deficit hyperactivity disorder (ADHD), or another personality disorder.
Your doctor may prescribe medicines to treat symptoms that can occur with borderline personality disorder, such as impulsive or reckless behavior, uncontrolled anger, thoughts of self-injury, depression, anxiety, and psychosis. Medicines to treat such symptoms include:
Ongoing treatment for borderline personality disorder includes:
Techniques that may help you manage borderline personality disorder include:
If your symptoms associated with borderline personality disorder get worse while you are being treated with professional counseling and medicines, you may need to be hospitalized briefly until serious symptoms (such as intense thoughts of suicide) are reduced.
Your doctor may also prescribe medicines, such as selective serotonin reuptake inhibitors (SSRIs), to help reduce symptoms and prevent relapse (a return of your symptoms). It may take several weeks for these medicines to become effective.
You can help manage symptoms by getting enough sleep regularly, eating a balanced diet, getting regular exercise, avoiding alcohol and medicines not prescribed for you, avoiding big decisions when you are feeling low, keeping scheduled counseling appointments, and taking all of your medicines as prescribed.
Successful treatment for borderline personality disorder is harder if you have:
There is no way to prevent borderline personality disorder. But you may be able to prevent a return of your symptoms (relapse) by going to your counseling appointments and taking your medicines as prescribed.
There are many steps you can take at home to help manage your borderline personality disorder symptoms.
If you know someone who has borderline personality disorder, you may want to watch for warning signs of suicide, because suicide attempts are common with this disorder. You also may want to seek support for yourself, because this condition can be demanding for those who care about the affected person.
Medicines may be used to try to reduce symptoms of borderline personality disorder, such as impulsive behavior or depression. Often a combination of medicines may be the best treatment.
The most commonly prescribed medicines for borderline personality disorder are:
It may take several weeks for medicines to become effective. You may need to try more than one medicine before you find the one that is right for you. Your doctor may also prescribe a combination of medicines to reduce your symptoms.
FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
No surgery is available to treat borderline personality disorder.
Professional counseling is an important part of treatment for borderline personality disorder. Other therapies, such as relaxation techniques, may also help you recover more quickly and improve your quality of life. Family therapy may help you and those who care about you to deal with borderline personality disorder.
Borderline personality disorder is often successfully treated with professional counseling such as:
A critical part of the treatment of borderline personality disorder is long-term professional counseling. It is important that you build a stable relationship with your counselor to successfully continue treatment. Your condition may cause you to go from viewing your counselor as nurturing to cruel, especially when you are asked to try to change a behavior. Try to find a counselor who has special training in treating borderline personality disorder.
Unfortunately, many people don't seek treatment for mental health problems. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.
If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.
| Borderline Personality Disorder Resource Center | |
| New York Presbyterian Hospital—Westchester Division | |
| 21 Bloomingdale Road | |
| White Plains, NY 10605 | |
| Phone: | 1-888-694-2273 |
| Email: | bpdresourcecenter@nyp.org |
| Web Address: | www.bpdresourcecenter.org |
| Mental Health America | |
| 2000 North Beauregard Street, 6th Floor | |
| Alexandria, VA 22311 | |
| Phone: | 1-800-969-NMHA (1-800-969-6642) referral service for help with depression (703) 684-7722 |
| Fax: | (703) 684-5968 |
| TDD: | 1-800-433-5959 |
| Web Address: | www.mentalhealthamerica.net |
Mental Health America (formerly known as the National Mental Health Association) is a nonprofit agency devoted to helping people of all ages live mentally healthier lives. Its Web site has information about mental health conditions. It also addresses issues such as grief, stress, bullying, and more. It includes a confidential depression screening test for anyone who would like to take it. The short test may help you decide whether your symptoms are related to depression. | |
| National Alliance on Mental Illness (NAMI) | |
| 3803 North Fairfax Drive | |
| Suite 100 | |
| Arlington, VA 22203 | |
| Phone: | 1-800-950-NAMI (1-800-950-6264) hotline for help with depression (703) 524-7600 |
| Fax: | (703) 524-9094 |
| Email: | info@nami.org |
| Web Address: | www.nami.org |
The National Alliance on Mental Illness is a national self-help and family advocacy organization dedicated solely to improving the lives of people who have severe mental illnesses such as schizophrenia, bipolar disorder (manic depression), major depression, obsessive-compulsive disorder, and panic disorder. NAMI focuses on support, education, advocacy, and research. The mission of the organization is to "eradicate mental illness and improve the quality of life of those affected by these diseases." | |
| National Institute of Mental Health (NIMH) | |
| 6001 Executive Boulevard | |
| Room 8184, MSC 9663 | |
| Bethesda, MD 20892-9663 | |
| Phone: | 1-866-615-6464 toll-free (301) 443-4513 |
| Fax: | (301) 443-4279 |
| TDD: | 1-866-415-8051 toll-free |
| Email: | nimhinfo@nih.gov |
| Web Address: | www.nimh.nih.gov |
The National Institute of Mental Health (NIMH) provides information to help people better understand mental health, mental disorders, and behavioral problems. NIMH does not provide referrals to mental health professionals or treatment for mental health problems. | |
| National Suicide Prevention Lifeline | |
| Phone: | 1-800-273-TALK (1-800-273-8255) 1-888-628-9454 Spanish |
| TDD: | 1-800-799-4TTY (1-800-799-4889) |
| Web Address: | www.suicidepreventionlifeline.org |
The National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service. Crisis centers are located in 130 locations across the United States. Callers are routed to the closest provider of mental health and suicide prevention services. | |
Citations
- American Psychiatric Association (2000). Personality disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 706–710. Washington, DC: American Psychiatric Association.
- Cloninger CR, Svrakic DM (2009). Personality disorders. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 2197–2240. Philadelphia: Lippincott Williams and Wilkins.
- Janowsky D (2008). Personality disorders. In MH Ebert et al., eds., Current Diagnosis and Treatment in Psychiatry, pp. 513–523. New York: McGraw-Hill.
- Paris J (2005). Borderline personality disorder. Canadian Medical Association Journal, 172(12): 1579–1583.
Other Works Consulted
- Skodol AE, Gunderson JG (2008). Personality disorders. In RE Hales, SC Yudofsky, eds., The American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 821–859. Washington, DC: American Psychiatric Publishing.
- Gross R, et al. (2002). Borderline personality disorder in primary care. Archives of Internal Medicine, 162(1): 53–60.
- Gunderson JG (2008). Borderline Personality Disorder: A Clinical Guide, 2nd ed., Washington, DC: American Psychiatric Publishing.
- Oldham JM (2005). Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder, 2nd ed., pp. 1–9. Arlington, VA: American Psychiatric Association.
- Sanislow CA, et al. (2002). Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: Findings from the collaborative longitudinal personality disorders study. American Journal of Psychiatry, 159(2): 284–290.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer | Lisa S. Weinstock, MD - Psychiatry |
| Last Revised | March 14, 2011 |
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Author: Healthwise Staff
Medical Review: Sarah Marshall, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry
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