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HomeTopicsPersonality DisordersBorderline
BPD: Borderline Personality DisorderBorderline personality disorder, or BPD, is a disorder of impulsiveness and instability. People with BPD have unstable moods, tend towards self-defeating or self-destructive behavior, and unstable, erratic relationships. Symptoms of BPD are significantly more common among women, accounting for seventy percent of all cases. Roughly two percent of the adult US population exhibits symptoms of borderline personality disorder (approximately six million people). BPD is often seen in combination with other personality disorders; between thirty to sixty percent of patients diagnosed with personality disorders have symptoms of BPD.
Causes and Risk Factors of Borderline Personality DisorderWhile the cause of BPD symptoms is unknown, several risk factors for the personality disorder have been identified. People who have immediate family members with borderline personality disorder are more at risk for developing BPD than the rest of the population, suggesting a possible genetic link. A family history of substance abuse, antisocial personality disorder, and mood disorders also increases the risk of developing BPD.
Other possible risks appear to suggest environmental factors for BPD. Between forty and seventy percent of patients with borderline personality disorder report childhood abuse; symptoms have also been linked to abandonment, sexual abuse, and unstable family dynamics. Neglect and early loss of parents have also been suggested as possible BPD risk factors. Symptoms of Borderline Personality DisorderA low self-image and lack of identity may be at the root of many borderline personality disorder symptoms. People with BPD often see themselves as bad, evil, and deserving of punishment. In some cases, the person with a borderline personality disorder feels so empty they doubt their own existence.
 Due to this lack of identity, the emotions, opinions, goals, values, and even sexual identity of the person with BPD may change rapidly. Often these symptoms cause individuals to sabotage themselves just before completing a task or goal, leading to failures academically, socially, and in the workplace.One of the most alarming symptoms of BPD is a tendency to seek out activities that can cause serious self-harm. The borderline personality sufferer may abuse drugs or alcohol, drive recklessly, shoplift, or engage in dangerous activities for no apparent reason. Self-injurious behavior is a common BPD symptom; individuals may cut or otherwise harm themselves. Sometimes this alarming behavior constitutes suicide attempts. People with BPD have also described self-injurious behavior as a validation when feeling empty — the pain verifies their own existence. Relationships and BPDBorderline personality disorder sufferers tend to have rocky and chaotic intimate relationships. One of the key symptoms of BPD is a fear of abandonment and being left alone. The BPD sufferer will plead, threaten, or manipulate in order to avoid abandonment (whether real or imagined).
Emotionally, a borderline personality disorder sufferer fluctuates wildly during the course of a relationship. A person with BPD will quickly move from feelings of intense love, to hate, and back again, either idolizing their partner or denigrating them. Verbal outbursts, fights, and desperate attempts to maintain the relationship and avoid abandonment are common. BPD Self-PerceptionAs noted above, one of the common symptoms of borderline personality disorder is the belief that the individual is bad, evil, or lacks enough identity to even exist. Individuals with borderline personality disorder tend to see themselves as victims who have no control over their own problems. They take little responsibility for themselves.
Fear of abandonment (and taking personal responsibility) can trigger some of borderline personality disorder's most disturbing symptoms, including self-injurious behavior and suicidal gestures. The borderline personality tends to see the world in black and white: Things are either good, or bad, with little middle ground, which contributes to the volatile nature of BPD relationships. Diagnosing Borderline Personality DisorderPeople experiencing BPD symptoms rarely seek treatment for borderline personality disorder. They may, however, come to clinical attention when seeking treatment for depression at the end of a relationship. Diagnosis of BPD is based on a psychological evaluation and a history of symptoms. According to the DSM-IV, a person with borderline personality disorder will have at least five of the following symptoms:
Comorbid Conditions and BPDBorderline personality disorder often exists alongside other personality disorders and mental disorders, and is therefore said to be comobid. BPD may be comorbid with any other personality disorder, and sometimes is present alongside other mood disorders, attention deficit hyperactivity disorder, substance abuse, post-traumatic stress disorder, and eating disorders. Out of all the eating disorders, bulimia and binge eating are most commonly seen with BPD.
BPD ComplicationsBorderline personality disorder complications include possibility of suicide. Eight to ten percent of BPD sufferers who attempt suicide eventually succeed. Repeated suicidal gestures and self-injuring behavior can result in permanent handicaps. Some people with borderline personality disorder also develop psychotic features during times of extreme stress.
Treating Borderline Personality DisorderThe overall prognosis for borderline personality disorder is poor. People with BPD symptoms may begin therapy, but their impulsivity and difficulties with authority cause two-thirds of patients to cease treatment within months. Group therapy may be more effective than individual therapy, as many BPD patients have authority issues and tend to resist the authority of the therapist. Group therapy can help treat self-destructive and other impulsive behavior.
Medication must be treated with caution when given to people with borderline personality disorder. While medication can be effective for comorbid depression and other mood disorders, the impulsive nature of BPD raises the danger that patients will either not comply with medication schedules, or will abuse the medication. While BPD treatments are limited, time brings some symptom relief. Borderline personality disorder symptoms, and suicide risk, are highest when the affected person is a young adult. By the time most people with BPD reach their forties symptoms have diminished somewhat and they are better able to function socially. Resources American Psychiatric Association. Diagnostic criteria for 301.83: Borderline personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, Washington, DC, 1994. BPD Central. (nd). What is borderline personality disorder (BPD)? National Institute of Mental Health. (2001). Borderline personality disorder: Raising questions, finding answers [NIH Publication No. 01-4928]. National Library of Medicine. (updated 2003). Borderline personality disorder. MedlinePlus Medical Encyclopedia. Paris, J. (nd). Borderline personality disorder: What is it, what causes it? How can we treat it?
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