What Are the Symptoms of Borderline Personality Disorder?

People with borderline personality disorder have a distorted self-image and poor emotion regulation.

Borderline personality disorder (BPD) is a mental illness characterized by unstable moods and behaviors. People with BPD often act impulsively, have extreme and sudden mood changes, can be violent, and have problems in relationships. They may also have difficulty reality testing, that is, they have trouble distinguishing reality from their inner thoughts and feelings.

Symptoms of borderline personality disorder usually begin in adolescence or young adulthood and include the following:

• Difficulty perceiving oneself as unique/having an unstable or distorted self-image
• Having poor boundaries between self and others
• Poor emotion regulation: rapid and extreme mood swings, such as sudden rage, sadness, or emptiness
• An inability to self-soothe or think clearly or logically when overcome with emotion that results in extreme emotional reactions to stresses and frustrations
• May make suicidal threats, self-harm, and exhibit angry behavior
• Inability to pursue meaningful short-term goals with satisfaction
• Unstable functioning in affect, mood, and sometimes difficulty reality testing
• Trouble with empathy and intimacy
• Unstable relationships with family and friends
• Risk-taking behaviors such as illegal drug use, unsafe sex, spending sprees, reckless driving, and can be violent with self or others

There does not seem to be one clear cause of borderline personality disorder, but rather a combination of several factors that may be risk factors:

• Genetics: People with a family history of the disorder seem to have a higher risk of developing it.
• Brain factors: structural and functional variations in the brain, problems with neurotransmitters or brain development
• Psychological factors: history of abuse, neglect, abandonment, or other traumatic life events
• Cultural or societal factors: childhood adversity, experiencing conflicts

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), bases a diagnosis of borderline personality disorder on a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity as is shown by at five or more of the following:

• Desperate efforts to avoid real or imagined abandonment
• A pattern of unstable and intense relationships that alternate between extremes of idealization and devaluation
• Unstable self-image or sense of self
• Impulsivity in at least two areas that could cause self-harm (such as substance abuse, unsafe sex, reckless driving, binge eating)
• Recurrent suicidal behavior, gestures, threats, or self-mutilation
• Sudden changes in mood, usually lasting a few hours and only rarely more than a few days
• Prolonged feelings of emptiness
• Inappropriate, intense anger or problems controlling anger
• Temporary stress-related paranoid thoughts or severe dissociative symptoms

Treatment of borderline personality disorder can be difficult. The main treatment for BPD is psychotherapeutic intervention, but patients may have other psychiatric symptoms, such as anxiety, depression, and transient psychosis that medications can treat.

The following are different types of therapies for BPD:

• Dialectic behavior therapy (DBT) uses cognitive-behavioral techniques and is currently the only data-supported treatment for BPD.
• For children and adolescents, family oriented interventions provide meaningful benefits.
• Children and adolescents with traits of BPD often benefit from structured day programs.
• Psychotherapy can be challenging because regression, overwhelming affect, and impulsive behavior is common.
• Hospitalization may be necessary in some cases due to suicidal or other self-harm behaviors.

The following medications treat borderline personality disorder:

• Selective serotonin reuptake inhibitor (SSRI) antidepressants reduce impulsivity and aggression.
• Low-dose antipsychotic agents, such as risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel), help with short-term control of temporary psychotic symptoms and reducing agitation.
• Naltrexone (ReVia, Vivitrol, Depade) shortens the duration and intensity of dissociative symptoms.

Patients with BPD often overdose on prescribed medications so drugs must be prescribed with caution along with an ongoing therapeutic relationship.

Benzodiazepines are not used in patients with BPD because they reduce inhibitions and can increase impulsiveness.

Borderline personality disorder can be associated with significant illness because it often occurs with other mental illnesses such as

• major depression,
• substance abuse, and
• psychotic disorders.

There is very little research available on borderline personality disorder in older adults, though BPD in itself is not life-threatening in terms of the physical changes in the body.

However, the behaviors associated with BPD can affect longevity. About 70%-75% of patients with borderline personality disorder have a history of deliberate acts of self-harm, and an estimated that 9% of patients with borderline personality disorder complete suicide.