Understanding Borderline Personality Disorder: Symptoms and Causes

BPD impacts behavior and how one thinks and feels about his or herself and others. People with BPD generally have a fear of abandonment and will go to extreme measures to prevent real or imagined abandonment. This can lead to unstable and intense relationships, idealizing someone one minute and thinking he or she does not care the next. In addition, people with BPD may experience inappropriate, intense anger and mood swings that can last from a few hours to a few days. Feelings of emptiness is another characteristic of BPD. Individuals may lose contact with reality, engage in self-harming behaviors, threaten or attempt to take their own life, and engage in risky behaviors. General uncertainty and indecision can result in frequent changes to jobs, friends, goals, and values.

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BPD affects every aspect of a person's life, including jobs, relationships, school, and self-image. Failing to complete education, multiple job changes or losses, and strained relationships can occur as a result of BPD.  Self-harming behaviors or threatening or attempting suicide may result in hospitalization. Legal issues and motor vehicle accidents may result from impulsive and risky behaviors.

People who are having suicidal thoughts should seek help immediately by calling 911 or a suicide hotline. Contacting a mental health provider or other health care provider, a trusted friend or family member, or a member of one's faith community are other good ways to reach out for help when it is needed.

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The cause of BPD isn't fully understood. However, researchers believe a combination of biological and environmental factors, such as childhood trauma, play a role in the development of the condition. Some research indicates certain areas of the brain, including those involved in impulsivity, emotion regulation, and aggression, are different in people with BPD.

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Some factors associated with personality development can put a person at increased risk of developing BPD. If a close relative -- a father, mother, brother, or sister -- has BPD or a similar condition, the individual is at higher risk of developing the disorder. Additionally, having a stressful childhood puts one at higher risk of developing BPD. Those with BPD often experienced abuse or neglect as children. They may have had families with unstable or hostile relationships or had a parent who had mental health problems.

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A diagnosis of borderline personality disorder is made based on a comprehensive psychological interview; official diagnosis typically is not made until one reaches adulthood because what looks like signs and symptoms of the condition in children and teenagers may go away once they get older and mature. Post-traumatic stress disorder, depression, substance misuse, bipolar disorder, anxiety disorders, attention-deficit/hyperactivity disorder, other personality disorders, and eating disorders may co-occur with BPD.

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Talk therapy, also known as psychotherapy, is an essential component of borderline personality disorder treatment. Those with BPD may benefit from individual and group therapy sessions. The goals of psychotherapy include educating the client about the condition and teaching him or her new skills to help decrease impulsivity, improve relationships, and manage emotions.

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Specialists designed Dialectical behavior therapy (DBT) specifically to treat BPD. DBT involves a skills-based approach that teaches clients how to tolerate distress, manage feelings, and improve relationships. Mentalization-based therapy (MBT) teaches clients to identify their own emotions and thoughts and develop alternative perspectives on situations. MBT focuses on thinking before reacting. Schema-focused therapy helps clients recognize unmet needs that have led to negative patterns and helps them have their needs met in healthy ways, promoting positive life patterns. Transference-focused therapy and systems training for emotional predictability and problem-solving (STEPPS) may also be useful in the treatment of BPD.

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Currently, the FDA has not approved any medications specifically for the treatment of BPD. General medications such as antidepressants, mood-stabilizing drugs, and antipsychotics may be helpful in treating conditions that co-occur with borderline personality disorder, such as depression, bipolar disorder, or anxiety disorders.

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BPD is typically at its worst in early adulthood and may become less severe over time. Research indicates that people with BPD who don't get adequate treatment are less likely to make healthy lifestyle choices and more likely to develop chronic physical or mental illnesses. The prognosis for someone with BPD depends on whether he or she is willing to accept help and how severe the condition is. BPD often improves gradually with long-term psychotherapy.

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