Borderline Personality Disorder

Definition

Borderline personality disorder (BPD) is a mental health problem. People with BPD may often have intense, unstable moods. This can cause problems with family, work life, goals, and self-image.

Treatment can help manage the condition.

Causes

The causes of BPD are not fully understood. It is likely due to a mix of genes, life events, and environment.

Central Nervous System—Brain.

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Risk Factors

BPD is more common in those with:

• Early or ongoing stressful events
• Past abuse, neglect, or abandonment as a child
• Past sexual abuse or violence
• Inborn sensitivity to stress
• Siblings or parents who have BPD

Symptoms

BPD can affect anyone. It is mostly diagnosed in adolescents and young adults. People with BPD may have:

• Fears of being left alone—leads to frantic behaviors
• Sudden, intense mood swings
• Problems controlling emotions or moods
• Relationship problems—viewing people as all good or all bad
• Unstable self-image
• Impulsive behavior, such as:
  • Excess spending
  • Risky sexual behavior
  • Gambling
  • Substance abuse
  • Binge eating
• A pattern of hurting themselves with cutting, scratching, or burning
• Feeling misunderstood, bored, and empty
• A strong sense of being flawed or bad
• Blaming others and not taking responsibility for behavior
• Problems controlling anger
• Periods of feeling paranoid or disconnected—often triggered by stress

People with BPD tend feel rejected easily. They may be upset at even mild separation from friends or family. Symptoms often become severe during stress or lonely times.

Diagnosis

The doctor will ask about symptoms and past health. A mental health screening will be done. It will ask about mood, outlook, and day to day life. A physical exam and tests may be done. It will help to rule out other health conditions. A psychiatrist may make the diagnosis. There is no test for BPD. Instead the doctor will look at symptoms over a long period of time.

Treatment

Psychotherapy can help to understand and manage BPD. The goal is to help the person:

• Improve how they cope with frustration, anxiety, loneliness, and anger
• Control impulsive behaviors
• Improve social skills

Therapy may be one on one or include family therapy. The exact type of therapy will be based on each person's needs. Some types of therapy used with BPD are:

• Dialectical behavior therapy (DBT)—Helps the person cope with emotions.
• Mentalization-based therapy (MBT)— Strengthen feelings to gain a sense of self and others.
• Systems training for emotional predictability and problem-solving (STEPPS)—Group therapy to help people manage behaviors. It is to help understand feelings and how to react to them.
• Transference-focused psychotherapy (TFP)— The therapist checks the person's emotional response to questions. Then, both work through emotions in the moment.

Medicine is not a main part of BPD treatment. It may be used to treat severe symptoms or other mental health issues such as depression.

Prevention

There are no guidelines to prevent BPD.