Borderline personality disorder (BPD) is an often profoundly misunderstood mental health condition commonly conflated with bipolar disorder. In reality, it’s an entirely different mental illness. Take a few minutes to read the facts below and better understand borderline personality disorder, along with the people who live with it.
1. Borderline personality disorder often causes symptoms like extreme mood shifts and uncertainty in how a person views themselves and others.
People with BPD tend to have difficulty regulating emotions, an unsteady sense of self, and a pattern of intense, unstable relationships. At its core, BPD affects how a person thinks and feels about themselves and others enough to negatively impact their daily life, according to the Mayo Clinic.
The fifth edition of the Diagnostic and Statistical Manual, which mental health professionals use to diagnose mental illnesses, requires that someone exhibit at least five of the following symptoms in order to get a BPD diagnosis:
- Panicked efforts to avoid abandonment (whether real or imaginary)
- A pattern of unsteady and intense relationships that vacillate between fondness and love (idealization) to dislike or anger (devaluation)
- A poor or unstable sense of self
- Impulsive and dangerous behaviors in at least two potentially harmful areas, like spending a lot of money or having unsafe sexual encounters
- Self-harm or suicidal behavior/threats
- Extreme mood shifts that typically last a few hours
- Feeling empty
- Anger control issues
- Feeling cut off from oneself or reality
It’s possible to experience a mix of these symptoms and not have borderline personality disorder. The signs need to be extraordinary and persistent in order to meet the criteria for this condition.
For instance, people with BPD don’t just experience mood changes. These shifts can be so severe they make a person feel overcome by massive waves of emotion, Francheska Perepletchikova, Ph.D, assistant professor of psychology in psychiatry at Weill Cornell Medical College and founder and director of the Youth-Dialectical Behavior Therapy Program at Weill Cornell Medicine and NewYork-Presbyterian Hospital, tells SELF. And the stimulus for these extreme emotional reactions can be minor, like a loved one leaving for a business trip, according to the National Institute of Mental Health (NIMH).
Or, as another example, many people without BPD have a fear of people they like or love leaving them. But people with BPD often experience this so intensely that they have a hard time trusting others and will preemptively cut people out of their lives, according to the NIMH.
2. BPD is thought to affect about 1 percent of people in the United States.
The 2007 National Comorbidity Survey Replication published in Biological Psychiatry offers an estimate of how many people have BPD. The nationally representative study examined 5,692 people, finding that while the prevalence of any personality disorder was around 9 percent, only 1.4 percent of respondents met the diagnostic criteria for BPD in particular.
3. People with BPD often have other mental health conditions.
According to The National Comorbidity Survey Replication, 84.5 percent of respondents with BPD had a co-occurring mental health disorder.
The nature of these comorbidities varies from person to person and can make recognizing BPD difficult, according to the NIMH. For example, intense episodes of depression can be a symptom of BPD, but they can also be the result of a condition like major depressive disorder or bipolar disorder.
The relationship between BPD and other conditions is not completely understood. Perepletchikova explains that in the case of something like a substance use disorder, it may be a negative coping mechanism to deal with the painful symptoms of BPD. Similarly, the feelings of abandonment and alienation (from oneself and others), along with a lack of close and stable relationships, may precipitate depression, Perepletchikova says.
4. Borderline personality disorder and bipolar disorder are not the same thing.
They do share some significant similarities, namely that bipolar disorder also causes extreme shifts in mood and behavior. However, those shifts are primarily between depressive and manic episodes (having an abnormally elevated and energetic mood) or hypomanic episodes, which also involve unusually high energy and activity levels but to a lesser extent. Also, the fear of abandonment and unstable personal relationships that are typically inherent to BPD aren’t in the diagnostic criteria for bipolar disorder.
5. People with BPD are at an elevated risk for self-harm and suicide due to a mix of intense emotions and impulsivity.
Along with self-harm, suicidal ideation and behavior and are significantly more prevalent among people with BPD, according to the NIMH. The generally accepted figure cited by the American Psychiatric Association estimates that 8 to 10 percent of people with BPD will die by suicide, which is tragically high. With that said, it’s important to keep in mind that since the rate of suicide attempts in this community is so elevated (some sources say as high as 60 to 70 percent), the number of completed suicides is thankfully lower than it could be.
People with BPD may turn to self-harm because it feels like instantaneous relief for heightened emotions, Perepletchikova explains. Similarly, someone may attempt suicide as an impulsive means of coping with the deep emotional suffering BPD can cause, Katherine Dixon-Gordon, Ph.D., a clinical psychologist and assistant professor who studies BPD at the University of Massachusetts Amherst, tells SELF.
6. There is no single cause of BPD, but experts believe there are several key risk factors involved.
According to the NIMH, research suggests that a combination of hereditary, neurological, and environmental factors increase a person’s likelihood of having BPD.
If a family member has BPD, you’re more likely to also have it, but there is no known gene linked to the condition, according to the NIMH. It also appears as though the brains of people with BPD have structural and functional changes in areas linked with things like emotional regulation, but it’s not clear if those changes are a cause or result of the condition. And when it comes to environmental factors, many people with BPD report instances of childhood trauma, including abuse, abandonment, and unstable relationships with their parents.
7. Some experts advocate for diagnosing BPD in adolescents while others prefer to wait until adulthood.
There has been general hesitation to diagnose personality disorders in those under 18. As the Mayo Clinic explains, sometimes what seems like BPD can simply be part of a child or teenager’s emotional maturation.
With that said, clinicians are discovering that BPD can be detected in children and adolescents. Possible signs are similar to those in adults and include impulsive risk-taking, frequent angry outbursts, continuous interpersonal issues, markedly low self-esteem, and repetitive self-injury or suicide attempts.
“The earlier we intervene, the more likely we are to help,” Dixon-Gordon explains.
8. The first-line treatment for BPD is therapy.
“The goal is to help our clients build up emotional regulation muscles, so to speak, so that they will be able to withstand the impact of those emotional [waves],” Perepletchikova says. “We cannot take away their emotional reactivity, but we can give them skills to [better] respond to the emotional reaction.”
One method for this is dialectical behavioral therapy (DBT), which combines acceptance and mindfulness of one’s emotional state with coping skills for these emotions, per the NIMH. Cognitive behavioral therapy (CBT), which can help people with BPD identify and manage their emotions and behaviors, is another common option, the NIMH says.
9. It can be hard for a person with BPD to trust their therapist, but that bond is often foundational to recovery.
This is why therapists treating BPD typically emphasize acceptance and validation, Perepletchikova says. (She notes that there is an important distinction between accepting a statement or behavior—“I understand why you did that”—and condoning it—“Good job, keep doing that.”)
In addition to this one-on-one model, group sessions led by a therapist can also help people with BPD learn how to best interact with and express themselves to other people, the NIMH says.
10. There are not any medications specifically recommended to treat BPD.
There simply aren’t yet clear enough benefits to using medications as the primary treatment for BPD, the NIMH explains.
However, a psychiatrist may prescribe medication to address certain symptoms that some people experience, Perepletchikova says, such as mood stabilizers for emotional instability. Additionally, someone with BPD who also has a clinically diagnosed co-occurring disorder, such as anxiety, depression, or PTSD, may take medications to treat those conditions.
11. BPD is often stigmatized, even among healthcare providers.
A 2013 review of available literature published in Innovations in Clinical Neuroscience found that some mental health providers hold false and harmful views on BPD. Laypeople can believe these myths, too.
One of the most pervasive misperceptions among professionals and non-professionals alike is that people with BPD are intentionally, maliciously trying to manipulate those around them with their displays of extreme emotion or self-harm, Dixon-Gordon says. This is false. These symptoms are stemming from mental illness, not a person deciding of their own volition that they’d like to manipulate other people.
12. People with BPD can be empathetic and lovely individuals.
“Extreme emotional sensitivity presents with serious challenges, but there are also benefits,” Perepletchikova says. In her experience, people with BPD are often able to understand the feelings of other people to a greater degree. She also believes that many people with BPD are unusually creative because they have a deeper and broader experience of human emotion from which to draw.
This is part of the reason that Perepletchikova says people with BPD are her favorite population to treat. “They are really fun, creative, compassionate, beautiful people,” she explains.
13. With solid therapy and hard work, the long-term outlook for people with BPD can be bright.
“Research shows that the remission rates are incredibly high,” Dixon-Gordon says. A study of 175 BPD patients, published in the Archives of General Psychiatry in 2011, found that 85 percent remitted within 10 years. (The researchers defined remission as meeting two or fewer BPD criteria.) Most of that change occurred in the earlier years, the study authors said.
“BPD does not have to define [you],” Dixon-Gordon says. “It’s treatable, and there’s help out there.”