Borderline Personality Disorder: Overview by a Psychiatrist

BPD borderline


Brief overview of Borderline Personality Disorder (BPD)


Borderline Personality Disorder (BPD) is a mental health condition that causes significant instability in emotions, behavior, relationships, and self-image. People with BPD often experience intense mood swings, difficulty regulating emotions, and make impulsive choices, which can lead to difficulties in relationships and self-destructive behaviors. 


What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a complex mental health condition that is defined as a persistent pattern of mood instability, behavioral issues, problems with self-image and challenges with relationships. 


The DSM-51 (the diagnostic manual that mental health professionals use to make diagnoses) outlines the criteria for BPD as 5 or more of the following:

  • Frantic efforts to avoid abandonment (real or imagined abandonment)
  • A pattern of unstable and intense personal relationships (alternating between idealizing the person then devaluing them)
  • Unstable self-image or sense of self
  • Impulsive behaviors (spending money, sex, drugs/alcohol, binge eating, reckless driving etc)
  • Recurrent suicidal gestures, threats, or self-mutilating (such as cutting)
  • Reactive moods (intense bad moods, irritability or anxiety that is short-lived, lasting hours or days)
  • Chronic feelings of emptiness
  • Inappropriate anger or difficulty controlling anger (temper, fights, anger)
  • Dissociative symptoms or paranoia that is temporary and related to stress 


BPD typically shows up in the teen years or early adulthood and can make daily functioning and quality of life very challenging if left untreated. Though there is no cure, with appropriate therapy and support, individuals with BPD can learn to manage their symptoms and lead fulfilling lives.


How Common is Borderline Personality Disorder?

According to surveys, approximately 1.6% of the population has borderline personality disorder. Of note, approximately 20% of patients hospitalized in mental health centers have borderline personality disorder, indicating that the disorder can seriously impact health. 


What Causes Borderline Personality Disorder?

The causes of BPD are complex and not fully understood, however they are thought to involve a combination of genetics, environmental, and psychosocial factors. 


Genetics of Borderline Personality Disorder

Studies have suggested a genetic component to BPD, meaning that people with a family member with the disorder are more likely to present with BPD as well. 


Brain Changes in People with Borderline Personality Disorder

Studies have found that people with BPD have abnormalities in the function and structure in some parts of the brain such as the amygdala and prefrontal cortex. These parts of the brain are related to emotional regulation and impulse control. 


Trauma and Borderline Personality Disorder

Exposure to trauma, neglect, abuse, or chaotic family situations in childhood are strongly associated with the development of BPD. These experiences can cause disruptions in normal attachments and relationships and can make forming stable relationships and regulating emotions difficult. 


Parental Invalidation and Borderline Personality Disorder

BPD is more common in people who grow up in an environment where their feelings and emotions are dismissed or invalidated – or in some cases where they are even punished for expressing them. This makes sense, as this invalidation can lead to difficulty understanding emotions and lead to feelings of rejection. 


Which other Disorders are Common in People with Borderline Personality Disorder?

People with borderline personality disorder often struggle with things like depression, anxiety, substance use disorders and eating disorders. 


How Borderline Personality Disorder Affects Daily Life

People with BPD have a difficult time on a daily basis, with struggles at school, work, and home. Here are some ways that a person with borderline personality disorder may struggle in their daily lives:


  • Emotional Instability: Intense emotions that can change quickly can be very difficult to manage. This can make dealing with stress and other people like co-workers or customers very difficult. 
  • Impulse Issues: Some people with BPD may find it difficult to avoid risky behaviors such as driving too fast, using alcohol or other drugs, or sexual activity that may put them at risk for infections or other consequences. This can cause strain to their relationships and job/school. 
  • Relationship Issues: BPD can cause difficulties in both forming new relationships and maintaining existing ones. People with BPD may struggle with trust, intimacy, and have very intense but unstable relationships. 
  • Sense of Self: People with BPD may struggle with knowing their true self. This means they might adopt different morals and values depending on who they are with. This can lead to feelings of emptiness or confusion. 
  • Self Harm: People with BPD might engage in self-harming behaviors like cutting themselves as a way to cope with their emotional pain. This can interfere with some activities, for example, like swimming or other activities that might expose the injuries. 
  • Suicidal Behaviors: Because people with BPD may struggle with suicidal thoughts or attempts, this can lead to hospitalizations and days missed in work or school. 
  • Conflicts: Because of several traits that some people with BPD have, they often struggle with ongoing conflicts with other people in various situations like relationships, school, work, or out in public. 


If you or someone you know is experiencing suicidal thoughts or exhibiting suicidal behaviors, it is crucial to seek immediate help from a qualified mental health professional, contact emergency services, or reach out to a trusted individual for support. The information provided on this website is not a substitute for professional advice, diagnosis, or treatment. Suicidal ideation is a serious concern that requires prompt attention and intervention. We strongly encourage anyone struggling with suicidal thoughts to prioritize their safety and well-being by accessing appropriate resources and support networks.

In the U.S. you can dial 911 for emergencies and 988 for the suicide hotline. 

You can also Text HOME to 741741 to connect with a trained Crisis Counselor at the Crisis Text Line. 


Treatment for Borderline Personality Disorder

Treatment for Borderline Personality Disorder (BPD) typically involves a combination of psychotherapy, medication management, and alternative therapies aimed at addressing the core symptoms and improving overall functioning and well-being.

    • Psychotherapy:
      • Dialectical Behavior Therapy (DBT): DBT is a structured therapy that focuses on teaching individuals skills to manage emotions, tolerate distress, improve interpersonal relationships, and regulate impulsive behaviors.
      • Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and challenge maladaptive thought patterns and behaviors, develop coping strategies, and improve problem-solving skills.
      • Schema-Focused Therapy: This therapy addresses deeply ingrained negative beliefs and schemas developed in childhood, aiming to restructure these schemas and promote healthier patterns of thinking and behavior.
      • Psychodynamic Therapy: Psychodynamic approaches explore the unconscious conflicts and dynamics underlying BPD symptoms, helping individuals gain insight into their emotions and interpersonal patterns.
  • Medication Management:
      • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants may be prescribed to help manage symptoms of depression, anxiety, and mood instability.
      • Mood Stabilizers: Medications such as lithium or anticonvulsants may be used to stabilize mood and reduce impulsivity and aggression.
      • Antipsychotics: In some cases, antipsychotic medications may be prescribed to alleviate symptoms of paranoia, dissociation, or severe mood swings.
  • Alternative Therapies and Self-Help Strategies:
    • Mindfulness and Meditation: Mindfulness-based practices can help individuals with BPD develop awareness of their emotions, thoughts, and bodily sensations, promoting emotional regulation and stress reduction.
    • Exercise and Physical Activity: Regular exercise can improve mood, reduce stress, and promote overall well-being.
    • Creative Therapies: Art therapy, music therapy, and other creative modalities can provide outlets for self-expression and emotional processing.
    • Support Groups: Participation in peer support groups or online communities can offer validation, encouragement, and practical coping strategies.

Overall, treatment for BPD is often long-term and requires a comprehensive, multidisciplinary approach tailored to the individual’s specific needs and preferences. With consistent and appropriate treatment, individuals with BPD can experience significant improvements in symptom management, interpersonal relationships, and overall quality of life.


List of Resources for Borderline Personality Disorder


Suicide & Crisis Lifeline: 24-hour, toll-free, and confidential support to anyone in suicidal crisis or emotional distress. Phone by dialing 988 or live chat.


Disaster Distress Hotline: Call or text 1-800-985-5990 


Veterans Crisis Line: Free and confidential number for Veterans 1-800-273-8255 or text 838255; or chat online 24/7


Crisis Text Line: Text HELLO or HOME to 741741 for free and confidential support 24 hours a day throughout the U.S.


National Alliance on Mental Illness (NAMI):



NAMI provides education, advocacy, and support for individuals and families affected by mental illness, including BPD. Their website offers articles, resources, and online support groups.


National Education Alliance for Borderline Personality Disorder (NEA-BPD):



NEA-BPD is a nonprofit organization dedicated to providing education, advocacy, and support for individuals and families affected by BPD. Their website offers educational materials, webinars, and information on treatment options.


Treatment and Research Advancements Association for Personality Disorder (TARA APD):



TARA APD is a nonprofit organization focused on raising awareness and funding research on personality disorders, including BPD. Their website provides information on symptoms, treatment options, and support resources.


Borderline Personality Disorder Resource Center (BPDRC):



BPDRC offers resources and information on BPD, including articles, videos, and self-help tools. They also provide information on treatment options and support groups.


  1. American Psychiatric Association Diagnostic and statistical manual of mental disorders. Fourth edition. Text revision. Washington (DC): The Association; 2000. p. 943