What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) once existed in the shadows, too often overlooked or misunderstood. Some medical authorities were uncertain if it was even real, or if its symptoms could all be explained by other forms of mental illness.

But over time the truth about BPD has emerged. It is now universally recognized by mental health professionals as a debilitating illness that affects every aspect of a person’s life.

Borderline personality disorder causes a broad range of reactions that can be considered self-destructive or self-sabotaging. It influences thoughts, emotions, behavior, and communication, adding a degree of volatility and unpredictability to daily living that can be unsettling for BPD sufferers and their loved ones.

The defining characteristics of borderline personality disorder include:

• A lack of emotional control combined with extreme or exaggerated emotional responses
• A tendency to act impulsively, recklessly, or dangerously
• Impaired reasoning and distorted perceptions of self, others, and the world
• Seriously disturbed, turmoil-plagued relationships

Any accurate description or definition of BPD must acknowledge these attributes, which will all be present to some degree whenever the disorder is diagnosed.

Prior estimates of borderline personality disorder incidence ranged between one and two percent, but recent research suggests that up to six percent of the adult population in the United States will suffer from BPD symptoms in any given year. Typically, a diagnosis for the disorder will not be made before a person reaches adulthood, even though the initial symptoms often appear during adolescence.

BPD is more frequently diagnosed in women, by a three-to-one ratio in comparison to men. But many experts believe borderline personality disorder has been underdiagnosed in men, and that any gap in incidence rates between the sexes is smaller than current statistics suggest.

Mental health professionals recognize nine primary symptoms of borderline personality disorder. Each symptom falls under the umbrella of one of the four categories of BPD consequences listed earlier (poor emotional control, impulsive tendencies, distorted perceptions, and disturbed relationships).

The core symptoms of borderline personality disorder include:

1. Emotional instability leading to extreme emotional swings
2. Chronic feelings of emptiness or meaninglessness
3. Intense and explosive anger
4. Unstable self-image and sense of self
5. Intense fear of abandonment, marked by desperate actions to avoid it
6. Chaotic, unpredictable relationships that alternate between idealization and disillusionment
7. Paranoia, suspicion, and a disconnection from reality, possibly including dissociative episodes
8. Impulsive, reckless, self-destructive actions (unsafe driving, overspending, binge eating, substance abuse, etc.)
9. Suicidal behavior and threats and/or self-harming activities

No two BPD sufferers are alike and few will experience each of these symptoms. Nevertheless, mental health professionals must uncover at least five of these symptoms to make a diagnosis of BPD.

Borderline Treatment at Bridges

Borderline personality disorder can strike families like a tidal wave, severely disrupting relationships and bringing chaos and disorder to homes that were previously stable and content. Because BPD is often misunderstood, or missed altogether (misdiagnosis is common), families are seldom prepared for it and do not know how to cope with its life-altering effects. BPD causes intense stress and leaves sufferers and their loved ones filled with dismay, unable to get a handle on a mental health condition that can change interpersonal and family dynamics in radical and highly unpleasant ways.

Households impacted by BPD are often marked by frequent conflict over matters large and small. Divorce and estrangement are common results, and the disorder tends to be especially harmful for young children of individuals with BPD, who have no defenses to protect themselves against the consequences of its most harmful symptoms.

Besides its effects on family life, BPD negatively affects sufferers in other ways. People with BPD have trouble fulfilling their duties on the job and in school, may experience significant financial losses because of their impulsive tendencies, are more likely to become the victims of or perpetrators of violence, and may even have trouble leaving the house at times.

Borderline personality disorder also makes sufferers vulnerable to a multitude of additional health problems. Co-occurring mental health disorders are diagnosed in more than three-quarters of individuals with BPD, and despite not being one of the most common forms of mental illness it accounts for about 20 percent of all psychiatric hospitalizations.

Self-harming behavior is an especially dangerous coping mechanism for BPD sufferers, who may not mean to injure themselves seriously but often do. Common forms of self-harm include cutting, burning, (non-fatal) drug overdose, scratching the skin to the point of bleeding, pulling out hair by the roots, and intentionally reckless actions that are likely to cause accidents.

Suicidal behavior occupies the extreme end of the self-harming continuum and represents one of the distinctive symptoms of borderline personality disorder. Studies suggest that suicide rates for this group may be as high as 10 percent, or 400 times the national average, which makes it one of the deadliest forms of mental illness.

There are three primary risk factors for borderline personality disorder, none of which is likely sufficient by itself to cause the disorder to develop.

• Genetics. People with a parent, child, or sibling with BPD are five times more likely to develop the disorder than others. There are instances of BPD sufferers whose identical twins did not have the disorder, however, which shows that elevated genetic risk alone is not the sole cause of BPD.
• Brain structure. Over time scientists studying the brains of people with BPD have found certain anomalies and signs of faulty functioning. The main source of trouble seems to be in the part of the brain normally responsible for moderating emotional responses.
• Environment and upbringing. Exposure to abuse, abandonment, and neglect during childhood is frequent among BPD sufferers. Childhood sexual abuse is perhaps the strongest BPD risk factor known (40-70 percent have reported exposure in various studies). Adult exposures to violence, personal loss, and toxic relationships may also play a role in the onset or worsening of BPD, although the links are stronger with childhood trauma.

For a long time, there were doubts in the mental health profession about the legitimacy of borderline personality disorder. This is no longer the case, but the overlap between BPD and other mental health disorders can still cause confusion during the diagnostic stage. This can prevent effective treatments from being implemented until after initial symptoms have worsened.

Borderline personality disorder is most commonly misdiagnosed as bipolar disorder, depression, anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), or ADHD. When this happens medications and therapies may be provided that are not suitable for treating BPD, and this can leave patients feeling incredibly frustrated and discouraged as they go on for months or even years showing no signs of improvement.

Adding even more complexity to the situation is the fact that BPD opens the door for other mental and behavioral health problems to develop, and few conditions are more frequently accompanied by co-occurring forms of mental illness than borderline personality disorder. Mood disorders, substance use disorders, and anxiety disorders are diagnosed in approximately 75 percent of BPD sufferers at some point in their lives, while eating disorders are diagnosed in more than half of all people with BPD.

It is ordinary for BPD sufferers to have multiple co-occurring disorders, and needless to say it can be difficult to identify borderline personality disorder when it is entangled with other conditions that cause similar symptoms.

But despite the complexities that must be acknowledged in any description of borderline personality disorder, people suffering from the symptoms of BPD should never be reluctant to put their trust in the mental health profession. Psychiatrists, psychologists, and clinical social workers are more skilled at diagnosing BPD than they used to be, as awareness of the condition’s existence has grown and detailed knowledge about its specific symptom set has spread. These experts also understand that co-occurring disorders are common, and they know how to connect diverse symptoms to their proper conditions.

Experienced mental health experts won’t overlook the possibility of BPD if the signs of the disorder are present, and as long as patients provide them with a thorough and accurate accounting of their symptoms and medical background a correct diagnosis should be made within a reasonable period of time.

Borderline personality disorder is highly amenable to treatment, although it may take some time for mental health professionals to find the proper mix of medications and the most effective forms of BPD therapy to facilitate rapid and sustainable healing. If patients are truly committed to their recovery, and if family members and friends are supportive of the recovery process and willing to participate in treatment regimens as appropriate, the odds of both short-term and long-term improvement are excellent.

While ongoing outpatient treatment programs are necessary for healing to occur, most borderline personality disorder sufferers can benefit enormously from more intensive rehabilitation programs offered by residential treatment centers. A 30- to 90-day inpatient program administered in a residential facility can be especially helpful during the beginning stages of treatment, when the symptoms of the disorder are most acute and patients are only beginning to accept the challenges they face.

During their time in residential rehab, BPD sufferers will have an opportunity to concentrate completely on their recovery in a supportive environment where round-the-clock care services can be provided as needed. This will help them build new and more productive habits of thinking, acting, and communicating, while they deepen their understanding of an illness that thrives on ignorance and misunderstanding.

Inpatient treatment should be considered mandatory when co-occurring disorders have been diagnosed. In residential treatment centers, integrated rehabilitation services that address all aspects of a patient’s illnesses can be offered and continued until the patient has made significant progress and is ready to move back home.

Borderline Treatment at Bridges