Borderline personality disorder (BPD) is a mental disorder that can make it difficult for people to form stable relationships with other people and to control their behavior and emotions. It usually arises in early adolescence.
The Diagnostic and Statistical Manual of Mental Disorders estimates the occurrence of BPD in the community to be between 1-6%, of which most are female. [1]
American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.
The causes of BPD and how a person develops the condition are not yet clear. People who have close family members (parents or siblings) with BPD are at significantly greater risk of developing the condition. Other biological factors as well as early social experiences - especially trauma in early life, such as neglect, abuse, domestic violence and poverty - are likely to be involved.
1. Physical injury to the body caused by force or a toxic substance. 2. Psychological damage caused by a severely disturbing experience.
One of the challenges of diagnosing BPD is that most people can occasionally display some of the behaviors described as symptoms of BPD. However, in someone with BPD these behaviors occur much more frequently and severely, and generally in a recurring pattern. Relating to other people and the world can be difficult and this can have a disruptive effect on many aspects of their life, particularly relationships.
People with BPD tend to:
Symptoms of BPD tend to arise in early adolescence; younger children are generally not diagnosed with the condition.
A borderline personality disorder can cause feelings of instability, anger and impulsiveness.
Assessment and diagnosis of BPD can be complex and will generally be performed by an experienced mental health professional, such as a psychiatrist. A general practitioner may make an initial assessment and provide treatment, assistance or referral for any urgent issues that may be related to BPD, such as self-harm.
A full medical assessment helps to determine whether there are any underlying medical conditions that may be contributing to a person's symptoms. Their specialist will ask them about their symptoms.
Family members, a partner or carer can be involved in the assessment and in developing a treatment plan. It can be helpful for them to understand BPD and to learn how best to handle it.
While there is no cure for BPD, the goal of treatment is to reduce symptoms and behaviors that are distressing, as well as learning how to better manage them.
A combination of approaches, including psychological therapy, various forms of support and, in some cases, medication, have been shown to be the most effective way to treat BPD.
Managing BPD may include treating other mental health conditions and dealing with other issues that may also be causing problems, which can involve a range of healthcare and other professionals.
Psychological therapy is sometimes referred to as 'talking therapy' and describes the process of treating a mental illness by helping a person to understand their condition and manage their symptoms.
A wide range of psychological therapies have been shown to be effective for treating BPD. They include cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPP) and dialectical behavioral therapy (DBT).
Some of the ways psychological therapies can help a person deal with BPD include:
A mental-health professional can discuss available therapy options and which ones may be most suitable for a person's needs.
Psychological therapy can help with a borderline personality disorder by providing ways of managing its symptoms.
Because BPD can affect many aspects of a person's life, including education, work, living arrangements and social life, community support programs can be helpful. BPD support groups can help someone with BPD to connect to other people who have been through similar experiences.
There are no medications that are recommended specifically for the treatment of BPD. In some cases, medications may be helpful to manage symptoms such as depression and anxiety that may also be problems for people with BPD. A mental health professional can advise which medications may be suitable.
Understanding BPD and how best to manage it can be very helpful for family members, partners, carers and friends of people with BPD. Counselling, information and support are available.
A form of psychological or 'talk' therapy based on cognitive behavioral therapy, but developed particularly for the treatment of people with borderline personality disorder.
A psychological or 'talk' therapy that focuses on improving the ways a person relates to other important people in their lives.
BPD can be very disruptive and distressing for some people and affect many aspects of their lives.
Self-harm and suicide are more common among people with BPD. Self-harm can be any behavior that is done to deliberately cause injury or harm to oneself. If there is any danger of self-harm or suicide, getting help quickly is important and can help to save lives.
In situations where there is immediate danger of suicide, call 911 for help.
Other ways of finding help for someone include:
A range of other mental health disorders can also commonly occur with BPD.
These can include:
Symptoms of BPD are often at their worst in the early adult years. It is usually in this period that the risk of suicide is at its highest.
Fortunately, symptoms do tend to reduce for most people with BPD as they get older. Most people in their 30s and 40s find that their symptoms are less disruptive and they are better able to handle relationships.
No effective methods of prevention for BPD have yet been identified. However, psychological treatment and support for children who experience the following problems may help to prevent BPD:
1. Physical injury to the body caused by force or a toxic substance. 2. Psychological damage caused by a severely disturbing experience.
If you or someone you know needs help, please call or visit:
National Suicide Prevention Lifeline. Website: Lifeline Call: 1-800-273-8255
We can all help prevent suicide. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.