Borderline personality disorder (BPD) is a serious mental illness that causes unstable moods, behavior, and relationships. It usually begins during adolescence or early adulthood.
Most people who have BPD suffer from:
- Problems regulating their emotions and thoughts
- Impulsive and sometimes reckless behavior
- Unstable relationships
- BPD affects 5.9% of adults (about 14 million Americans) at some time in their life
- BPD affects 50% more people than Alzheimer’s disease and nearly as many as schizophrenia and bipolar combined (2.25%).
- BPD affects 20% of patients admitted to psychiatric hospitals
- BPD affects 10% of people in outpatient mental health treatment
Research has shown that outcomes can be quite good for people with BPD, particularly if they are engaged in treatment. With specialized therapy, most people with borderline personality disorder find their symptoms are reduced and their lives are improved. Although not all the symptoms may ease, there is often a major decrease in problem behaviors and suffering. Under stress, some symptoms may come back. When this happens, people with BPD should return to therapy and other kinds of support.
Many individuals with BPD experience a decrease in their impulsive behavior in their 40’s.
A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on
- An in-person interview to discuss symptoms
- Input from a family or close friend that adds to the information provided by the individual coming for treatment.
A careful and thorough medical exam can help rule out other possible causes of symptoms.
Making for Diagnosis
Unfortunately, BPD is too often misdiagnosed. Some people who have borderline personality disorder are misdiagnosed with bipolar disorder. There are important differences between these conditions but both involve unstable moods. For the person with bipolar disorder, the mood changes exist for weeks or even months. The mood changes in BPD are much shorter and are often within a day.
To be diagnosed with BPD, a person must experience at least five of the following symptoms:
- Fear of abandonment
- Unstable or changing relationships
- Unstable self-image; struggles with identity or sense of self
- Impulsive or self-damaging behaviors (e.g., excessive spending, unsafe sex, substance abuse, reckless driving, binge eating).
- Suicidal behavior or self-injury
- Varied or random mood swings
- Constant feelings of worthlessness or sadness
- Problems with anger, including frequent loss of temper or physical fights
- Stress-related paranoia or loss of contact with reality
Causes of Borderline Personality Disorder
Research on the causes and risk factors for BPD is still in its early stages. However, scientists generally agree that genetic and environmental influences are likely to be involved.
Imaging studies in people with BPD have shown abnormalities in brain structure and function, evidence that biology is a factor. In people with BPD, more activity than usual has been seen in the parts of the brain that control feeling and expressing emotions.
Certain events during childhood may also play a role in the development of the disorder, such as those involving emotional, physical and sexual abuse. Loss, neglect and bullying may also contribute. The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk.
Borderline personality disorder often occurs with other illnesses. This can make it hard to diagnose, especially if symptoms of other illnesses overlap with the BPD symptoms
Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, substance abuse or eating disorders. In men, BPD is more likely to accompany disorders such as substance abuse or antisocial personality disorder.
According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also suffer from another mental illness.
Most of these are listed below, followed by the estimated percent of people with BPD who have them:
- Major Depressive Disorder – 60%
- Dysthymia (a chronic type of depression) – 70%
- Substance abuse – 35%
- Eating disorders (such as anorexia, bulimia, binge eating) – 25%
- Bipolar disorder – 15%
- Antisocial Personality Disorder – 25%
- Narcissistic Personality Disorder – 25%
- Self-Injury – 55%-85%