Borderline Personality Disorder: Risk Factors, Symptoms and Treatment

Impulsive behaviors. Unstable relationships. Mood swings. Inappropriate, intense anger. These are some of the telltale symptoms of borderline personality disorder (BPD).

According to the American Psychiatric Association's DSM-5 guide, borderline personality disorder is "a pervasive pattern of instability in interpersonal relationships, self-image and emotion." People with borderline personality disorder tend to experience chronic feelings of emptiness along with on-and-off episodes of intense irritability, anxiety or sadness. Not only do BPD sufferers struggle with their sense of identity, they have difficulty maintaining healthy and stable relationships.

A recent study on the prevalence of mental health disorders found BPD affects 1.6% of the U.S. population, which makes the personality disorder more common than many other types of mental illness. Borderline personality symptoms typically develop in late adolescence or early adulthood, and women are more likely to be diagnosed with the condition than men.

What Are the Symptoms of BPD?

Personality disorders can be a difficult condition to diagnose, but mental health experts have identified nine common symptoms of BPD:

• Frantic efforts to avoid real or imagined abandonment by family members or friends
• Difficulty regulating emotions—feeling emotions intensely and for extended periods of time
• Impulsive, self-destructive behaviors such as substance abuse, excessive spending, unsafe sex, binge eating, self-injury, or suicidal threats or attempts
• A distorted or unstable self-image, affecting mood, values, goals and relationships
• Self-harm behaviors
• Periods of severe depression, major mood swings or extreme anxiety
• Chronic feelings of emptiness or boredom
• Inability to manage angry outbursts, often followed by intense feelings of shame and guilt
• Paranoia or dissociative symptoms (a feeling of not being "real" or a sense of being "out of body")

What Causes Borderline Personality Disorder?

While not fully understood, scientists suspect the personality disorder involves a combination of genetics, environmental factors and brain function rather than one single cause. Here's more information on each of these possible contributing factors.

Is Borderline Personality Disorder Genetic?

Although no specific gene has been identified, research suggests that people who have a close family member with BPD may be at a higher risk of developing the mental disorder.

Environmental Factors and BPD

Research identifies several common influences among individuals with BPD, including:

• Childhood emotional, physical or sexual abuse
• Childhood exposure to long-term fear or distress
• Childhood neglect by one or both parents, or other primary caregivers
• Growing up with a parent or family member with chronic mental illness and/or substance abuse (alcohol or other drug addiction)

Brain function – Problems with the brain's emotion regulation system. An individual's environment as a child significantly affects brain development in this area.

How Is Borderline Personality Disorder Diagnosed?

A diagnosis of borderline personality disorder is not based on a definitive medical test of a specific sign or symptom. Rather, this personality disorder is best diagnosed by a mental health professional using a comprehensive clinical assessment. This may include speaking with previous care providers, reviewing medical evaluations and talking with family members and friends.

Because borderline personality disorder can be difficult to diagnose and treat, therapists and clinicians usually conduct ongoing monitoring and assessment in order to provide the most-effective care plan. In many cases, borderline personality disorder treatment addresses co-occurring mental health conditions such as bipolar disorder. Many people who suffer with BPD experience other mental or behavioral health issues, such as:

• Substance use disorders
• Depression
• Anxiety disorders
• Eating disorders
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Attention-deficit/hyperactivity disorder (ADHD)
• Other personality disorders

Can People with BPD Improve their Mental Health and Well-being?

Yes! The answer is a resounding, "yes." With treatment by trained clinicians using evidenced-based therapies, many people with borderline personality disorder experience fewer and less-severe symptoms. BPD treatment centers can help people gain control of their emotions and their lives.

What Is the Most Effective Treatment for BPD?

First, early diagnosis and intervention are key. Because individuals with BPD often struggle with impulsivity, substance abuse issues, eating disorders or self-harming behaviors, an integrated clinical approach to treatment is needed. Long-term individual and group psychotherapy is standard treatment for borderline personality disorder. Additionally, there are several evidenced-based therapies found to be effective in BPD treatment. Psychotherapy and development of a trusting therapeutic alliance with a skilled therapist appear to be the most predictive factors for positive treatment outcomes. Here's a little information about three of the most helpful types of psychotherapy for BPD patients.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) was developed in the 1980s specifically to treat borderline personality disorder. The DBT approach combines the practice of mindfulness with real-life coping skills to improve distress tolerance, emotion regulation and interpersonal relationships. Dialectical Behavior Therapy is a form of cognitive therapy or "talk therapy" that can involve role-playing interactions with others and practicing ways to calm down when emotionally unstable or upset. DBT usually involves both individual and group therapy.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) addresses unhelpful thought and behavior patterns often associated with borderline personality disorder. The goal of this therapy approach is to help patients recognize negative patterns and replace them with useful coping techniques in order to develop new patterns of thought, behavior and emotional response.

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) employs mindfulness and behavior therapy to increase the patient's ability to engage in values-based behaviors while experiencing difficult emotions or thoughts. The idea is to move through unwanted thoughts and feelings rather than ignore them or obsess over them.

Medications are sometimes prescribed as part of borderline personality disorder treatment. Although there isn't a specific medication to treat BPD symptoms, medication can be an instrumental part of a patient's treatment plan. For example, mood stabilizers and anti-depressants can help with mood instability, bipolar disorder or depression. A psychiatrist may prescribe a low-dose antipsychotic for patients who struggle with disorganized thinking.

To ensure safety, short-term hospitalization may be needed for individuals experiencing extreme emotional distress, and/or highly impulsive self-destructive behaviors or suicidal behavior.

What BPD Treatment Options Are Available?

Again, accurate assessment is imperative for the successful treatment of BPD. That's why completing a comprehensive mental health assessment with a trained mental health professional is the first step in the healing process. Treatment options for BPD include outpatient individual and group therapy, residential mental health treatment and residential treatment for co-occurring mental health disorders. The increasing availability of telehealth options have made access to individual counseling and group therapy more convenient.