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Borderline Personality Disorder

BPDBorderline personality disorder is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes self-image issues, difficulty managing emotions and behavior, and a pattern of unstable relationships.

With borderline personality disorder, you have an intense fear of abandonment or instability, and you may have difficulty tolerating being alone. Yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though you want to have loving and lasting relationships.

SYMPTOMS

Signs and symptoms may include:

  • An intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
  • A pattern of unstable intense relationships, such as idealizing someone one moment and then suddenly believing the person doesn’t care enough or is cruel
  • Rapid changes in self-identity and self-image that include shifting goals and values, and seeing yourself as bad or as if you don’t exist at all
  • Periods of stress-related paranoia and loss of contact with reality, lasting from a few minutes to a few hours
  • Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship
  • Suicidal threats or behavior or self-injury, often in response to fear of separation or rejection
  • Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety
  • Ongoing feelings of emptiness
  • Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights

TREATMENT

Dialectical behavior therapy (DBT) focuses on the concept of mindfulness or paying attention to the present emotion. DBT teaches skills to control intense emotions, reduce self-destructive behavior, manage distress, and improve relationships. It seeks a balance between accepting and changing behaviors. This proactive, problem-solving approach was designed specifically to treat BPD. Treatment includes individual therapy sessions, skills training in a group setting, and phone coaching as needed. DBT is the most studied treatment for BPD and the one shown to be most effective.

Mentalization-based therapy (MBT) is a talk therapy that helps people identify and understand what others might be thinking and feeling.

Transference-focused therapy (TFP) is designed to help patients understand their emotions and interpersonal problems through the relationship between the patient and therapist. Patients then apply the insights they learn to other situations.

Medications cannot cure BPD but can help treat other conditions that often accompany BPD such as depression, impulsivity, and anxiety. Often patients are treated with several medications, but there is little evidence that this approach is necessary or effective. People with BPD are encouraged to talk with their prescribing doctor about what to expect from each medication and its side effects.

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