Borderline Personality Disorder

Borderline personality disorder affects how you feel about yourself, relate to others, and behave. Symptoms may include:

• An intense fear of abandonment, including going to extreme measures to avoid separation or rejection, even if these fears are made up.
• A pattern of unstable, intense relationships, such as believing someone is perfect one moment and then suddenly believing the person doesn’t care enough or is cruel.
• Quick changes in how you see yourself, including shifting goals and values and seeing yourself as bad or as if you don’t exist.
• 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, dangerous driving, unsafe sex, spending sprees, binge eating, drug misuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship.
• Threats of suicide or self-injury, often in response to fears of separation or rejection.
• Extreme mood swings that last from a few hours to a few days, including periods of being very happy, irritable, anxious, or feeling shame.
• Ongoing feelings of emptiness.
• Inappropriate, intense anger, such as losing your temper often, being sarcastic or bitter, or physically fighting.

If you’re aware that you have any of the symptoms above, talk to your doctor or other regular healthcare professional or see a mental health professional.

If you have fantasies or mental images about hurting yourself, or you have thoughts about suicide, get help right away by taking one of these actions:

• Call your mental health professional, doctor, or another healthcare team member.
• Reach out to a loved one, close friend, trusted peer, or co-worker.

If you notice symptoms in a family member or friend, talk to that person about seeing a doctor or mental health professional. But you can’t force someone to change. If the relationship causes you a lot of stress, you may find it helpful to see a therapist.

As with other mental health conditions, the causes of borderline personality disorder aren’t fully known. In addition to environmental factors — such as a history of child abuse or neglect — borderline personality disorder may be linked to:

• Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly related to other mental health conditions among family members.
• Changes in the brain. Some research has shown that changes in certain brain areas affect emotions, impulsiveness, and aggression.

Factors related to personality development that can raise the risk of getting borderline personality disorder include:

• Hereditary exposure. You may be at a higher risk if a blood relative — your mother, father, brother, or sister — has the same or a similar condition.
• Stressful childhood. Many people with the condition report being sexually or physically abused or neglected during childhood. Some people have lost or were separated from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health issues. Others have been exposed to hostile conflict and unstable family relationships.

Borderline personality disorder can damage many areas of your life. It can negatively affect close relationships, jobs, school, social activities, and how you see yourself. This can result in:

• Repeated job changes or losses.
• Not finishing an education.
• Multiple legal issues, such as jail time.
• Conflict-filled relationships, marital stress, or divorce.
• Injuring yourself, such as by cutting or burning, and frequent stays in the hospital.
• Abusive relationships.
• Unplanned pregnancies, sexually transmitted infections, motor vehicle accidents, and physical fights due to impulsive and risky behavior.
• Attempted suicide or death due to suicide.

Also, you may have other mental health conditions, such as:

• Depression.
• Alcohol or other substance misuse.
• Anxiety disorders.
• Eating disorders.
• Bipolar disorder.
• Post-traumatic stress disorder (PTSD).
• Attention-deficit/hyperactivity disorder (ADHD).
• Other personality disorders.

Personality disorders, including borderline personality disorder, are diagnosed based on a:

• Detailed interview with your doctor or a mental health professional.
• Mental health evaluation, which may include completing a series of questions.
• Medical history and exam.
• Discussion of your symptoms.

A diagnosis of borderline personality disorder usually is made in adults — not in children or teenagers. That’s because what may appear to be symptoms of borderline personality disorder in children or teenagers may go away as they get older and mature.

Borderline personality disorder is mainly treated using psychotherapy, which is also known as talk therapy. But medicine may be added. Your doctor also may recommend that you stay in the hospital if your safety is at risk.

Treatment can help you learn skills to manage and cope with your condition. You also should be treated for any other mental health conditions that often occur along with borderline personality disorder, such as depression or substance misuse. With treatment, you can feel better about yourself and have a stabler, more fulfilling life.

Talk Therapy

Talk therapy is an essential treatment approach for borderline personality disorder. Your mental health professional may adjust the type of therapy to meet your needs best. Talk therapy seeks to help you:

• Focus on your ability to function.
• Learn to manage emotions that feel uncomfortable.
• Reduce your impulsiveness by helping you note feelings rather than act on them.
• Work on making relationships better by being aware of your feelings and those of others.
• Learn about borderline personality disorder.

Types of talk therapy that are effective include:

• Dialectical behavior therapy (DBT). DBT provides group and individual treatment designed to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions better, handle distress, and understand relationships.
• Cognitive behavioral therapy (CBT). CBT helps you change your beliefs from distorted ways of seeing things. It also can help with relationship issues. The goal is to learn to pinpoint negative thoughts and cope with those thoughts. This treatment can reduce mood swings and make you less anxious. It also can make it less likely that you’ll harm yourself or attempt suicide.
• Schema-focused therapy. Schema-focused therapy focuses on changing negative thought patterns.
• Mentalization-based therapy (MBT). MBT helps you note your thoughts and feelings and see things differently. MBT stresses thinking before reacting.
• Systems Training for Emotional Predictability and Problem-Solving (STEPPS). STEPPS is used in addition to other types of talk therapy.
• Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you learn about your emotions and issues relating to others by creating a relationship between you and your therapist. You then apply what you know to other situations.

Medicines

Some medicines can help with conditions that occur with borderline personality disorder, such as depression, aggression, or anxiety. Medications used to treat these conditions may include antidepressants, antipsychotics, or mood-stabilizing drugs.

Talk to your doctor or mental health professional about medicines’ benefits and side effects.

Hospitalization

Sometimes, you may need to be treated in a psychiatric hospital or clinic. Staying in the hospital may also keep you safe from harming yourself or help you talk about thoughts or behaviors related to suicide.

Recovery Takes Time

Learning to manage your emotions, thoughts, and behaviors takes time. Most people improve greatly, but some people always struggle with some symptoms of borderline personality disorder. You may have times when your symptoms are better or worse. But treatment can make functioning easier and help you feel better about yourself.

You have the best chance for success when you work with a mental health professional who has experience treating borderline personality disorder.

Symptoms related to borderline personality disorder can be stressful and challenging for you and those around you. You may be aware that your emotions, thoughts, and behaviors are harmful to yourself. But you may feel that you don’t know how to manage them.

In addition to getting professional treatment, you can help manage and cope with your condition if you:

• Learn about the condition so that you understand its causes and treatments.
• Know what may make you angry or impulsive.
• Seek professional help and stick to your treatment plan. Attend all therapy sessions and take medicines as directed.
• Work with your mental health professional to plan what to do the next time a crisis occurs.
• Stay away from drugs and alcohol.
• Consider involving people close to you in your treatment to help them understand and support you.
• Manage strong emotions by practicing coping skills like breathing techniques and mindfulness meditation.
• Set limits for yourself and others by learning how to express emotions that don’t push others away or make you feel abandoned or unstable.
• Don’t assume what people are feeling or thinking about you.
• Reach out to others with borderline personality disorder to share your experiences and what you’ve learned.
• Build a support system of people who can understand and respect you.
• Keep a healthy lifestyle, such as eating a nutritious diet, being physically active, and participating in social activities.
• Don’t blame yourself for the condition. But take responsibility for treating it.

What You Can Do

Before your appointment, make a list of:

• Any symptoms you or people close to you have noticed, and for how long.
• Key personal information, including traumatic events in your past and any current significant stressors.
• Your medical information, including other physical or mental health conditions.
• All medicines you take, including prescription medicines available without a prescription, vitamins, and other supplements — and the doses.
• Questions you want to ask to make the most of your appointment.

Take a family member or friend along, if possible. Someone who has known you for a long time may be able to share important information with the doctor or mental health professional with your permission.

Essential Questions to Ask

Questions to ask at the appointment include:

• What’s causing my symptoms or condition?
• What treatments are most likely to be effective?
• Will my symptoms get better with treatment?
• How often will I need therapy sessions, and for how long?
• Are there medicines that can help?
• What are the possible side effects of the medicines you may prescribe?
• Do I need to take any precautions or follow any restrictions?
• I have other health conditions. How can I best manage them together?
• How can my family or close friends help me in my treatment?
• Do you have any printed material that I can take? What websites do you recommend?

Don’t hesitate to ask questions during your appointment.

What to Expect From Your Doctor

A doctor or mental health professional is likely to ask you some questions, such as:

• What are your symptoms? When did you first notice them?
• How are these symptoms affecting your life, including your relationships and work?
• How often do you experience a mood swing each day?
• How often have you felt betrayed, victimized, or abandoned? Why do you think that happened?
• How well do you manage anger?
• How well do you manage being alone?
• How do you see your value as a human being?
• Have you ever felt you were evil?
• Have you had any issues with behavior that is risky or harmful to yourself?
• Have you ever thought of or tried to harm yourself or attempt suicide?
• Do you use alcohol or recreational drugs or misuse prescription drugs? If so, how often?
• How would you describe your childhood, including your relationship with your parents or caregivers?
• Were you physically or sexually abused or neglected as a child?
• Have any of your blood relatives or caregivers been diagnosed with a mental health issue, such as a personality disorder?
• Have you been treated for other mental health issues? If yes, what diagnoses were made, and what treatments were most effective?
• Are you being treated for any other medical conditions?

Be ready to answer questions to ensure there’s time to go over any points you want to focus on.

If you feel like harming yourself, please know that help is available, and you don’t have to face this alone. Connect with Sehatyab, an online platform that provides access to professional therapists who can support you during this tough time.
Take a moment to think about what you’d like to discuss or work on. Write down your feelings, concerns, or any specific incidents you want to address during the session.