Borderline personality disorder (BPD) is one of the most commonly diagnosed personality disorders out of the ten, yet it is also one of the most misunderstood. Some may loosely use the term to describe unstable behavior without fully understanding what BPD is. BPD severely influences how a person is able to control their emotions leading to severe adverse effects in their daily life. Personality disorders, such as this one, need diagnosis and treatment by a doctor.
What is BPD?
BPD is part of cluster B of the ten personality disorders. The disorders in cluster B are described as being unpredictable and erratic in behavior as well as thought. Like the cluster B description, those with BPD usually showcase a pattern of instability in relationships, self-image, and emotions. Individuals with BPD may experience overwhelming emotions and have difficulty forming long-lasting relationships with others. These overwhelming emotions impact how someone sees themselves and others. Unfortunately, this may lead to self-harming behavior or even suicide.
Due to their sensitivity to rejection and loss, their perceived image of others and themselves may change drastically at a sudden moment. This instability may result in impulsive actions which can damage themselves or others. This impulsivity could manifest in unsafe sex, binge eating, or a lack thereof, spending large amounts of money without previously doing so, etc. Those with BPD have significant difficulty managing or regulating their emotions. An example of this could be a sudden or perceived rejection and having difficulty feeling comfortable or peaceful again. However, this emotion may suddenly change within a short period of time. This can severely impact several aspects of life, including simple daily tasks.
Individuals with BPD can have very intense relationships with others. Individuals with BPD may experience intense fear of rejection from partners and begin to idealize potential relationships within the first few days of meeting them. They may even become immensely affectionate but suddenly change their behavior which others may describe as the “cold shoulder.” This may be due to the perceived rejection from others and feeling as though the same thing is being done to them. Individuals with BPD may have difficulty with change, whether or not it is unavoidable. This can be incredibly upsetting for those experiencing these emotions. Due to this, individuals with BPD may not feel capable of being alone and may experience feelings of fractured identity. This can lead to self-harm or suicide. If you or someone you know is feeling this way, please contact:
A suicide hotline such as 988 which is available 24/7.
A therapist or other mental health provider you trust.
A loved one you know you will be able to trust.
If in immediate danger, please get in touch with your emergency help number immediately.
Symptoms of BPD
BPD tends to affect women more than men, but studies have shown no difference in diagnoses. It is speculated that women have a higher diagnosis percentage of BPD because they are more likely to seek help. It has been noticed, however, that men are more likely to project their symptoms physically, while women are more likely to do the opposite. This may be due to expectations created for men and women, such as social stereotypes. There is a lack of study on personality disorders when it comes to transgender and gender-diverse individuals meaning that we are unable to see if there are any differences in diagnosis between cis- and transgender individuals.
Those with BPD are more likely to seek help for different reasons, such as self-harming behavior or depression. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013), five or more of the following symptoms must have been present by early adulthood to be diagnosed:
“A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more
than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays
of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.”
These symptoms significantly affect a person’s ability to function and interact with others. We must remember that one person’s experience with BPD won’t be precisely the same as another person’s experience. Additionally, people’s experiences with BPD will be unique. If you have doubts about getting a diagnosis because you feel you don’t fit the criteria, please remember that this is, potentially, only your experience. It won’t be the same as everyone else’s.
Causes of BPD
Studies are still being done on the causes of BPD along with other personality disorders, so we are not able to make a conclusive statement. However, it is thought that a mixture of environmental and genetic factors are at play for the development of BPD. This may include:
Physical or emotional abuse, including sexual abuse
Biological family has a history of BPD
Instability in early life
Individuals would be more at risk for BPD if they experienced physical or emotional abuse, including neglect. Sexual abuse makes a person much more likely to develop BPD. However, it isn’t necessary for diagnosis. Children in a household where parents or guardians are exhibiting behavior associated with BPD are more at risk of repeating these behaviors later in life.
REFERENCES
American Psychiatric Association. (2022). Personality Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787.x18_Personality_Disorders
Borderline Personality Disorder. (2023, February). Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/borderline-personality-disorder
Borderline personality disorder - Symptoms and causes. (2022). Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237
Borderline Personality Disorder. (2022). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/borderline-personality-disorder
Borderline Personality Disorder: Causes, Symptoms & Treatment. (2022). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9762-borderline-personality-disorder-bpd
Borderline Personality Disorder | MentalHealth.gov. (2022). Mentalhealth.gov. https://www.mentalhealth.gov/what-to-look-for/personality-disorders/borderline-personality-disorder
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Lubit, R. H. (2021, May 3). Borderline Personality Disorder: Practice Essentials, Background, Pathophysiology. Medscape.com; Medscape. https://emedicine.medscape.com/article/913575-overview
NHS Choices. (2023). Symptoms - Borderline personality disorder. https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/symptoms/
NEA.BPD. (2014, February). BPD OVERVIEW | National Education Alliance for Borderline Personality Disorder. Borderlinepersonalitydisorder.org. https://www.borderlinepersonalitydisorder.org/what-is-bpd/bpd-overview/
Zimmerman, M. (2021, May 5). Borderline Personality Disorder (BPD). Merck Manuals Professional Edition; Merck Manuals. https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/borderline-personality-disorder-bpd
Wonderfully written! It's so interesting how many of the personality disorders have similar characterisrics. With BPD in particular, the pattern of unstable and intense relationships with idealization and devaluation remind me of the characteristics of a narcissistic partner in the sense of the love bombing stage followed by gaslighting. I also found it interesting that more women than men have been diagnosed with BPD, but that is most likely due to more women seeking help than men. Great information!
Your writing is very clear. :) I really appreciate how you provide examples with your explanations. For instance, when you discuss how people with BPD "have significant difficulty managing or regulating their emotions", you immediately follow it with an example of how this could look in real life such as the person receiving a "sudden or perceived rejection". Your writing makes a difference! Keep up the excellent work!