Borderline Personality Disorder

Written by Rose Kivi and Marijane Leonard | Published on August 16, 2012
Medically Reviewed by George Krucik, MD

Overview

Borderline personality disorder (BPD) is a mental illness that develops during adolescence or early adulthood. It is marked by a pattern of emotional instability, impulsive behavior, a distorted self-image, and unstable relationships. Approximately 5.9 percent of people will develop BPD.

What Causes BPD?

Researchers are still trying to learn the exact cause of BPD. Multiple factors may contribute to the disorder. These include:

Genetics

BPD may be a genetic condition. A scientific study on twins and BPD suggested that there is a good likelihood that the disorder is inherited. Personality traits—such as aggression and impulsivity—seen in BPD and other disorders may also be inherited, according to another study.

Environmental Factors

Growing up in an unstable, abusive, or neglectful environment may cause or be a factor in the development of BPD.

Serotonin Abnormalities

Abnormalities in serotonin (a hormone that regulates mood) production may make you susceptible to developing BPD.

Who Is at Risk for BPD?

You may be at risk for developing BPD if:

  • you have a family member who has BPD
  • you felt emotionally unstable or emotionally vulnerable as a child
  • people in your household were impulsive when you were a child
  • you were emotionally abused as a child

How Is BPD Diagnosed?

Your mental healthcare provider will diagnose BPD. He or she will ask you questions and analyze your emotional and behavioral history. Based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, you must meet at least five of the following criteria to be diagnosed with BPD:

  • You frantically try to avoid real or imaginary abandonment.
  • You have a pattern of unstable relationships where you alternate between idealizing and devaluing others in your relationships.
  • You have an unstable self-image or self-identity.
  • You act impulsively in at least two areas of your life in ways that can be self-damaging (overspending, substance abuse, etc.)
  • You have a history of suicidal or self-mutilating behavior.
  • You have frequent mood swings that usually last for a few hours but may last for a few days or more.
  • You have severe and long-term feelings of emptiness.
  • You have difficulty controlling your anger or get severely angry without cause. (You may feel angry all the time, display your anger frequently, or get in frequent physical fights.)
  • You have periods of stress-related paranoia or experience severe dissociation (when you feel like your mind is detached from your emotions or body).

How Is BPD Treated?

Your mental healthcare provider may recommend one or more of the following treatments for BPD.

Psychotherapy

Psychotherapy is the main treatment. Your mental healthcare provider may recommend one of the following types:

Cognitive Behavioral Therapy (CBT)

CBT helps you to identify and change unhealthy beliefs, behaviors, and any inaccurate perceptions you have about yourself or others. This therapy teaches you healthy ways to react when you are feeling angry, insecure, anxious, or suicidal.

Dialectical Behavior Therapy (DBT)

DBT teaches you how to recognize, be aware of, and accept your beliefs and behaviors. You also learn healthy responses to these behaviors .

Schema-Focused Therapy

Schema-focused therapy helps you to view yourself and the world in a more positive way.

Medication

Medication does not cure BPD; it relieves symptoms associated with the disorder. Your doctor may prescribe medication in addition to psychotherapy treatment. Medications your doctor may prescribe include antidepressants to treat depression, antipsychotics to treat aggression, and antianxiety medications to treat anxiety.

Hospitalization

Your doctor may recommend that you temporarily stay in a hospital for treatment if your symptoms are severe. You may also be hospitalized for suicidal behavior, suicidal thoughts, or thinking about harming or causing harm to yourself or others.

Alternative Therapy

Omega-3 fatty acids may relieve symptoms of depression and aggression in people who have BPD. More research needs to be conducted to confirm the benefits of omega-3 fatty acids.

Complications of BPD

BPD may occur with or lead to other disorders such as:

  • depression
  • anxiety disorders
  • eating disorders
  • bipolar disorder
  • substance abuse

Your BPD symptoms can increase your risk of:

  • relationship problems
  • being in an abusive relationship as the abused or abuser
  • sexually transmitted infections
  • work problems
  • suicide
  • self-injury
  • being in a motor vehicle accident
  • getting in physical fights
  • becoming the victim of violent crimes
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Article Sources:

  • American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Forth Edition Text Revision ed.). : Amer Psychiatric Pub.
  • SAMSHA. Report to congress on borderline personality disorder. 2011
  • Torgersen S, Lygren S, Oien PA, Skre I, Onstad S, Edvardsen J, Tambs K, Kringlen E. A twin study of personality disorders. Compr Psychiatry. 2000 Nov–Dec;41(6):416–25.
  • Coolidge FL, Thede LL, Jang KL. Heritability of personality disorders in childhood: a preliminary investigation. J Pers Disord. 2001 Feb;15(1):33–40.
  • X. Ni. et al. (2009). Serotonin genes and gene-gene interactions in borderline personality disorder in a matched case-control study.. Progress in Neuro-Psychopharmacology & Biological Psychiatry , 1;33(1), 128-133.
  • Bornovalova, M. et al. (2006). Temperamental and environmental risk factors for borderline personality disorder among inner-city substance users in residential treatment.. Journal of Personality Disorders, 20(3), 218-231.
  • Zanarini MC, Frankenburg FR. omega-3 Fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry. 2003 Jan;160(1):167–9.

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