Overview
Borderline personality disorder is a mental illness that severely impacts a person’s ability to regulate their emotions. This loss of emotional control can increase impulsivity, affect how a person feels about themselves, and negatively impact their relationships with others. Effective treatments are available to manage the symptoms of borderline personality disorder.
Signs and Symptoms
People with borderline personality disorder may experience intense mood swings and feel uncertainty about how they see themselves. Their feelings for others can change quickly, and swing from extreme closeness to extreme dislike. These changing feelings can lead to unstable relationships and emotional pain.
People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their interests and values can change quickly, and they may act impulsively or recklessly.
Other signs or symptoms may include:
- Efforts to avoid real or perceived abandonment, such as plunging headfirst into relationships—or ending them just as quickly.
- A pattern of intense and unstable relationships with family, friends, and loved ones.
- A distorted and unstable self-image or sense of self.
- Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating. Please note: If these behaviors happen mostly during times of elevated mood or energy, they may be symptoms of a mood disorder and not borderline personality disorder.
- Self-harming behavior, such as cutting.
- Recurring thoughts of suicidal behaviors or threats.
- Intense and highly variable moods, with episodes lasting from a few hours to a few days.
- Chronic feelings of emptiness.
- Inappropriate, intense anger or problems controlling anger.
- Feelings of dissociation, such as feeling cut off from oneself, observing oneself from outside one’s body, or feelings of unreality.
Not everyone with borderline personality disorder may experience all of these symptoms. The severity, frequency, and duration of symptoms depend on the person and their illness.
People with borderline personality disorder have a significantly higher rate of self-harming and suicidal behavior than the general population.
People with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away.
If you or someone you know is in immediate distress or is thinking about hurting themselves, call or text the 988 Suicide & Crisis Lifeline at 988or chat at 988lifeline.org. You can also contact the Crisis Text Line (text HELLO to 741741).
Risk Factors
Researchers aren’t sure what causes borderline personality disorder, but studies suggest that genetic, environmental, and social factors may increase the risk of developing it. These factors may include:
- Family history: People who have a close family member (such as a parent or sibling) with the illness may be at a higher risk of developing borderline personality disorder.
- Brain structure and function: Research shows that people with borderline personality disorder may have structural and functional changes in the brain, especially in the areas that control impulses and emotion regulation. However, the studies do not demonstrate whether these changes were risk factors for the illness or if such changes were caused by the disorder.
- Environmental, cultural, and social factors: Many people with borderline personality disorder report experiencing traumatic life events, such as abuse, abandonment, or hardship during childhood. Others may have been exposed to unstable, invalidating relationships or conflicts.
Although these factors may increase a person’s risk, it doesn’t mean it is certain that they’ll develop borderline personality disorder. Likewise, people without these risk factors may develop the disorder in their lifetime.
Diagnosis
A licensed mental health professional—such as a psychiatrist, psychologist, or clinical social worker—who is experienced in diagnosing and treating mental disorders can diagnose borderline personality disorder based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam also can help rule out other possible causes of symptoms. In diagnosing the illness, providers will discuss a person’s symptoms and ask about family medical histories, including histories of mental illness.
Borderline personality disorder is usually diagnosed in late adolescence or early adulthood. Occasionally, a person younger than age 18 may be diagnosed with borderline personality disorder if symptoms are significant and last at least a year.
What other illnesses can co-occur with borderline personality disorder?
Borderline personality disorder often occurs with other mental illnesses, such as post-traumatic stress disorder (PTSD). These co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with symptoms of the disorder. For example, a person with borderline personality disorder also may be more likely to experience symptoms of major depression, PTSD, bipolar disorder, anxiety disorders, substance abuse, or eating disorders.
Treatments and Therapies
Borderline personality disorder historically has been viewed as challenging to treat. But with newer, evidence-based treatment, many people with this disorder experience fewer and less severe symptoms, improved functioning, and better quality of life. It is important for patients with borderline personality disorder to receive treatment from a licensed mental health professional. Other types of treatment, or treatment from a provider who is not appropriately trained, may be ineffective or dangerous.
Many factors affect the length of time it takes for symptoms to improve once treatment begins. It is important for people with borderline personality disorder and their loved ones to be patient and receive support during treatment.
Seek—and stick with—treatment.
Studies funded by the National Institute of Mental Health (NIMH) indicate that individuals with borderline personality disorder who don’t receive adequate treatment are more likely to develop other chronic medical or mental illnesses and are less likely to make healthy lifestyle choices.
Psychotherapy
Psychotherapy, sometimes called “talk therapy,” is the first-line treatment for people with borderline personality disorder. Most psychotherapy occurs with a licensed, trained mental health professional in one-on-one sessions or with other individuals in group settings. Group sessions may help teach people with borderline personality disorder to interact with others and express themselves effectively.
Two examples of psychotherapies used to treat borderline personality disorder are:
- Dialectical Behavior Therapy (DBT): This treatment was developed specifically for individuals with borderline personality disorder. DBT uses concepts of mindfulness or awareness of one’s present situation and emotional state. DBT also teaches skills to help people control intense emotions, reduce self-destructive behaviors, and improve relationships.
- Cognitive Behavioral Therapy (CBT): This treatment can help people identify and change core beliefs and behaviors that come from inaccurate perceptions of themselves and others and problems interacting with others. It may help people reduce mood swings and anxiety symptoms and may reduce the number of self-harming or suicidal behaviors.
Read more on NIMH’s Psychotherapies health topic page.
Medications
Because the benefits of prescription medication for borderline personality disorder are unclear, medications aren’t typically used as the primary way to treat the illness. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental disorders such as mood swings or depression. Treatment with medications may require coordinated care from more than one medical professional.
Medications also can sometimes cause side effects in some people. Talk to your provider about what to expect from a particular medication. Read more in NIMH’s Mental Health Medications health topic.
Other Elements of Care
Some people with borderline personality disorder experience severe symptoms and need intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care.
Therapy for Caregivers and Family Members
Having a relative or loved one with the disorder can be stressful, and family members or caregivers may unintentionally act in ways that can worsen their loved one’s symptoms.
Although more research is needed to determine how well family therapy helps with borderline personality disorder, studies on other mental disorders show that including family members can help support a person’s treatment. Families and caregivers also can benefit from therapy.
Family therapy helps by:
- Allowing the relative or loved one to develop skills to understand and support a person with borderline personality disorder.
- Focusing on the needs of family members to help them understand the obstacles and strategies for caring for someone with the disorder.
Finding Help
If you’re not sure where to get help, a health care provider can refer you to a licensed mental health professional, such as a psychiatrist or psychologist with experience treating borderline personality disorder. If you need help starting the conversation, check out the Tips for Talking With Your Health Care Provider fact sheet.
Other resources include:
- Substance Abuse and Mental Health Services Administration’s Behavioral Health Treatment Services Locator, a tool for finding mental health services in your area
- NIMH’s Help for Mental Illnesses webpage
- Agency for Healthcare Research and Quality’s website
Tips for Family and Caregivers
Here are some ways to help a friend or relative with the disorder:
- Take time to learn about the illness to understand what your friend or relative is experiencing.
- Offer emotional support, understanding, patience, and encouragement. Change can be difficult and frightening to people with borderline personality disorder, but things can improve over time.
- Encourage your loved one in treatment for borderline personality disorder to ask about family therapy.
- Seek counseling for yourself. Choose a different therapist than the one your relative is seeing.
Join a Study
Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.
Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.
To learn more or find a study, visit:
- NIMH’s Clinical Trials webpage: Information about participating in clinical trials
- Clinicaltrials.gov: Current Studies on Borderline Personality Disorders: List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
Health Hotlines
- 988 Suicide & Crisis Lifeline: The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress. Call or text 988 to connect with a trained crisis counselor. Support is also available via live chat. Para ayuda en español, llame al 988.
- Disaster Distress Hotline: People affected by any disaster or tragedy can call this helpline, sponsored by the Substance Abuse and Mental Health Services Administration, to receive immediate counseling. Call or text 1-800-985-5990 to connect with a trained professional from the closest crisis counseling center within the network.
- Veterans Crisis Line: This helpline is a free, confidential resource for Veterans of all ages and circumstances. Call 1-800-273-8255, press "1"; text 838255; or chat online to connect with 24/7 support.
- Crisis Text Line: Text HELLO to 741741 for free and confidential support 24 hours a day throughout the U.S.
- More NIH Information Lines
Learn More
Free Brochures and Shareable Resources
- Borderline Personality Disorder: A brochure that offers basic information about borderline personality disorder, including signs and symptoms, treatment, and finding help. Also available en español.
- 5 Action Steps for Helping Someone in Emotional Pain: Infographic presenting five steps for helping someone in emotional pain to prevent suicide. Also available en español.
- Suicide in America: Frequently Asked Questions: Fact sheet can help you, or a friend or family member, learn about the signs and symptoms, risk factors and warning signs, and ongoing research about suicide and suicide prevention. Also available en español.
- Warning Signs of Suicide: An infographic presenting behaviors and feelings that may be warnings signs that someone is thinking about suicide. Also available en español.
- Shareable Resources on Borderline Personality Disorder: Help support borderline personality disorder awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about borderline personality disorder.
Multimedia
- Experts Discuss Borderline Personality Disorder: Learn the signs, symptoms, diagnosis, treatments, and the latest research on borderline personality disorder.
Federal Resources
- Borderline Personality Disorder (MedlinePlus Medical Encyclopedia)
- Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders (Substance Abuse and Mental Health Services Administration)
- Personality Disorders (MedlinePlus - also en español)
Research and Statistics
- Journal Articles: References and abstracts from MEDLINE/PubMed (National Library of Medicine).
- Statistics: Personality Disorders: Webpage listing information on the prevalence of personality disorder among adults.
Last Reviewed: April 2022
Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.
FAQs
What are the main early signs of borderline personality disorder? ›
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.
What is the main cause of borderline personality disorder? ›Environmental factors
being a victim of emotional, physical or sexual abuse. being exposed to long-term fear or distress as a child. being neglected by 1 or both parents. growing up with another family member who had a serious mental health condition, such as bipolar disorder or a drink or drug misuse problem.
Borderline personality disorder (BPD) is a serious, long-lasting and complex mental health problem. People with BPD have difficulty regulating or handling their emotions or controlling their impulses.
What is BPD favorite person? ›A favorite person is the center of attention of an individual living with BPD. This means they consider this person as a trusted friend, confidant, and counselor all wrapped in one.
Why do people with BPD push people away? ›As a result, the fear of being abandoned often causes people with BPD to form unhealthy attachments, sometimes abruptly cutting off, as well as making frantic attempts to hold onto relationships. These overly intense or erratic behaviors, in turn, often push loved ones away.
How can you tell if a woman is borderline? ›The primary pattern of those with BPD is intense mood swings. Emotion dysregulation is a hallmark of the disorder. These will usually catch you by surprise, as they can be disproportionate to the situation, with fast positive close behavior shifting to fast criticism and anger.
What does BPD look like in females? ›What are the symptoms of BPD? A person with BPD may experience intense times of anger, depression, and anxiety that may last only hours or, at most, a day. A person with BPD may also be aggressive, hurt themself, and abuse drugs or alcohol.
How is borderline diagnosed? ›Personality disorders, including borderline personality disorder, are diagnosed based on a: Detailed interview with your doctor or mental health provider. Psychological evaluation that may include completing questionnaires. Medical history and exam.
What age does borderline personality disorder develop? ›Most personality disorders begin in the teen years when your personality further develops and matures. As a result, almost all people diagnosed with borderline personality disorder are above the age of 18. Although anyone can develop BPD, it's more common if you have a family history of BPD.
What age do people develop borderline personality disorder? ›According to the DSM-5, BPD can be diagnosed as early as at 12 years old if symptoms persist for at least one year. However, most diagnoses are made during late adolescence or early adulthood.
What kind of trauma causes BPD? ›
Verbal, emotional, physical, and sexual abuse, together with emotional and physical neglect, and chronic exposure to peer victimization were identified as potential factors that increase the risk for early BPD.
Does BPD ever go away? ›BPD is not necessarily a lifelong disorder. Many patients retain residual symptoms later in life.
What happens if BPD is left untreated? ›Some of the most common effects of untreated BPD can include the following: Dysfunctional social relationships. Repeated job losses. Broken marriages.
Are people with BPD psychotic? ›Psychotic symptoms, especially hallucinations, are highly prevalent in patients with BPD. Recent studies suggest that hallucinations in BPD are similar to those in patients with psychotic disorders in terms of phenomenology, but their emotional impact seems to be even stronger in patients with BPD.
How does a BPD show love? ›The Science of Falling in Love
Affection – People with BPD are either extremely affectionate or withdrawn, which may be confusing for those who don't have the disorder. Abandonment – Lots of people are scared that their partner isn't happy; but when you have BPD, you may be in constant worry that they will leave.
Previous research has demonstrated that patients with borderline personality disorder (BPD) are more sensitive to negative emotions and often show poor cognitive empathy, yet preserved or even superior emotional empathy.
How long does the average BPD relationship last? ›Results found in a 2014 study found the average length of a BPD relationship between those who either married or living together as partners was 7.3 years. However, there are cases where couples can stay together for 20+ years.
When does a borderline need space? ›Should i be the one to leave her go? Usually when a BPD wants space from the relationship it means they want to look elsewhere, while still maintaining a connection to you in case dating doesn't work out. Being on a break is a grey area that's neither an on or an off relationship.
What do you do when your BPD is mad at you? ›Listen actively and be sympathetic and focus on emotions rather than the words. Ensure that you demonstrate that the person with BPD feels heard. When someone is upset or angry, it's easy and understandable to reciprocate, but it is not helpful.
How are people with BPD in relationships? ›People with BPD often have patterns of intense or unstable relationships. This may involve a shift from extreme adoration to extreme dislike, known as a shift from idealization to devaluation. Relationships may be marked by attempts to avoid real or imagined abandonment.
What does a BPD depressive episode look like? ›
People with BPD often describe feeling intensely bored, restless, and/or desperately lonely when they are depressed. Further, depressed episodes in people with BPD are often triggered by interpersonal losses (for example, the breakup of a relationship).
When does BPD show up? ›According to the DSM-5, BPD can be diagnosed as early as at 12 years old if symptoms persist for at least one year. However, most diagnoses are made during late adolescence or early adulthood.
What does BPD look like in females? ›What are the symptoms of BPD? A person with BPD may experience intense times of anger, depression, and anxiety that may last only hours or, at most, a day. A person with BPD may also be aggressive, hurt themself, and abuse drugs or alcohol.
How can you tell if a female has BPD? ›The primary pattern of those with BPD is intense mood swings. Emotion dysregulation is a hallmark of the disorder. These will usually catch you by surprise, as they can be disproportionate to the situation, with fast positive close behavior shifting to fast criticism and anger.
What type of medication is used for BPD? ›Antipsychotics are widely used in BPD, as they are believed to be effective in improving impulsivity, aggression, anxiety and psychotic symptoms [Nose et al. 2006; American Psychiatric Association, 2001].
Can antidepressants worsen BPD? ›In fact, many antidepressants can cause mood swings as a side effect, which can amplify the flurry of emotions that you are already feeling due to BPD, highlighting the necessity of proper diagnosis and receiving the appropriate antidepressant medication.
Is BPD the most painful mental disorder? ›Borderline personality disorder (BPD) has long been believed to be a disorder that produces the most intense emotional pain and distress in those who have this condition. Studies have shown that borderline patients experience chronic and significant emotional suffering and mental agony.
Does BPD ever go away? ›BPD is not necessarily a lifelong disorder. Many patients retain residual symptoms later in life.
Does BPD get worse with age? ›Although there is sometimes a reduction of Borderline Personality Disorder symptoms as a person ages, it is dangerous to assume that you can just wait out the disorder and hope to get better. Generally, the symptoms of BPD are worse in one's early years and tend to decrease during the 30s and 40s.
What is it like living with borderline personality disorder? ›Your experience of living with BPD is unique to you, but this page describes some common experiences that you might recognise: Difficult feelings and behaviour towards yourself. Difficult feelings and behaviour towards others. Problems with drugs or alcohol.
How long does the average BPD relationship last? ›
Results found in a 2014 study found the average length of a BPD relationship between those who either married or living together as partners was 7.3 years. However, there are cases where couples can stay together for 20+ years.
How long do BPD people live? ›The mean patient age was 27 years, and 77% were women. After 24 years, more patients with BPD died by suicide than patients with other PD (5.9% vs 1.4%). Similarly, rates of death from other causes were higher in patients with BPD (14.0%) compared with comparison patients (5.5%).
How do you stop a borderline episode? ›- Take a warm shower or bath.
- Play music that relaxes you.
- Engage in a physical activity.
- Do brain teasers or problem-solving activities.
- Talk to a sympathetic loved one.
Those who have BPD tend to be very intense, dramatic, and exciting. This means they tend to attract others who are depressed and/or suffering low self-esteem. People who take their power from being a victim, or seek excitement in others because their own life is not where they want it to be.
How do borderlines act in relationships? ›People with BPD often have patterns of intense or unstable relationships. This may involve a shift from extreme adoration to extreme dislike, known as a shift from idealization to devaluation. Relationships may be marked by attempts to avoid real or imagined abandonment.
How do they test for BPD? ›There's no specific test for BPD, but a healthcare provider can determine a diagnosis with a comprehensive psychiatric interview and medical exam. After that, you can get appropriate treatment and begin to manage your symptoms better and move forward in your life.