Borderline

Personality
Disorder
What is Borderline Personality Disorder?
Borderline personality disorder is an illness marked by an ongoing pattern of varying
moods, self-image, and behavior. These symptoms often result in impulsive actions
and problems in relationships with other people. A person with borderline personality
disorder may experience episodes of anger, depression, and anxiety that may last
from a few hours to days. Recognizable symptoms typically show up during
adolescence (teenage years) or early adulthood, but early symptoms of the illness
can occur during childhood.

National Institute
of Mental Health
What are the signs People with borderline personality disorder may
and symptoms? experience mood swings and may display
uncertainty about how they see themselves and
their role in the world. As a result, their interests and
values can change quickly. People with borderline personality disorder also tend to view
things in extremes, such as all good or all bad. Their opinions of other people can also
change quickly. An individual who is seen as a friend one day may be considered an
enemy or traitor the next. These shifting feelings can lead to intense and unstable
relationships.
Other signs or symptoms may include:
♦ Efforts to avoid real or imagined abandonment, such as rapidly initiating intimate
(physical or emotional) relationships or cutting off communication with someone in
anticipation of being abandoned
♦ A pattern of intense and unstable relationships with family, friends, and loved ones,
often swinging from extreme closeness and love (idealization) to extreme dislike or
anger (devaluation)
♦ 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
occur primarily during times of elevated mood or energy, they may be indicative of a
mood disorder, rather than borderline personality disorder.
♦ Self-harming behavior, such as cutting
♦ Recurring thoughts of suicidal behaviors or threats
♦ Intense and highly changeable moods, with each episode lasting from a few hours to
a few days
♦ Chronic feelings of emptiness
♦ Inappropriate, intense anger or problems controlling anger
♦ Difficulty trusting, which is sometimes accompanied by irrational fear of other
people’s intentions
♦ 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 experiences every symptom. Some
individuals experience only a few symptoms, while others have many. Symptoms
can be triggered by seemingly ordinary events; for example, people with borderline
personality disorder may become angry and distressed over minor separations—due to
business trips or changes in plans—from people to whom they feel close. The severity
and frequency of symptoms and how long they last will vary depending on the
individual and their particular illness.
What causes borderline Scientists aren’t sure what causes borderline
personality disorder? personality disorder, but research suggests
that genetic, environmental, and social
factors play a role.
♦ Family History. People who have a close family member (such as a parent or sibling)
with the disorder may be at a higher risk of developing borderline personality disorder
or borderline personality disorder traits (such as impulsiveness and aggression).
♦ Brain Factors. Studies show that people with borderline personality disorder can
have structural and functional changes in the brain especially in the areas that
control impulses and emotional regulation. But is it not clear whether these changes
were risk factors for the disorder, or 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 adversity during childhood. Others may have been exposed to
unstable, invalidating relationships, and hostile conflicts.
Although these factors may increase a person’s risk, it does not mean that the person
will develop borderline personality disorder. Likewise, there may be people without
these risk factors who will develop borderline personality disorder in their lifetime.

A licensed mental health professional—such

How do I know if I have as a psychiatrist, psychologist, or clinical
borderline personality social worker—experienced in diagnosing
disorder? 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 can also help rule out other possible
causes of symptoms.
The mental health professional may ask about symptoms and personal and family
medical histories, including any history of mental illness. This information can help
determine the best treatment.
WHAT OTHER ILLNESSES OFTEN CO-OCCUR WITH BORDERLINE
PERSONALITY DISORDER?

Borderline personality disorder often occurs with other mental illnesses. These co-
occurring disorders can make it harder to diagnose and treat borderline personality
disorder, especially if symptoms of other illnesses overlap with the symptoms of
borderline personality disorder. For example, a person with borderline personality
disorder may be more likely to also experience symptoms of major depression, bipolar
disorder, anxiety disorders, substance abuse, or eating disorders.
How is borderline Borderline personality disorder has
personality disorder historically been viewed as difficult to
treated? treat. But with newer, evidence-based
treatment, many people with borderline
personality disorder experience fewer and less severe symptoms, improved functioning,
and an improved quality of life. It is important for patients with borderline personality
disorder to receive evidence-based, specialized treatment from an appropriately-
trained mental health professional. Other types of treatment, or treatment provided by
a provider who is not appropriately trained, may not benefit the patient.
Many factors affect the length of time it takes for symptoms to improve once treatment
begins, so it is important for people with borderline personality disorder and their
loved ones to be patient and to receive appropriate support during treatment.
IT IS IMPORTANT TO SEEK—AND STICK WITH—TREATMENT.

NIMH-funded studies indicate that borderline personality disorder patients 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. Borderline personality
disorder is also associated with a significantly higher rate of self-harm and suicidal
behavior than the general population.

SUICIDE AND Borderline personality disorder is associated with higher

SELF-HARMING rates of suicide and self-harming behaviors. Patients with
BEHAVIORS borderline personality disorder who are thinking of harming
themselves or attempting suicide need help right away.
If you or a friend or family member is experiencing suicidal thoughts or self-
harming behaviors:
Call the National Suicide Prevention Lifeline (NSPL) toll-free at 1–800–273–TALK
(8255), 24 hours a day, 7 days a week. The service is available to everyone. The
deaf and hard of hearing can contact the NSPL via TTY at 1–800–799–4889. All
calls are free and confidential. Contact social media outlets directly if you are
concerned about a friend’s social media updates or dial 911 in an emergency. Learn
more on the NSPL’s website.
Take seriously any comments about suicide or wishing to die. Even if you do
not believe your family member or friend will attempt suicide, the person is clearly
in distress and can benefit from your help in finding treatment. For more about
suicide prevention, visit www.nimh.nih.gov (search word: suicide prevention).

The treatments described below are just some of the options that may be available
to a person with borderline personality disorder.
PSYCHOTHERAPY
Psychotherapy is the first-line treatment for people with borderline personality
disorder. It can be provided one-on-one between the therapist and the patient or in a
group setting. Therapist-led group sessions may help teach people with borderline
personality disorder how to interact with others and how to express themselves
effectively. It is important that people in therapy get along with and trust their therapist.
The very nature of borderline personality disorder can make it difficult for people with
this disorder to maintain a comfortable and trusting bond with their therapist.
Two examples of psychotherapies used to treat borderline personality disorder include
Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT).
DBT, which was developed for individuals with borderline personality disorder,
uses concepts of mindfulness and acceptance or being aware of and attentive to the
current situation and emotional state. DBT also teaches skills to control intense
emotions, reduce self-destructive behaviors, and improve relationships.
CBT can help people with borderline personality disorder identify and change core
beliefs and behaviors that underlie inaccurate perceptions of themselves and others
and problems interacting with others. CBT may help reduce a range of mood and
anxiety symptoms and reduce the number of suicidal or self-harming behaviors.
MEDICATIONS

Medications are not typically used as the primary treatment for borderline personality
disorder as the benefits are unclear. However, in some cases, a psychiatrist may
recommend medications to treat specific symptoms, such as mood swings, depression,
or other mental disorders that may occur with borderline personality disorder. Treatment
with medications may require care from more than one medical professional.
Certain medications can cause different side effects in different people. Individuals
should talk to his or her provider about what to expect from a particular medication.
OTHER ELEMENTS OF CARE

Some people with borderline personality disorder experience severe symptoms and
require intensive, often inpatient, care. Other people may need outpatient treatments but
never need hospitalization or emergency care.
THERAPY FOR CAREGIVERS AND FAMILY MEMBERS

Families of people with borderline personality disorder may also benefit from therapy.
Having a relative with the disorder can be stressful, and family members may
unintentionally act in ways that worsen their relative’s symptoms.
 Some borderline personality disorder therapies include family members in treatment
sessions. These sessions help families develop skills to better understand and support
a relative with borderline personality disorder. Other therapies focus on the needs of
family members to help them understand the obstacles and strategies for caring for
someone with borderline personality disorder. Although more research is needed to
determine the effectiveness of family therapy in borderline personality disorder, studies
on other mental disorders suggest that including family members can help in a
person’s treatment.

Research on borderline personality

What research is being done disorder is focusing on biological and
to improve the diagnosis environmental risk factors, with special
and treatment of borderline attention on symptoms that may emerge
personality disorder? at a young age. Researchers are conducting
studies focused on adolescents at risk for
borderline personality disorder to develop
methods that help identify the disorder early. Borderline personality disorder research
is also focused on the development and evaluation of psychotherapy and
pharmacological interventions to prevent self-harming and suicidal behaviors, which
occur at a high rate among people with borderline personality disorder.
HOW CAN I TAKE PART IN CLINICAL RESEARCH?

Clinical trials are research studies that look at new ways to prevent, detect, or treat
diseases and conditions, including borderline personality disorder. During clinical trials,
treatments might be new drugs, new types of psychotherapy, new combinations of
drugs, or new ways to use existing treatments. The goal of clinical trials is to determine
if a new test or treatment works and is safe.
Although individual participants 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. Decisions about participating
in a clinical trial are best made in collaboration with a licensed health professional.
To learn more about clinical trials, please visit NIH Clinical Trials and You (www.nih.gov/
health/clinicaltrials/index.htm). To find a clinical trial, visit www.ClinicalTrials.gov.

MENTAL HEALTH TREATMENT LOCATOR

Where can I
For more information, resources, and research on mental
find help?
illnesses, visit the NIMH website at http://www.nimh.nih.gov.
The National Library of Medicine’s MedlinePlus website
(https://medlineplus.gov/) also has information on a wide variety of mental disorders.
For general information on mental health and to locate treatment services, call the
Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment
Referral Helpline at 1–800–662—HELP (4357). SAMHSA also has a Behavioral Health
Treatment Locator on its website (https://findtreatment.samhsa.gov) that can be
searched by location.
QUESTIONS TO ASK YOUR DOCTOR

Asking questions and providing information to your doctor or health care provider can
improve your care. Talking with your doctor builds trust and leads to better results,
quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality
website for tips at www.ahrq.gov/patients-consumers.
More information about finding a health care provider or treatment for mental
disorders is available on our Help for Mental Illnesses webpage, available at
http://www.nimh.nih.gov/findhelp.

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For More Information

To learn more information about borderline personality disorder, visit:

Medline Plus (National Library of Medicine)
http://medlineplus.gov
(En español: http://medlineplus.gov/spanish)
For information on clinical trials, visit:
ClinicalTrials.gov: http://www.clinicaltrials.gov
(En español: http://salud.nih.gov/investigacion-clinica/)
For more information on conditions that affect mental health, resources, and research,
visit the NIMH website (http://www.nimh.nih.gov).

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health
National Institute of Mental Health
NIH Publication No. QF 17-4928