For people with borderline personality disorder (BPD), life is similar to a rollercoaster ride, not only in terms of their unstable relationships and emotions but also because of their wavering sense of self. Their goals, self-image, and basic likes and dislikes are prone to changing frequently, and in ways that may feel unclear or confusing. Such people are usually extremely sensitive; even the smallest things can trigger the most intense reactions in them, and once upset, people with BPD can be difficult to calm down.
The excessive volatility, overwhelming emotions, and impulsiveness, along with many other issues, constitute a spectrum of borderline personality disorder symptoms that can sometimes be very difficult to recognize, despite being visibly clear. However, catching these symptoms and commencing an appropriate treatment plan is necessary to help people struggling with BPD regain control of their feelings, actions, thoughts, and life.
Mentioned below are some of the most common characteristics of borderline personality disorder that a person diagnosed with this condition may exhibit:
Fear of Abandonment
Many people fighting borderline personality disorder are terrified of being left alone or abandoned. Even something as minor as a loved one coming home late from work or going away for a meeting may trigger intense fear in them. What follows is a prompt and frantic effort to keep the other person close, which may involve begging, being clingy, fighting, or even tracking every movement of their loved one. Unfortunately, all these efforts do the very opposite of what people with BPD are trying to accomplish by pushing their loved ones farther from them.
Unstable Relationships
Most relationships between people with borderline personality disorder are short-lived and intense. They may fall in love quickly, believing that every new person will make them feel whole, but they are disappointed very quickly. For them, their relationships are either horrible or perfect without any middle ground. The family members, friends, and other loved ones of a person with BPD often feel like experiencing emotional whiplash due to their rapid swings from idealization to anger, hate, and devaluation in relationships.
Shifting Self-Image
When someone develops borderline personality disorder, their sense of self becomes unstable. They may feel good about themselves one day but quickly turn to hate themselves a few days later. Such people lack a clear idea of who they are or what they want in life. As a result, they frequently change their friends, values, lovers, religions, goals, aims, and even sexual identities.
Impulsive and Damaging Behaviors
Borderline personality disorder often triggers people to engage in sensation-seeking, potentially harmful behaviors, especially when stressed or upset. For example, they may impulsively spend money they cannot afford, drive recklessly, binge-eat, consume alcohol or drugs, or engage in risky sex. These behaviors often help them feel better in the moment but end up hurting them in the long run.
Self-harm
Some people with BPD experience self-harm or suicidal thoughts, but these are not universal. Seek prompt professional or crisis support. Serious injury, suicidal intent or inability to stay safe requires local emergency services; stay with the person if safe while help is arranged.
Extreme Emotional Swings
Unstable moods and rapid mood swings are extremely common in people with BPD. One moment, they may feel extremely happy and confident; the next, they may suddenly become despondent. The slightest and apparently insignificant things that most people easily brush off can send these patients into an emotional tailspin and perpetuate mood swings that are most intense but pass fairly quickly. For most people, these mood swings last from a few minutes to a few hours.
Chronic Feelings of Emptiness
People with a borderline personality disorder often talk about feeling empty from the inside. They may also believe they are a nobody to an uncomfortable extent and often try to fill this void with unhealthy behaviors, such as using drugs or food.
Explosive Anger
Most individuals with BPD struggle with a short temper and intense anger. They may also find it difficult to control themselves once something triggers them. Throwing things, yelling, or getting consumed by rage are common characteristics of a typical anger episode.
Losing Touch with Reality
People with borderline personality disorder also frequently develop suspicions or paranoia about others’ motives or intentions. They may also lose touch with reality, especially under stressful situations, through a phenomenon called dissociation.
Like most psychological disorders, the exact cause triggering borderline personality disorder is unknown. However, experts believe it to be a multifactorial disease that may involve equal contributions from genetics and environmental factors. Some proposed causes of BPD in females and males include the following:
Brain Structure
There is enough evidence to suggest that people with borderline personality disorder have specific differences in the structure and functions of their brains. These differences are particularly evident in areas that control emotional regulation and impulse control. However, more research is needed to determine if these changes occur due to BPR or are a part of the cause.
Genetics
A vital genetic component is linked to the prevalence of borderline personality disorder. The condition appears to run in families, affecting close family members in different generations
Negative Life Experiences
Many people diagnosed with borderline personality disorder have experienced a certain negative life experience in the form of neglect, trauma, childhood abuse, abandonment of a caregiver, etc. However, this association does not confirm the presence of BPD in every single person who experiences these experiences.
An expert may give the diagnosis of borderline personality disorder to an individual who has experienced at least five of the following symptoms for a long time:
- Feeling extremely worried about abandonment and going to great lengths to prevent it
- Feeling insecure about self and experiencing a change in the sense of self depending on people around you
- Experiencing intense emotions that may last from a few hours to a few days and may change rapidly, for example, transitioning from feeling very happy to suddenly becoming depressed in minutes
- Difficulty in establishing relationships and keeping them stable
- Experiencing feelings of emptiness most of the time
- Feeling intense anger that may quickly get out of control
- Acting impulsively and engaging in behaviors that can harm you, such as reckless driving, using alcohol or drugs, and binge eating
- Relying on self-harm to manage everyday feelings/ developing suicidal tendencies
- Experiencing dissociation or extreme paranoia under stressful circumstances
At a time, experts believed borderline personality disorder was untreatable with very little chance of recovery. However, research has since proven that BPD is treatable, and the symptoms associated with it can be well-managed with various treatment options. Treatment has now become essential given the high possibility of risky behaviors, suicide attempts, and self-harm occurring in individuals diagnosed with this psychiatric illness.
To get control over BPD, it is essential to get help from a qualified mental health professional. Only a professional can help such people live a better quality of life with fewer, well-managed symptoms through consistent treatment. Structured psychotherapy is the primary treatment for BPD. Care should be individualized, with support for co-occurring conditions and a crisis plan where needed. The plan may vary depending on the following factors:
- How much the borderline personality disorder symptoms affect an individual
- How much they are willing to participate and engage in treatment
- If they are willing to change how they react to their feelings and thoughts
- If they can work in collaboration with a counselor
- If they have adequate professional and personal support available
Psychotherapy
Psychotherapy continues to be the standard treatment for borderline personality disorder. Depending on individual situations, this treatment modality may involve a patient’s close friends, family members, or caregivers. Some common types of therapies proven to be particularly beneficial for people with BPD include the following:
- Dialectical behavior therapy, or DBT, is a type of cognitive behavioral therapy that helps individuals learn how to be present in the moment. It also equips them with the skills to cope with stress healthily, regulate their emotions, and improve their new and existing relationships.
- Group therapy is a treatment in which a therapist works with multiple patients with borderline personality disorder and promotes discussions between them. This platform allows people with similar issues to share their experiences and learn from one another.
- Mentalization-based treatments, or MBT, focus on helping individuals with borderline personality disorder recognize that their feelings and thoughts deeply connect with their behaviors
Medication
Medication is not routinely recommended for BPD itself or its core symptoms. A prescriber may treat a co-occurring condition or consider brief, monitored crisis treatment, with a clear indication and review plan. The following classes are not a routine BPD regimen:
- Antidepressants
- Mood stabilizers
- Antipsychotics
- anxiolytics
Other Treatments
People in an active crisis secondary to borderline personality disorder may require more intensive treatments or possible hospitalizations. Acute psychiatric admission may be needed when significant risk cannot be managed through crisis or community services. It is not a routine residential stay until every symptom resolves. Discuss alternatives, potential benefits and harms, and the purpose and expected duration of admission. Immediate danger requires emergency help.
