What Is BPD? Symptoms, Causes, and Treatment of Borderline Personality Disorder

According to a qualitative investigation, people with borderline personality disorder are constantly stigmatized because of their diagnosis [1]. Existing myths make society fear and avoid people with BPD, subjecting them to social isolation. However, it is important to separate the person from their condition, so today we will try to understand the specifics of borderline personality disorder, its symptoms, and causes.

What Is Borderline Personality Disorder?

Borderline personality disorder is a mental condition characterized by mood swings, impulsive behavior, sometimes suicidal thoughts, as well as instability in self-perception and relationships with others, according to the National Institute of Mental Health [2].

People with a borderline personality disorder experience an intense fear of loneliness and have difficulty regulating their emotions, especially anger. They are often prone to risky actions towards themselves and others, so they may struggle to build and maintain relationships.

In the United States, the prevalence of the disorder is on average 2.7%, but can be as high as 5.9%. Among patients with mental disorders hospitalized for inpatient treatment, the prevalence reaches 20%. Although about 75% of inpatients are women, the ratio between men and women in the general population is 1:1, studies show [3].

If you feel frequent mood changes, a sense of emptiness, or fear of abandonment, and it lowers your quality of life, take the BPD test to assess your symptoms.

Symptoms of Borderline Personality Disorder and Diagnosis

Symptoms of borderline personality disorder vary, but a key symptom is an intense fear of abandonment. People with borderline personality disorder may feel anxiety or rage at the slightest sign of rejection, even if it is only imagined [4].

This feeling is reinforced by a tendency to think in black and white terms: at first, the person may idealize someone, showering them with attention, but at the slightest disappointment, they move on to intense emotions like blaming and devaluing, believing that they have not been appreciated. Such changes in perception lead to unstable relationships with others and make it difficult to build trusting connections.

People with borderline personality disorder may also have difficulty maintaining a stable perception of themselves, which is why they often change their life goals, values, career priorities, and social connections.

Borderline personality disorder often occurs together with other severe symptoms and conditions like eating disorders, such as anorexia nervosa, and anxiety disorders. 

BPD may also be characterized by impulsivity. This may show up in sensation-seeking and dangerous behavior, such as gambling, unprotected sex, and reckless driving.

Under severe stress, people with borderline personality disorder may experience temporary dissociative episodes and paranoid thoughts. In rare cases, psychosis-like symptoms such as hallucinations or delusions may occur, but they are usually short-lived and caused solely by emotional stress. In most cases, these symptoms appear in early adulthood and diminish with age, but do not disappear completely.

Not every person with borderline personality disorder experiences all the listed symptoms. Additionally, certain symptoms may show up with different levels of complexity, frequency, and duration.

Diagnosis of Borderline Personality Disorder

The diagnosis of borderline personality disorder is based on DSM-5-TR criteria, which require the identification of persistent features of emotional instability, impulsivity, and interpersonal difficulties. The diagnosis is confirmed by the presence of five or more of the following criteria:

• A desire to avoid loneliness, often to the extreme.
• Unstable and intense relationships, with shifts from idealization to devaluation.
• Unstable self-esteem and frequent changes in self-image.
• Impulsivity in two or more areas, such as sexual life, eating, or spending sprees.
• Repeated suicidal behavior or self-harming gestures.
• Short-term but intense mood swings.
• Chronic feelings of inner emptiness.
• Difficulty controlling anger, excessive and disproportionate reactions.
• Paranoid ideas or dissociative symptoms associated with stress.

For an accurate diagnosis, it is important to exclude other mental disorders, such as bipolar disorder, depression, anxiety disorders, or the effects of substance abuse. According to a psychiatric study, borderline personality disorder may be confused with bipolar disorder due to the similarity in emotional changes; however, in bipolar disorder, these changes are more prolonged and less reactive [5].

What Does a Person with Borderline Personality Disorder Act Like?

An alarming event, a stressful experience, family history, or a genetic predisposition can trigger the appearance of borderline personality disorder. Signs of borderline personality disorder usually appear in late adolescence or early adulthood [4]. The most common symptoms of BPD include:

1. Fear of abandonment

People with borderline personality disorder find it difficult to be alone. Therefore, the person may experience fear of loneliness and often make desperate attempts to avoid it. This may show up as suicidal behavior and attention-seeking behaviors. 

They may also become angry and manipulative. They may become controlling of others, not letting them leave, or even tracking their location. When someone with BPD becomes angry, it’s usually because they feel deeply hurt, threatened, or misunderstood, not because they want to control others maliciously. These behaviors can seem controlling, but they’re usually driven by panic and emotional dysregulation, not cold calculation.

2. Difficulty maintaining healthy interpersonal relationships

Their relationships with other people usually fluctuate from great love and idealization to hostility and devaluation of a partner or a friend.

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3. Unstable self-image and self-esteem

People with borderline personality disorder are typically self-critical. They feel shame, reproach themselves, consider themselves “losers”, and can do anything to confirm this. For example, they might intentionally get a bad grade at university or get fired from work.

4. Frequent mood changes

In just a few hours, a person with borderline personality disorder can experience joy and sadness, happiness and fear, satisfaction and depression. The spectrum of emotions can be very different and intense, which can lead to panic attacks, serious conflicts, and even thoughts about attempting suicide.

5. Suicidal behavior and self-harm

A sign of borderline personality disorder is resorting to self-harm or threatening to harm oneself. Self-harming behavior, including cutting or burning, is also common and serves as a way to cope with emotional pain, rejection, or loneliness. 

According to the research on suicidality in borderline personality disorder, even if such behavior is not aimed at suicide, the risk of attempting suicide in such patients is significantly higher than in the general population, at about 8–10% [6]. Often, this higher risk is associated with a feeling of abandonment and shows up in manipulation.

6. Difficulty managing anger

People with BPD may experience sudden periods of intense anger, which show up in violent outbursts, biting sarcasm, or angry tirades, especially directed at people to whom they are attached. After such outbursts, they often feel shame and guilt, which reinforces their self-image as a “bad” person.

Causes and Risk Factors of Borderline Personality Disorder

The exact causes of borderline personality disorder are unknown, but it is believed to be influenced by both genetic and environmental factors. In childhood, stress caused by physical or sexual abuse, loss of loved ones, and prolonged childhood emotional neglect plays a significant role, according to recent research [4]. 

Some people have a genetic predisposition to hyperreactivity to stressors, which increases the risk of developing borderline personality disorder. Children who grow up in an environment with unstable relationships and a lack of emotional support are most likely to have an increased risk of developing this disorder. Some of the main causes and risk factors for BPD are:

• Genetic predisposition
• Traumatic events in childhood
• Poor family environment
• Lack of support and love in early childhood
• Mental or emotional abuse

We asked Rychel Johnson, M.S., LCPC, what other causes, risk factors, or triggers are associated with borderline personality disorder.
BPD often arises from a complex interplay of factors rather than one clear cause. A significant number of individuals with BPD report histories of early trauma, which can disrupt emotional development and a healthy sense of self. People with heightened emotional sensitivity from an early age may struggle to develop healthy coping mechanisms. Stressful life events, such as abandonment or instability in relationships, can also trigger or exacerbate BPD symptoms. Understanding these factors can be a compassionate and empowering part of seeking mental wellness and can help build more stable emotional foundations.

Treatment Options for Borderline Personality Disorder Diagnosed

Mental health professionals who help with cases of borderline personality disorder can work in the following areas of psychotherapy [4]:

Cognitive behavioral therapy (CBT)

This evidence-based treatment allows people with borderline personality disorder to learn to identify and transform negative opinions and behavior patterns.

Dialectical behavior therapy (DBT)

It helps develop skills in emotional regulation, interpersonal communication, and overcoming self-destructive behavior.

Mentalization-Based Therapy (MBT)

This approach helps people better understand and interpret their own and others’ thoughts, feelings, and intentions to improve emotional regulation and relationships.

Medication

Medications are not always effective for borderline personality disorder, but may be prescribed to treat co-occurring mental health conditions such as depression or anxiety. Borderline personality disorder treated with prescription medication results in better control of intense emotions. The medication course is developed based on the individual characteristics of the patient and includes the following drug groups:

• Selective serotonin reuptake inhibitors (SSRIs) are aimed at preventing depressive episodes and reducing anxiety/panic/borderline states.
• Mood stabilizers are prescribed to neutralize depressive symptoms, mood lability, and impulsivity.
• Atypical antipsychotics have been proven effective in neutralizing symptoms such as aggression, distortion of reality perception, paranoia, dichotomous thinking, and disorganization.

In general, mental health professionals may help people with borderline personality disorder:

• Learn how to feel your feelings and master emotional regulation techniques for better understanding and managing emotions.
• Increase self-esteem, understand the need for a more positive attitude towards themselves, and begin to identify their strengths and values.
• Improve interpersonal skills, learn how to be emotionally available and build healthy relationships with others, better understand human emotions and express their own needs, and set healthy communication boundaries.
• Understand and overcome traumatic experiences, find the root of problems, and develop healthy solutions.
• Reduce the risk of self-destructive behavior, develop a safety plan to be able to cope with impulsive and self-destructive thoughts and feelings.

Myths, Misconceptions & Stigma

Despite increased awareness in recent years, borderline personality disorder remains one of the most stigmatized mental conditions [1]. Misinformation, cultural stereotypes, and fear-driven narratives contribute to widespread myths that can prevent people from seeking help or being treated with compassion. Here are the most common myths:

1. BPD is untreatable

Borderline personality disorder is a complex mental condition, but it is treatable if you choose the right path to overcome the symptoms and their underlying cause. With consistent mental health treatment and support from family members, people with BPD can learn to live a full and happy life.

2. Any mood changes during the day indicate borderline personality disorder

Emotional lability can occur in many people under a variety of circumstances. For example, hormonal changes during puberty, pregnancy, postpartum, perimenopause, or thyroid imbalances can all affect mood regulation. Another reason may be post-traumatic stress disorder (PTSD) because trauma survivors may experience intense emotional reactivity, often triggered by reminders of past events [7].

Emotional lability also occurs with depression [8]. Because the psyche is exhausted, and in a state of extreme exhaustion, a hyperreaction to stimuli appears. As a result, a person may express an excessively emotional response to some simple everyday life events.

3. People with borderline personality disorder are dangerous to others and hard to communicate with

The thing is that the lack of empathy or cruelty toward others is not a diagnostic criterion for borderline personality disorder. These traits are more commonly associated with other conditions, such as Antisocial Personality Disorder or Narcissistic Personality Disorder in extreme forms, not BPD [9].

Living with Borderline Personality Disorder

It’s important to remember that borderline personality disorder does not define a person. Many people with borderline personality disorder have meaningful and fulfilling lives and see long-term improvement with the right resources, support, and perseverance.

The Breeze app is one of the tools that may come in handy. Our user Alice, who has BPD, shared her experience: “For a long time, it seemed like my emotions were taking over because I have borderline personality disorder. I would feel totally bonded to someone one minute, and then I would be terrified that they would abandon me.  I’d send messages I regretted, say things out of fear or anger, and then feel guilty and ashamed.

My recovery began with therapy, specifically DBT, where I learnt how to stay grounded and reduce self-destructive behaviors.  However, using the Breeze app was what truly transformed my day-to-day life.

I use one of the journaling prompts in Breeze to figure out what triggered me when I’m feeling overwhelmed. I was able to identify patterns in my thoughts and actions, such as the connection between my fear of abandonment and early experiences, thanks to the quizzes. Additionally, the relaxation games help me relax without going into a downward spiral on days when everything seems too much.

While Breeze doesn’t take the place of therapy, it does assist me in putting what I’ve learnt into practice. Although I’m still working things out, I now have tools and emotional support that I can use every day.”

Sources

1. Navarre KM. “You sure she’s not making this up?”: A qualitative investigation of stigma toward adults with borderline personality disorder in physical healthcare settings. February 2025.
2. National Institute of Mental Health. Borderline Personality Disorder.
3. Mark Zimmerman. Borderline Personality Disorder (BPD). September 2023.
4. Jennifer Chapman; Radia T. Jamil; Carl Fleisher; Tyler J. Torrico. Borderline Personality Disorder. April 2024.
5. Ruggero CJ, Zimmerman M, Chelminski I, Young D. Borderline personality disorder and the misdiagnosis of bipolar disorder. April 2010.
6. Paris J. Suicidality in Borderline Personality Disorder. May 2019.
7. National Institute of Mental Health. What is post-traumatic stress disorder, or PTSD?
8. Scoppetta M, Di Gennaro G, Scoppetta C. Selective serotonine reuptake inhibitors prevents emotional lability in healthy subjects. November 2005.
9. di Giacomo E, Andreini E, Lorusso O, Clerici M. The dark side of empathy in narcissistic personality disorder. March 2023.