Borderline Personality Disorder: What It Is and How to Cope

Many of us live with intense emotions but for those with Borderline Personality Disorder (BPD), these intense emotions and quick mood changes can be life altering and control their self image, relationships with others, and how they function in society. BPD is exhausting and sometimes exhausting doesn’t describe it well enough. BPD is widely misunderstood. Even though millions of people throughout the world deal with BPD many others struggle to understand it and how it affects those with it and the people around them. The stigma around BPD often comes from an inaccurate understanding of the disorder.

The goal today is to help you understand what BPD really is, recognize its symptoms, explore treatment options, and learn practical coping strategies. It doesn’t matter is you are dealing with BPD personally, whether you want to just know more about BPD, or if you have a loved one dealing with BPD, the goal is to help everyone understand it better.

What is Borderline Personality Disorder (BPD)?

BPD is a mental health condition marked by persistent patterns of instability in relationships, self image, emotions, and behavior. The name comes from psychiatrists believing the disorder sits on the border of neurosis and psychosis. Neurosis is consistent with symptoms of anxiety, distress, or obsessive behaviors while psychosis is consistent with experiencing hallucinations and/or delusions. Now, with more research, science has found that BPD is a distinct personality disorder.

According to the National Institute of Mental Health, BPD affects approximately 1.4% of adults in the United States, with nearly 75% of diagnoses occurring in women. However, recent research suggests the gender gap may be narrowing as diagnostic criteria and awareness improve.

Having BPD can be incredibly frustrating because of the stigma around the disorder. Many healthcare providers are not properly trained in dealing with BPD and often become frustrated with those with BPD. Many people believe people with BPD are manipulative or attention seeking. This belief creates judgement that leads to many people not treating those with BPD with respect. Most often people make assumptions about who the person is instead of getting to know them and their needs. This stigma often increased feelings of shame and isolation in those with BPD. But, we know that BPD is a legitimate mental health condition that is treatable and can have a hopeful prognosis with treatment.

Core Symptoms of BPD

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines nine key criteria for BPD diagnosis. A person must exhibit at least five of these symptoms consistently across different situations to receive a diagnosis.

A word of caution: Please do not self-diagnose. It is incredibly important that you seek the opinion of a professional to determine if you or someone you know has BPD. It is recommended to seek the opinion of a psychiatrist or psychiatric nurse practitioner before determining a diagnosis of BPD.

Fear of Abandonment: An intense fear of real or imagined abandonment drives many BPD behaviors. This often looks like worrying that a friend no longer wants to be your friend because they did not respond to your text immediately. Or, assuming that your loved ones will “leave” you because they do not want to hang out when you want to. Often, this can lead to trying to “end” relationships “first” to avoid the intense feelings the person with BPD is predicting will occur with abandonment.

Unstable Relationships: Relationships tend to be intense but unstable, swinging between extremes of idealization and devaluation. This means the person with BPD will often see those they are in relationship with as “all good” or “all bad”. They could see their partner as “all good” until their partner does something where the person with BPD perceives they have been harmed, then they will see their partner as “all bad”. This creates a great deal of instability for both people in the relationship.

Identity Disturbance: A consistently unstable sense of self. This often looks like the person with BPD changing how they present themselves to match what they perceive the different people they interact with need or want. So with one person the person with BPD will be calm and quiet as they perceive this to be the need but with another person they are bubbly and outgoing. This changes from person to person and situation to situation.

Impulsivity: This manifests in potentially harmful behaviors like excessive spending, risky sexual behavior, substance abuse, reckless driving, or binge eating. This one is straight forward. Impulsivity with BPD does not often look like the impulsivity we see with ADHD, although they can overlap.

Suicidal or Self-Harming Behavior: Unfortunately, suicidal thoughts and self-injury are common in BPD. These behaviors often serve as ways to cope with overwhelming emotional pain. Often people will see these as attention seeking behaviors. It is important that we take suicidal thoughts seriously every time. If you have a loved one with BPD or know someone with BPD it can be incredibly important to learn how to respond to suicidal thoughts and self-harming behaviors. A great resource for this can be your local NAMI (National Alliance on Mental Illness) chapter.

Emotional Instability: Intense episodes of sadness, anxiety, or irritability can last hours or days. Emotional instability is often described as mood swings, and they can occur swiftly and often with BPD. Some people with BPD will enter an interaction bubbly and happy but leave angry. Some will have a great day but have one thing that causes them to feel incredibly angry or sad in the evening. The mood swings are unpredictable and often occur more frequently as compared to mood swings in bipolar disorder.

Chronic Emptiness: Many describe a persistent feeling of emptiness or boredom, as if something fundamental is missing from their lives. This is also fairly straight forward. A chronic feeling of emptiness will often cause the person with BPD to seek to fill this emptiness with things that can ultimately be self-destructive.

Intense Anger: Difficulty controlling anger can lead to inappropriate outbursts, sarcasm, or physical fights, often followed by intense shame and guilt. As we can see, those with BPD deal with very intense emotions, anger is no different. Intense anger can lead to other self-destructive choices when coupled with impulsivity.

Stress-Related Paranoia or Dissociation: During times of severe stress, some people experience paranoid thoughts or dissociative symptoms, feeling disconnected from themselves or their surroundings.

The 4 Types of BPD

While not officially recognized in diagnostic manuals, many clinicians and researchers identify four subtypes of BPD based on predominant symptoms and behaviors:

Discouraged/Quiet BPD

Often called “high-functioning” BPD, this subtype involves turning intense emotions inward rather than expressing them outwardly. Those with quiet BPD often look successful but are struggling internally with shame, depression, and often suicidal thoughts. We often see those with quiet BPD avoid conflict with others and they often struggle to express their needs.

Impulsive BPD

This subtype is characterized by risk-taking behaviors and difficulty with impulse control. Those with impulsive BPD will engage in substance use, risky sexual behaviors, overspending, and other impulsive and self destructive behaviors. It has been found that those with impulsive BPD are more charismatic and energetic but struggle with emotions, mood swings, and relationship instability.

Petulant BPD

Individuals with this subtype often feel misunderstood and may exhibit passive-aggressive behaviors. They can be stubborn, moody, and pessimistic, with a tendency to blame others for their problems. Relationships are often marked by patterns of demanding attention while simultaneously pushing people away. Those with petulant BPD will do things to get your attention but fight with you, ultimately creating a wall between themselves and you.

Self-Destructive BPD

This subtype involves more obvious self-harm behaviors and suicidal ideation. People may engage in cutting, burning, or other forms of self-injury, often as a way to cope with emotional pain or feel something when experiencing numbness.

Understanding Causes and Risk Factors

BPD develops through a complex interaction of biological, environmental, and social factors. Understanding these causes can help reduce self-blame and guide treatment approaches.

Biological Factors

Research has shown that there may be changes in brain structure and functioning of the different areas of the brain in people with BPD. It has been found there are often changes in the areas of the brain that are responsible for emotional regulation, impulse control, and decision making. Science has also shown that there are some genetic factors involved in BPD. Neurotransmitter imbalances, particularly involving serotonin and dopamine, may also contribute to the emotional instability characteristic of BPD.

Environmental Factors

Childhood trauma is present in approximately 70-80% of people diagnosed with BPD. This includes:

• Physical, sexual, or emotional abuse
• Severe neglect or abandonment
• Witnessing domestic violence
• Inconsistent or invalidating parenting
• Early separation from caregivers

It is important to know and remember that trauma doesn’t always involve obvious abuse. Chronic invalidation, having emotions dismissed or criticized, can be as equally damaging as abuse, especially when it occurs during critical developmental periods.

Social Factors

Social isolation, discrimination, poverty, and lack of social support can increase risk. Additionally, certain cultural attitudes toward emotional expression may affect how symptoms manifest and whether treatment is sought.

Treatment Options for BPD

The good news is that BPD is highly treatable. Multiple evidence-based treatments have shown significant effectiveness in reducing symptoms and improving quality of life.

Dialectical Behavior Therapy (DBT)

DBT was developed specifically for BPD by Dr. Marsha Linehan. DBT is considered the gold standard treatment for BPD. This therapy combines cognitive-behavioral techniques with mindfulness and distress tolerance skills. DBT often includes individual therapy, group skills training, phone coaching, and therapist consultation, when used to fidelity.

The four core modules of DBT are:

• Mindfulness: Learning to stay present and observe thoughts and feelings without judgment.
• Distress Tolerance: Developing skills to tolerate crisis situations without making them worse.
• Emotional Regulation: Understanding and managing intense emotions.
• Interpersonal Effectiveness: Communicating needs and maintaining relationships.

Medication Options

While no medications are specifically FDA-approved for BPD, various medications can help manage specific symptoms:

• Antidepressants for mood symptoms, such as intense depressive symptoms.
• Mood stabilizers for emotional instability and, mood swings.
• Antipsychotics for severe symptoms or dissociation.
• Anti-anxiety medications for short-term crisis management and anxiety symptoms.

Medication decisions should always be made collaboratively with a qualified psychiatrist or psychiatric nurse practitioner who understands BPD.

Support Groups and Peer Support

Feeling connected with others who understand the ups and downs of BPD can be incredibly helpful. While there are groups in DBT they are more formal and discourage connection outside of treatment. Support groups can provide more informal support to the person’s life. Support groups are often available both in-person and online.

Lifestyle Interventions

Taking care of yourself can be one of the most profound treatment options for those with BPD. Getting regular exercise, enough sleep, eating healthy, and reducing your stress as possible can be life changing in itself. While this can be life changing, it is important to recognize the need for professional treatment for BPD.

Living with BPD: The Path Forward

Recovery vs. “Curing” BPD

BPD is a chronic condition, but this doesn’t mean hopelessness. Recovery looks different for everyone. Recovery will be different based on the symptoms you experience, the treatment you receive, and your willingness to address your symptoms. It is important to know that we are not looking to eliminate symptoms entirely with treatment but rather to manage the symptoms so that life is more tolerable and enjoyable. Many people with BPD go on to lead fulfilling lives with meaningful relationships and successful careers. While research shows symptoms often improve overtime, even without treatment, it is known that treatment significantly speed up the improvement.

Building a Support System

Recovery happens in relationships. Building a support system might include:

• Mental health professionals who understand BPD.
• Family and friends educated about the condition.
• Support groups or peer connections.
• Crisis resources for difficult moments.

Self-Care and Coping Strategies

Effective self-care for BPD goes beyond bubble baths and face masks. It includes:

• Maintaining consistent routines, for stability.
• Practicing emotional regulation skills daily, for managing mood swings.
• Setting and maintaining boundaries, to have healthy relationships.
• Engaging in meaningful activities, to build self-esteem.
• Regular self-reflection and monitoring, to see progress.

Crisis planning is also essential. Having a written plan for managing intense emotions or suicidal thoughts can provide direction during overwhelming moments.

Supporting Someone with BPD

If someone you care about has BPD, your support can make a tremendous difference in their recovery journey. The following steps can be incredibly helpful in understanding BPD and how to support your loved one or friend.

Educate yourself about BPD to understand what your loved one is experiencing. Understanding BPD can help you be more compassionate when intense emotions and behaviors are at the forefront of your relationship. A great resource for education is NEABPD.

Validate their emotions while maintaining boundaries. Validation is the best way to combat the feelings of shame and guilt that so often affect those with BPD. Validating does not mean you are condoning behaviors or choices. It is okay to validate their experience while also feeling like their response was hurtful.

Encourage professional treatment but don’t try to be their therapist. Your role is to provide support, not treatment. Help them find a DBT therapist in their area or online. Encourage them to see a psychiatrist or psychiatric nurse practitioner for diagnosis and treatment options.

Take care of yourself too. Supporting someone with BPD can be emotionally demanding. If you are not caring for yourself, you cannot care for them as well. Consider finding a therapist you can talk to in order to help care for yourself. Caring for someone with BPD can be incredibly difficult.

Be patient with the recovery process. Healing from BPD takes time, and there will likely be setbacks along the way. Healing is not linear.

Hope for Healing

Borderline Personality Disorder is a complex but treatable condition. The journey with BPD is incredibly difficult but there is hope. Treatment has shown great promise in managing BPD symptoms. So many people with BPD live meaningful and fulfilling lives every day.

If you recognize yourself in these descriptions, remember that seeking help is a sign of strength, not weakness. BPD symptoms often improve significantly with appropriate treatment, and early intervention typically leads to better outcomes. Please reach out to a psychiatrist or psychiatric nurse practitioner to ask about diagnosis. As with all symptoms and diagnoses, it is important to seek professional advice as many diagnoses can be mistaken for the wrong diagnosis.

Recovery is possible. You can build the skills needed to live a better life. Reach out for help today. Life with manageable emotions and relationships is achievable.

FAQs

Why is BPD called Borderline?

Borderline personality disorder was originally named Borderline because it was thought that the disorder sat on the “border” of neurosis and psychosis. This may be the origin of the name but it is now known that BPD is it’s own disorder.

Who diagnoses BPD?

BPD can be diagnosed by licensed mental health professionals such as:

• Psychiatrists
• Psychiatric Nurse Practitioners
• Psychologists
• Clinical Social Workers
• Licensed therapists