Borderline personality disorder (BPD), sometimes referred to as emotionally unstable personality disorder, is a mental health condition that impacts the way you think and feel about yourself and others, which can cause problems with how you function in your everyday life. It can include difficulty managing behavior and emotions, a pattern of unstable and intense relationships, and issues with self-image.
“The cause of BPD is still being researched, but many signs point to genetics and environmental influences,” said Giitou Neor, a therapist and MyWellbeing community member. “Some signs of BPD include a fear of abandonment, a pattern of unstable and intense interpersonal relationships, emotional instability, intense anger, and recurrent suicidal behavior.”
“Borderline personality disorder is a widely misunderstood and stigmatized diagnosis,” said Eliza Hecht, a therapist and MyWellbeing community member. “Many people write off people diagnosed with BPD off as manipulative or difficult. I prefer to look at the symptoms associated with BPD as a pattern of thinking and behavior rather than a diagnosis.”
“People who express symptoms of BPD feel their emotions more intensely than other people, for reasons both biological and environmental,” she said. “Because of this, it can be harder to regulate emotions and resist the behavioral urges these emotions spark. This can lead to a lot of really maladaptive behavior—lack of impulse control, volatile relationships, very intense emotional reactions, self-harm, even suicidality. All of this behavior, however, comes from feelings of intense pain and a lack of skills to tolerate it, not malice or lack of empathy.”
If you have borderline personality disorder, don't get discouraged. Many people with this disorder get better over time with treatment and can learn to live satisfying lives. But how do you know if you have borderline personality disorder?
“I think of BPD as being a disorder that is characterized by someone's ability to maintain relationships and their emotional reactivity,” said Dahlia Mayerson, a therapist and MyWellbeing community member. “Unlike bipolar disorder, which is really about someone's individual, internal state regardless of external circumstances, someone with BPD is easily triggered by others.” She also said people with BPD typically:
“Signs and symptoms of BPD include severe difficulty regulating one's emotions, often leading to anger outbursts, unstable relationship patterns, suicidality, episodes of self-harm, chronic feelings of emptiness, unstable sense of self, and mood swings,” said Elle Michel, a therapist and MyWellbeing community member. “People with BPD often have a chronic fear of abandonment and may go to extremes to avoid real or perceived abandonment.”
“Broadly speaking, borderline personality disorder is characterized by a pattern of emotional reactivity that is slow to return to baseline,” said S. Jenny Klein, a therapist and MyWellbeing community member. “Specific signs and symptoms can include a heightened fear of abandonment and frantic attempts to prevent this from happening, difficulty managing emotions especially anger, impulsivity, alternating feelings of devaluation and idealization of others, and self-harm behaviors stemming from significant distress that an individual with BPD experiences. Thus interpersonal relationships are often tumultuous and unstable.”
“BPD is often caused by childhood trauma or an invalidating social environment,” said Elle. “In some senses, BPD is like a specialized form of post-traumatic stress disorder (PTSD). A person's natural sensitivity to their environment can contribute to the development of BPD.”
Research suggests that genetic, environmental, and social factors play a role. People who have a close family member with BPD may be at a higher risk of developing BPD or its traits. Many people with BPD have experienced traumatic life events during childhood, such as abuse or abandonment or been exposed to unstable relationships or severe conflict. Studies have also shown that some people with BPD have structural and functional changes in their brain especially in the areas the correspond with emotional regulation and impulse control, but it’s unclear as to whether these were existing conditions that put the person at risk for developing BPD or were caused by BPD itself.
While factors like these can increase a person’s risk of developing BPD, the presence of risk doesn’t ensure that any one person will have BPD. There are people who have these risks who will never develop BPD and there are also people who might still develop BDP without these risk factors.
“As a clinician I try not to pathologize what are often natural survival reactions to environmental and relational traumas,” said Zhanna Gerlovina, a therapist and MyWellbeing community member. “Borderline personality disorder falls into this category for me. When I hear BPD, I think of a person with a difficult attachment history who, as a result, can have difficulty with emotional regulation and trust in relationships.”
“For example, someone who experienced absent, neglectful or abusive caretakers in childhood may have a hard time feeling secure in their adult relationships,” she said. “This is a natural response—why would they feel safe in a relationship with others if they could not feel safe with their primary caretakers? This person may experience impulsivity, self-harm, and/or isolation as they try to navigate relationships because they do not have an internal reference for what safe relationships look like. People with difficult attachment histories can benefit from long-term psychodynamic psychotherapy—a therapeutic relationship that prioritizes building rapport, trust, and safety as a means of healing.”
“While reading about BPD can help you learn about it and help you start to identify if you relate to common BPD symptoms, it's best to be diagnosed by a mental health professional who is trained in diagnosing and working with BPD,” said Elle.
A licensed mental health professional will conduct a detailed interview and medical exam, a discussion of your symptoms, and an understanding of your medical and family history, if known.
“One of the most interesting things about borderline personality disorder is that many people can see themselves or their loved ones meeting the criteria,” said Joey Ackerman, a therapist and MyWellbeing community member. “From chronic feelings of emptiness, anger, and emotional instability, many people can easily relate because they have experienced these feelings or exhibited these behaviors before.”
“For those who are reading up on the disorder, it’s super important to be able to differentiate that a real clinical diagnosis is when these things interfere greatly with one's overall level of functioning, and that many of the symptoms are happening consistently over time and creating a great level of distress for an individual,” she said.
When it comes to mental health, there isn’t a concrete right or wrong or black and white answer—therapists apply their own personalization and integrate that into their own work. When it comes down to it, your therapist will use the best treatment for you.
“Holistic coaching often speaks to finding yourself and authentic expression,” said Joanne Davies, a hypnotherapist and MyWellbeing community member. “As anyone with BPD knows, this can feel so out of reach. But it doesn't have to be inaccessible for people with BPD/EUPD: it just requires a less mainstream approach.”
“One of the ways I support my clients is to practice compassion (loving kindness) techniques together, towards no one in particular,” she said. “It doesn't have to be self love and it doesn't have to be love towards others at all, when that is too hard. In my experience the highly sensitive core of many people with BPD/ EUPD symptoms can become a strength with the right nurturing.”
“To treat borderline personality disorder we use strategies to help clients let go of dysfunctional behaviors and learn new ways to cope with stress,” said Eliza. “One of the most common treatments for borderline personality disorder is dialectical behavior therapy. The goal of DBT is that clients develop the ability to live their lives to the fullest, letting go of old dysfunctional behaviors and embracing new, healthy ways of coping with stress.”
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.
“In DBT, we believe that all behavior that is unhelpful comes from a skills deficit, not a character deficiency or lack of motivation to change,” said Eliza. “The idea is to provide clients with practical tools and skills they can access in difficult situations. I’ve had clients describe DBT skills as feeling like a set of flash cards in their back pocket that they can pull out when they need them.”
While cognitive behavioral therapy focuses on restructuring thoughts in order to change self-destructive behaviors and relies on cognitive capabilities, logic and reason, to direct responses and change emotions, dialectical behavior therapy is more about finding balance through navigating dialectics, getting unstuck from extremes, and validating our emotions while also addressing behaviors and changing them.
“DBT involves individual and group therapy where clients are taught specific coping skills to help them cope with and reduce their distress safely,” said Elle. She outlined the four sets of skills that DBT focuses on helping clients build:
“Successful treatment of BPD symptoms can involve individual talk therapy once or twice a week, skills training in a group setting, and medications to help the issues related to co-occurring disorders,” said Linnea Michaels, a therapist and MyWellbeing community member. “It is through dialectical behavior therapy that a clinician and client can focus on emotional regulation, mindfulness, interpersonal effectiveness, and distress tolerance. These dialectical strategies can help us feel unstuck as we confront black-and-white thinking and automatic negative thoughts.”
“I have seen DBT completely change people’s lives,” said Eliza. “I’ve seen clients who were so miserable that they were self-harming, blowing up relationships, who felt like their lives and emotions were completely out of control, learn DBT skills, practice them, and go on to live lives that felt meaningful and fulfilling and stable. I believe everyone can benefit from DBT—I personally use DBT skills every day.”
Whatever your diagnosis is, you are not alone. While learning to manage your thoughts, behaviors, and emotions can take time, many people improve with treatment, although some symptoms of borderline personality disorder might always be a struggle. Getting the treatment you deserve will help you regulate how you feel about yourself and how you function with others.
“Sometimes a diagnosis of borderline personality disorder can feel hopeless,” said Eliza. “When approached properly—without judgment and with tools—people experiencing difficulty regulating their emotions, impulse control issues, and intense, unstable relationships can learn to manage them and build lives worth living. It takes work, but it works.”
Caitlin is an organizational change strategist, advisor, writer, and the founder of Commcoterie, a change management communication consultancy. She helps leaders and the consultants who work with them communicate change for long-lasting impact. Caitlin is a frequent speaker, workshop facilitator, panelist, and podcast guest on topics such as organizational change, internal communication strategy, DEIBA, leadership and learning, management and coaching, women in the workplace, mental health and wellness at work, and company culture. Find out more, including how to work with her, at www.commcoterie.com.