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Signed in but can't access contentOxford Academic is home to a wide variety of products. The institutional subscription may not cover the content that you are trying to access. If you believe you should have access to that content, please contact your librarian. Institutional account managementFor librarians and administrators, your personal account also provides access to institutional account management. Here you will find options to view and activate subscriptions, manage institutional settings and access options, access usage statistics, and more. Borderline personality disorder (BPD) is a complex condition. It affects how a person feels about themselves and others. BPD is characterized by intense, unstable emotions and relationships as well as insecurity and self-doubt. BPD makes everything about a person feel unstable, ranging from moods, thinking, behavior,
relationships, and sometimes identity. People with this condition have described BPD as the feeling of having an exposed nerve ending, essentially leaving someone to be easily triggered by small things. But there are effective treatments for it. Understanding the Rollercoaster of BPDPeople with borderline personality disorder often feel a huge amount of emotional instability. It impacts a person’s self-image, likes and dislikes, and goals. This often makes them confused about their sense of self. The condition makes it difficult for a person to be comfortable in their skin. Many people with BPD act impulsively, have intense emotions, and experience dissociation and paranoia when most distressed. This emotional volatility can cause relationship turmoil. Also, the inability to self-soothe can lead to impulsive, reckless behavior. 1.4% of American adults experience BPD People with BPD are often on edge. They have high distress and anger levels, so they may be easily offended. They struggle with beliefs and thoughts about themselves and others, which can cause distress in many areas of their lives. People living with BPD often have an intense fear of instability and abandonment. As a result, they have problems being alone. The condition is also known for anger, mood swings, and impulsiveness. These qualities can dissuade people from being around someone with BPD. On top of this, many people with the condition struggle with self-awareness and how others perceive them. This makes them extremely sensitive. BPD is a mind and body condition. Its symptoms begin to manifest during the early teenage years and gradually improve during adult life. Watch NowDr. Lois Choi-Kain helps us understand borderline personality disorderBPD may be caused by genetics, brain abnormalities, and/or environmental factors. Due to the wide variety of suspected risk factors, it’s hard to determine who will develop it. Environmental FactorsEarly childhood adversity, such as child abuse or neglect, may be a cause. GeneticsResearch suggests that it may be an inherited genetic condition or linked with other mental disorders among other family members. Brain AbnormalitiesCertain brain differences are thought to be contributing causes of the disorder. When certain brain chemicals responsible for mood regulation don’t function properly, there are changes in some areas of the brain. This has been linked to aggression, difficulty regulating destructive urges, and depression. BPD Doesn’t Often Occur AloneEffective treatment involves addressing related disorders. Many people diagnosed with borderline personality disorder experience other conditions, including:
There Are Many MisconceptionsThis disorder is misunderstood by many, including some mental health practitioners. This confusion can impact and influence the way that people are treated. Even worse, long-standing myths can discourage people from seeking help for the condition, especially if they feel their experience is being misunderstood. Some common myths and misconceptions are: Myth: It’s Not TreatableBorderline personality disorder is very treatable. In the past, since BPD affects someone’s personality, many were quick to conclude that it was untreatable because someone’s personality cannot be changed. More recently, many therapies have been proven effective as treatments, including dialectical behavior therapy (DBT), mentalization-based treatment (MBT), and transference-focused psychotherapy (TFP). Now, a growing number of less intensive, generalist approaches, like general psychiatric management (GPM), are also being practiced around the world. A BPD diagnosis doesn’t mean that someone will live with symptoms forever. With treatment, the symptoms ebb and flow. Many people with the condition can have high-functioning lives. Myth: People With BPD Are Victims of Child AbuseThis is not always the case. While some cases of borderline personality disorder stem from childhood trauma, a diagnosis is more likely to be the result of a combination of environmental factors. These can include attachment, childhood trauma, biological factors, and social factors. Myth: It Affects Only WomenIt’s estimated that over 14 million Americans have BPD. Once more commonly diagnosed in women, the largest study done on psychiatric disorders shows that it occurs equally often in women and men. One explanation behind it appearing to affect more women is that women are more likely to seek mental health care than men. Since research on BPD is often conducted in a psychiatric setting, it was previously less likely for men with borderline personality disorder to be included in these research efforts. Another explanation is that BPD is often misdiagnosed in men. Many men with the condition are often diagnosed with depression or PTSD. Meg’s Journey With BPDMeg is a participant in McLean’s Deconstructing Stigma campaign, and she struggles with BPD. Read more about Meg’s mental health story and her message of hope for those who are also struggling. Recognizing Borderline Personality Disorder in Yourself—or OthersPeople with borderline personality disorder struggle with self-regulation. Self-regulation is the ability to manage emotions, thoughts, and behaviors in ways that have positive outcomes, like self-esteem and good relationships. To be officially diagnosed, a person has to exhibit five or more related symptoms. These symptoms have to be ongoing and impact various aspects of life. There are a handful of medically recognized symptoms of borderline personality disorder. Instability in RelationshipsIntense and short-lived relationships are common for people with BPD. It’s very common for someone with this disorder to have intense, unstable relationships filled with drastic and quick-changing feelings. A person with BPD may fall in love quickly and assume that the other person will make them happy. Typically, this results in the person feeling hurt and disappointed and can further intensify emotional swings. People with this condition may have either perfect or horrible relationships, with rapid changes in perception resulting from anger, hate, and devaluation. Extreme Emotional SwingsSomeone with this condition often experiences unstable moods and emotions. The little things that don’t mean much to others—like someone not holding the door open for you or meeting a new friend—can be either very exciting or frustrating. Many with this condition can be happy one moment and extremely sad or disappointed the next. Their moods are also very intense and unpredictable in timing. They can last anywhere from a few minutes to a few hours or longer. Explosive Feelings of AngerMany people with BPD struggle with intense anger and a short temper. This makes it difficult for them to feel in control of their emotions once they have been provoked. They can quickly fill with rage, though this anger may not always be outwardly directed and can result in self-harm. Sometimes the person might be angry at themselves and not at anyone or anything else. Self-HarmSelf-harm is risky behavior that may make the person feel good at the moment of distress. Many people with BPD often engage in self-harming activities, think about suicide, and make suicidal gestures and threats. Many people with borderline personality disorder engage in sensation-seeking behavior that could be harmful, especially when they are angry. Risky or deliberate self-harm activities may include:
Not all self-harm is intended to end in death. It’s important to remember that it’s often used as a way to feel better in a grim moment. However, if it goes untreated, these risky behaviors can end in suicide. McLean’s Michael Hollander, PhD, an expert in self-harm in adolescents, helps us understand more about teen cutting and self-injury. Lingering Feelings of Emptiness or WorthlessnessA lot of people with the condition struggle with emptiness or worthlessness. Many with BPD report feeling like there is a void inside of them or like they don’t matter. As a result, they often turn to sex, drugs, or food to try to feel satisfied. Feeling Out of Touch With RealityMany diagnosed with BPD feel suspicious about events in their lives. They struggle with feelings of suspicion and paranoia about the intentions of people around them. When they are stressed, they may lose touch with reality and become disassociated. Disassociation feels like being spaced out, foggy, or as if you exist outside of your own body. BPD can be confused with other forms of mental illness, so a diagnosis is important. If you or someone close to you often has feelings of emptiness, loneliness, or insecurity that cause irrationality or impulsivity, it’s important to talk to your health care provider. Understanding BPD in TeensThe difference between typical teen behaviors and emerging personality disorders can be hard to recognize. How can you tell which is which? When Is It Time To See a Professional?If you are experiencing any of the previously mentioned signs and symptoms associated with borderline personality disorder, please consult a mental health professional. This condition is common and treatable. You should see a doctor any time your symptoms are triggered. If you are unsure of your triggers, try to think of a time in the past when you experienced raging and intense emotions, acted impulsively, or had a desire to harm yourself. The events before this emotion are likely your triggers. Many who have BPD experience suicidal thoughts. These can include but aren’t limited to mental images and fantasies about self-harm and plotting suicide. If you are experiencing suicidal thoughts and may harm yourself or someone else, call 911 immediately or visit your nearest emergency room. Understanding and Recognizing SymptomsPeople with BPD are sensitive to stress, so stressful situations activate symptoms related to the condition. The stressors that promote BPD’s most volatile symptoms can be external or internal, and they often vary from one person to another. There are both interpersonal and mental triggers of borderline personality disorder, many of which are unique to the individual. Managing these symptoms, either for yourself or your partner, starts by understanding emotions, thoughts, and memories that set off symptoms. Then you can better manage addressing the symptoms if a stressor is unavoidable. You should work with a mental health professional to learn physical and mental exercises to understand triggers and develop skills to successfully manage them. Interpersonal Relationship EventsSeparations, disagreements, and rejections—real or perceived—are the most common triggers for symptoms. A person with BPD is highly sensitive to abandonment and being alone, which brings about intense feelings of anger, fear, suicidal thoughts and self-harm, and very impulsive decisions. When something happens in a relationship that makes them feel abandoned, criticized, or rejected, their symptoms are expressed. People with borderline personality disorder experience rejection sensitivity, which makes relationships very intense and dependent. Events that can worsen this can be losing a job, ending a relationship, or experiencing rejection of any type. Identifying EpisodesTo better manage triggers, it is crucial to understand episodes. These episodes are highly dependent on the situation at hand and the specific individual, but there are common red flags for recognizing an episode. Things that can indicate an episode is occurring:
These episodes can also involve extreme feelings of positivity and euphoria. People with this condition can be very impulsive. It’s important to note these emotional highs as signs of an episode because they may be involved in risky behavior as well. Treating Borderline Personality DisorderTreatment involves breaking down the dysfunctional patterns of the brain’s thinking, feeling, and behavior that cause distress to maintain a better emotional balance. Sometimes health care providers may suggest medication as part of a care plan. The treatment options often used are general psychiatric management (GPM), dialectical behavior therapy (DBT), mentalization-based treatment (MBT), and transference-focused psychotherapy (TFP). General Psychiatric ManagementSometimes referred to as good psychiatric management, GPM is designed to provide “good enough” treatment to most patients. This treatment is not inferior to others. Studies have shown that GPM can be as effective as DBT in treating patients. GPM combines the essential ingredients of other treatments to provide care to the patient, even when specialized or more resource-intensive treatments are not available. Dialectical Behavior TherapyDBT is known as the gold standard BPD treatment. It emphasizes the development of four skill sets: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. DBT teaches patients to control their intense emotions and minimize their destructive patterns. Through DBT, patients can also learn how to build interpersonal skills and develop self-awareness. DBT has been clinically tested, proven to be effective in borderline personality disorder and depression treatment in adolescents and adults, and is used extensively at McLean Hospital. Watch Now!Mentalization-Based TreatmentMBT aims to help patients by improving interpersonal and relationship skills while reducing self-destructive behaviors. Mentalizing focuses on the ability to differentiate and concentrate on your emotional state of mind and separate your own thoughts and feelings from those around you. Since individuals with BPD can find it difficult to recognize the impacts of their behaviors, MBT encourages focusing and reflecting on mental states to better understand how mental state affects behavior in ourselves and others. Transference-Focused PsychotherapyTFP focuses on the patient’s sense of identity and aims to create more stable and realistic experiences of both self and others. With BPD, one’s sense of identity may feel contradicted. TFP focuses on addressing identity-based problems with interpersonal relationships, self-esteem, and mood. By helping patients learn to verbalize what they are feeling—versus acting impulsively on emotions—TFP helps with increased functioning and satisfaction in interpersonal relationships. In addition to these therapies, group and individual therapy may be useful as well. Group and individual therapies cover a broad range of topics and are not necessarily sessions dedicated to BPD. Group and individual therapy can be beneficial for addressing mindfulness, interpersonal relationships, stress management, emotion regulation, and family relationships. How Is Borderline Personality Disorder Diagnosed?Borderline personality disorder is a complex condition that doesn’t present itself the same way in every person. Some mental and psychological disorders have similar symptoms, so it’s vital to see a licensed mental health professional for an assessment and the right diagnosis. To diagnose, your provider may go through the following:
Most diagnoses are in patients 18 and older. BPD can, however, be diagnosed in younger patients. If you are experiencing the mentioned signs and symptoms associated with borderline personality disorder, please consult a mental health professional. People with this condition often experience suicidal thoughts, such as mental images and fantasies about self-harm and plotting suicide. You should contact a suicide hotline number, a close loved one, or a mental health provider to get help. Suicide prevention resources can be found below. Good News: There’s Hope for Folks With BPD!Because borderline personality disorder is as unique as each person who lives with it, treatment requires a specialized approach. Many people have BPD and, at times, experience emotional anguish from the condition. However, you don’t have to resort to living a life that’s full of pain and heartbreak. It’s important to take care of yourself, recognize your triggers, and work with your health care team to determine what treatments will help keep it in check. By committing to care and learning as much as possible about it, you can make a difference in your quality of life—and the lives of those around you. McLean Is Here to HelpWant More Info?Looking for even more information about borderline personality disorder? You may find these resources helpful. Interesting Articles, Videos, and MoreLearn more about borderline personality disorder and what you can do if you or a loved one is displaying signs of BPD.
Helpful LinksThese organizations may also have useful information: Behavioral Tech: Training for Mental Health
Professionals Borderline Personality Disorder Resource Center National Education Alliance for Borderline Personality Disorder New England Personality Disorder Association Personality Disorder Awareness Network (PDAN) Treatment and
Research Advances Association for Borderline Personality Disorder Suicide Prevention ResourcesAlthough it is not possible to predict suicide with any certainty, our best tool is recognition of the signs that many people exhibit when contemplating suicide. The following three behaviors should prompt you to seek immediate help for yourself or a loved one:
If You or Someone You Know Needs Help
If you are suicidal or are a danger to yourself to others, please call 9-1-1 or visit your nearest emergency room immediately. These organizations also offer suicide prevention resources: Suicide Prevention Lifeline American Foundation for Suicide
Prevention Samaritans: Massachusetts 24-Hour Crisis HelpLine Stop A Suicide Today! Suicide Prevention Resource Center Books About BPDHandbook of Good Psychiatric Management for Adolescents With Borderline Personality Disorder Good Psychiatric Management and Dialectical Behavior Therapy: A Clinician’s Guide to
Integration and Stepped Care Applications of Good Psychiatric Management for Borderline Personality Disorder: A Practical Guide Borderline Personality Disorder: A Case-Based Approach Beyond Borderline: True Stories of Recovery From Borderline Personality Disorder Borderline Personality and Mood Disorders: Comorbidity and Controversy Handbook of Good Psychiatric Management (GPM) for Borderline Patients Mindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy Borderline Personality Disorder in Adolescents: a Complete Guide
to Understanding and Coping When Your Adolescent Has BPD Understanding and Treating Borderline Personality Disorder: A Guide for Professionals and Families Identifying and Understanding the
Narcissistic Personality Borderline Personality Disorder What is the most effective treatment for borderline personality disorder?Psychotherapy. Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline personality disorder.
Which type of treatment is a strong research supported psychological treatment for borderline personality disorder?DBT is the most studied treatment for BPD and the one shown to be most effective. Mentalization-based therapy (MBT) is a talk therapy that helps people identify and understand what others might be thinking and feeling.
What is the gold standard treatment for borderline personality disorder?Dialectical behavior therapy (DBT) is often called the “gold standard” of borderline personality disorder treatment. It teaches you self-awareness, emotional regulation, and healthy relationship skills. It aims to help you develop the skills to cope with difficult emotions.
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