Borderline personality disorder

Definition

Borderline personality disorder is a condition in which people have long-term patterns of unstable or turbulent emotions, such as feelings about themselves and others.

These inner experiences often cause them to take impulsive actions and have chaotic relationships.

Alternative Names

Personality disorder - borderline

Causes, incidence, and risk factors

The causes of borderline personality disorder (BPD) are unknown. Genetic, family, and social factors are thought to play roles.

Risk factors for BPD include:

• Abandonment in childhood or adolescence
• Disrupted family life
• Poor communication in the family
• Sexual abuse

This personality disorder tends to occur more often in women and among hospitalized psychiatric patients.

Symptoms

People with BPD are often uncertain about their identity. As a result, their interests and values may change rapidly.

People with BPD also tend to see things in terms of extremes, such as either all good or all bad. Their views of other people may change quickly. A person who is looked up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships.

Other symptoms of BPD include:

• Fear of being abandoned
• Feelings of emptiness and boredom
• Frequent displays of inappropriate anger
• Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting
• Intolerance of being alone
• Repeated crises and acts of self-injury, such as wrist cutting or overdosing

Signs and tests

Like other personality disorders, BPD is diagnosed based on a psychological evaluation and the history and severity of the symptoms.

Treatment

Many types of individual talk therapy, such as dialectical behavioral therapy (DBT), can successfully treat BPD. In addition, group therapy can help change self-destructive behaviors.

In some cases, medications can help level mood swings and treat depression or other disorders that may occur with this condition.

Support Groups

Expectations (prognosis)

The outlook depends on how severe the condition is and whether the person is willing to accept help. With long-term talk therapy, the person will often gradually improve.

Complications

• Depression
• Drug abuse
• Problems with work, family, and social relationships
• Suicide attempts and actual suicide

Calling your health care provider

Call your health care provider if you or your child has symptoms of borderline personality disorder. It is especially important to seek help right away if you or your child is having thoughts of suicide.

Prevention

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References

Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 39.