Overview

Borderline personality disorder is a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. It includes a pattern of unstable intense relationships, distorted self-image, extreme emotions and impulsiveness.

With borderline personality disorder, you have an intense fear of abandonment or instability, and you may have difficulty tolerating being alone. Yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though you want to have loving and lasting relationships.

Borderline personality disorder usually begins by early adulthood. The condition seems to be worse in young adulthood and may gradually get better with age.

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.

Symptoms

Borderline personality disorder affects how you feel about yourself, how you relate to others and how you behave.

Signs and symptoms may include:

  • An intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
  • A pattern of unstable intense relationships, such as idealizing someone one moment and then suddenly believing the person doesn't care enough or is cruel
  • Rapid changes in self-identity and self-image that include shifting goals and values, and seeing yourself as bad or as if you don't exist at all
  • Periods of stress-related paranoia and loss of contact with reality, lasting from a few minutes to a few hours
  • Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship
  • Suicidal threats or behavior or self-injury, often in response to fear of separation or rejection
  • Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety
  • Ongoing feelings of emptiness
  • Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights

When to see a doctor

If you're aware that you have any of the signs or symptoms above, talk to your doctor or a mental health provider.

If you notice signs or symptoms in a family member or friend, talk to that person about seeing a doctor or mental health provider. But you can't force someone to seek help. If the relationship causes you significant stress, you may find it helpful to see a therapist yourself.

Causes

As with other mental disorders, the causes of borderline personality disorder aren't fully understood. In addition to environmental factors — such as a history of child abuse or neglect — borderline personality disorder may be linked to:

  • Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental disorders among family members.
  • Brain abnormalities. Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

Risk factors

Some factors related to personality development can increase the risk of developing borderline personality disorder. These include:

  • Hereditary predisposition. You may be at a higher risk if a close relative — your mother, father, brother or sister — has the same or a similar disorder.
  • Stressful childhood. Many people with the disorder report being sexually or physically abused or neglected during childhood. Some people have lost or were separated from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health issues. Others have been exposed to hostile conflict and unstable family relationships.
  • Personality. Personality traits that include impulsiveness and aggression may play a role in the development of borderline personality disorder.

Complications

Borderline personality disorder can damage many areas of your life. It can negatively affect intimate relationships, jobs, school, social activities and self-image, resulting in:

  • Repeated job changes or losses
  • Not completing an education
  • Multiple legal issues, such as jail time
  • Conflict-filled relationships, marital stress or divorce
  • Self-injury, such as cutting or burning, and frequent hospitalizations
  • Involvement in abusive relationships
  • Unplanned pregnancies, sexually transmitted infections, motor vehicle accidents and physical fights due to impulsive and risky behavior
  • Attempted or completed suicide

In addition, you may have other mental health disorders, such as:

  • Depression
  • Alcohol or other substance misuse
  • Anxiety disorders
  • Eating disorders
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Other personality disorders
July 30, 2015
References
  1. Personality disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed July 1, 2015.
  2. Borderline personality disorder. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml. Accessed July 1, 2015.
  3. Silk KR. Borderline personality disorder: Epidemiology, clinical features, course, assessment, diagnosis, and differential diagnosis. http://www.uptodate.com/home. Accessed July 1, 2015.
  4. Silk KR. Treatment of borderline personality disorder. http://www.uptodate.com/home. Accessed July 1, 2015.
  5. Newlin E, et al. Personality disorders. Continuum: Lifelong Learning in Neurology. 2015;21:806.
  6. Gonzalez CA (expert opinion). Mayo Clinic, Rochester, Minn. July 16, 2015.
  7. Palmer BA (expert opinion). Mayo Clinic, Rochester, Minn. July 12, 2015.

Borderline personality disorder