Borderline Personality Disorder (BPD)

What is borderline personality disorder?

People with borderline personality disorder (BPD) have stormy and unpredictable ways of relating to other people. This behavior covers up poor self-esteem and feelings of anger and of not deserving anything good. These ways of thinking, feeling, and behaving cause many problems at work, in school, and socially.

How does it occur?

Experts believe that BPD may be caused by differences in the brain or nervous system. It might also be related to problems in the family such as abuse, financial stresses, death of loved ones, or mental illness. It usually begins in adolescence or early adulthood. It is estimated that from 1% to 14% of people are affected. It affects more women than men.

How is it diagnosed?

There are no blood tests, physical exams, or imaging studies that can diagnose BPD. Your healthcare provider or mental health therapist will ask about symptoms such as:

• unstable personal relationships that switch back and forth between hate and love
• frantic efforts to avoid being abandoned
• an unstable sense of self
• acting without thinking, doing things on impulse that could be harmful to yourself like reckless driving, drug or alcohol abuse, and careless sexual behavior
• suicidal behavior
• intense ups and downs in mood
• feeling empty much of the time
• trouble controlling anger
• distrust of others, paranoia, and feeling separate from yourself.

What are the symptoms?

People who have this disorder may see the world in terms of extremes: good/bad; love/hate; "your fault"/"my fault." There is no middle ground. Other symptoms include:

• feeling hopeless, powerless, anxious, and depressed
• not being able to have pleasure without feeling guilty about it
• having some sexual problems. They may be unsure about which sex they are attracted to, or in some cases, even be confused about their own gender. They may have no sexual feelings at all, or may need to fill an inner sense of emptiness by having a lot of sex.
• having a hard time understanding what others are feeling. They may often feel frightened that others don't like or respect them. They have a lot of trouble trusting others.
• feeling as if they are different, damaged, or flawed in some way
• struggling with very strong anger or rage at others
• having a hard time taking care of themselves in basic ways such as eating, bathing, and sleeping regularly when under a lot of stress
• fearing that their only hope of getting needs met is to manipulate others
• losing touch with reality. They may hear voices at times or feel paranoid. These symptoms usually aren't permanent but come and go depending on stress levels.

How is it treated?

This is a difficult disorder to treat, but the following can help reduce symptoms such as impulsive behavior and unstable relationships:

• medicines, especially for symptoms of anxiety, panic, depression, or mood swings
• short-term, structured time in the hospital if you are hurting yourself, such as self-cutting, self-burning, or attempting suicide
• day treatment programs, including structured activities and group therapy every day
• therapy that helps you feel cared about and understood
• learning different ways to deal with stress
• treatment for any alcohol or drug abuse problems.

Dialectic behavior therapy is now being used to treat BPD. This type of therapy helps you learn to regulate your emotions, tolerate distress, manage yourself, and be more effective with other people.

How long do the effects last?

People with this disorder may need lifelong treatment with medicine, therapy, or both.

For more information, contact the Depression and Bipolar Support Alliance (DBSA), the National Alliance for the Mentally Ill (NAMI), or Mental Health America (formerly the National Mental Health Association or NMHA).

• DBSA's toll-free telephone number is 1-800-826-3632. Its Web site address is http://www.dbsalliance.org.
• NAMI's toll-free number is 1-800-950-NAMI. The Web site address is http://www.nami.org.
• NMHA's toll-free Information Center number is 1-800-969-NMHA. The Web site address is http://www.NMHA.org.