Signs and Symptoms of Borderline Personality Disorder

By The Fix staff 12/13/14
Borderline Personality Disorder

Borderline Personality Disorder (BPD) shows itself in unstable interpersonal relationships and an ongoing pattern of problems with self-image, impulsivity, and intense fears of being abandoned. The Mayo Clinic presents a simple definition of BPD on its website.

People with BPD are women more often than men. The most common outward signs are intense and dramatic behaviors. These may include:

  • love-hate expressions in relationships
  • risky behaviors such as reckless driving or unsafe sex
  • spending sprees
  • self-harming such as cutting
  • suicidal gestures

When a person is dealing with BPD, often first noticed in late adolescence or early adulthood, the only thing that's consistent is that thoughts and behaviors are inconsistent. This inconsistency continues throughout an individual's adult life if not properly diagnosed and treated. As said by the National Institute of Mental Health (NIMH), some symptoms of borderline personality disorder may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent.

Two features of BPD make it very dangerous: the self-harm (which includes cutting, risky behaviors, and suicidal gestures that can go too far) and its changeable nature. BPD can look like a number of other conditions and can go undiagnosed, and therefore untreated, for years. According to the NIMH, about 1.6% of adults in the United States have BPD in any given year, which translates to over five million individuals.

Diagnostic Criteria:

Every individual has behaviors that others may consider odd, weird, or unhealthy. It is only when those behaviors interfere with a person functioning in their chosen society that those behaviors are considered an illness. For BPD to be diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR), at least five of the following signs and symptoms must be present with enough intensity to cause concern and distress:

1. Intense fear of abandonment

2. Pattern of unstable relationships - This instability can apply to family, friends, colleagues, and primary relationships

3. Unstable self-image or sense of identity

4. Impulsive and self-destructive behaviors – examples of which may include using illegal drugs, unsafe sex, recklessness in driving a motor vehicle, or spending sprees (especially when they don't have the money)

5. Suicidal behavior or self-injury – Cutting themselves or other self-harm or suicidal tendencies

6. Wide mood swings – People with BPD can act like you are their best friend one minute and their worst enemy the next.

7. Chronic feelings of emptiness – the person expresses there is nothing, or a vacuum instead of a personality, at their core

8. Anger-related problems – frequently losing their temper or having physical fights

9. Periods of paranoia and loss of contact with reality

Personality disorder vs mental illness:

There is a difference between what is considered a mental illness and a personality disorder.

Mental illness– definitive, dramatic onset. According to the Collins English Dictionary, it is "any of various disorders in which a person's thoughts, emotions, or behaviour are so abnormal as to cause suffering to himself, herself, or other people." A mental illness often has a buildup over a period of time, then reaches "critical mass" and expresses itself through dramatically different behavior from what is usual for that person.


Personality Disorder– According to Stedman's Medical Dictionary, "Any of a group of disorders in which patterns of perceiving, relating to, and thinking about one's self and one's environment interfere with the long-term functioning of an individual, often manifested in deviant behavior and lifestyle." A personality disorder is an enduring pattern of perception and behavior that is pervasive and inflexible.


Both conditions, in order to be considered needing treatment, must cause distress or suffering to the person who has the condition. Usually, a mental illness or personality disorder interferes with a person's ability to function in everyday life. The person, not family or friends, must want to get help.


Currently, BPD has no physical symptoms and cannot be diagnosed through any kind of medical tests. Most sufferers are initially underdiagnosed, or misdiagnosed. BPD can occur with several other mental disorders, including addictions, anxiety, bipolar disorder, eating disorders, or major depressive disorder. Physical medical conditions may also be present that can confuse the issue, such as arthritis, high blood pressure, chronic back pain, type-II diabetes, and fibromyalgia.

Mental health professionals take a multi-step approach to diagnosing BPD:

1. A thorough physical exam to rule out any physical causes for the observed signs and symptoms. An M.D. performs this exam and may also involve medical tests like a CT scan, an MRI, blood work, and x-rays.

2. Psychological evaluation, which a mental health professional conducts. This involves talking with the patient, family, and friends – if permission is given to do so –  then getting a complete clinical history, and looking at the signs and symptoms, behaviors, and functionality of the individual.

3. Once all the facts and observations, along with the results of the physical exam, are brought together, the mental health professional provides a provisional diagnosis. Because BPD can occur at the same time as other mental conditions, it is best not to be too rigid in formulating a diagnosis.


First and most importantly, a person has to want to address a mental or personality issue. Unlike physical illness or trauma (like a broken bone), mental or personality conditions can only be treated when the individual wants to do it. The individual can be committed to a psychiatric facility, and kept in a locked unit for safety reasons, but this is never a cure. The person must make up their own mind to recover.

Psychotherapy, also known as "talk therapy," has been found to be the most effective way to deal with Borderline Personality Disorder. There are four main psychotherapy approaches to consider:

Cognitive-Behavioral Therapy (CBT)– a kind of talk therapy that focuses on identifying and then challenging a person's beliefs about themselves. In a person with BPD, these beliefs are inaccurate. A psychotherapist who uses CBT works with an individual to :


  • become aware of inaccurate or distorted self-concepts
  • define them; put words to them that are as specific as possible
  • question the validity of these beliefs
  • come up with more accurate ways of looking at the self
  • identify and reduce the incidence of self-harming or self-destructive behaviors

Dialectical behavior therapy (DBT) – a form of psychotherapy that is based on the concept of mindfulness. DBT differs from other psychological approaches by teaching individuals to be aware of and attentive to whatever situation they are in. DBT introduces skills to control intense emotions, lessen the occurrence of self-destructive behaviors, and make it possible for the person with BPD to consider developing healthy relationships with others. The National Association on Mental Illness (NAMI) offers comprehensive information about DBT.


Mentalization-Based Therapy (MBT)- a type of talk therapy that helps a person identify and separate their thoughts and feelings from those of others. MBT's main focus is on thinking and responding rather than simply reacting to a situation.


Schema-Focused Therapy (SFT)- combines a variety of therapy approaches to help a person identify and recognize life patterns (schema) that they may repeat without being aware they are doing so. SFT helps a person identify and keep constructive patterns and identify and change destructive ones.


There are other types and styles of psychotherapy, but these four have turned out to be the most effective.


Because treating BPD is an ongoing process, it is critically important for a person to have some kind of follow-up care. This can take the shape of:

One-on-one (individual) sessions with a mental health professional. This can be as simple as a short tune-up or phone session to make sure any questions or concerns are addressed right away.

Group therapy/check-in sessions designed for people dealing with BPD. A mental health professional facilitates this venue. Practice in healthy interpersonal interactions is encouraged in addition to checking in.

Support groups to reassure the person that they are not alone and that help from other people who are dealing with the same disorder is available for the asking.

The Role of Family and Friends

BPD, as with all mental conditions, must want to be addressed by the person who suffers from it. Forcing someone to get treatment for a mental disorder often dooms the effort to failure. Being consistent and supportive toward a person with BPD's efforts to get better is the very best thing that can be provided.

The most successful therapy is one a person wants to do. Once someone successfully works through a course of psychotherapy, be it CBT, DBT (which is often cited as being most successful in treating people with BPD), MBT, SFT, or another type of therapy, they usually do not relapse into their former behaviors. According to NIMH, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. There may not be an official cure for Borderline Personality Disorder, but most people with BPD who want to get better, i.e., get into remission, do.

Please read our comment policy. - The Fix