Borderline personality disorder: Symptoms and causes

Have a hard time controlling or regulating your emotions? It may have to do with borderline personality disorder or BPD, a mental health condition that is usually experienced in early adulthood. If you have BPD, your moods will change very quickly and you will end up lashing out at work or someone you love. All this can cause problems in your professional as well as personal lives. It does not mean you have to cut off all ties and live in isolation. It is true that there is no specific medicine to deal with this mental health condition. But there are a few medications that can be teamed up with therapies to improve your quality of life.

What is borderline personality disorder?

“BPD or borderline personality disorder is a mental health condition that is classified under personality disorders and generally manifests in early adulthood,” says psychiatrist Dr Deeksha Kalra. The prevalence of BPD is between 0.7 and 2.7 percent, according to research published in StatPearls in 2024.

It is typically characterised by unstable moods, behaviour and relationships. This mental health condition can affect various aspects of life like work, social interactions, and self-image. “People suffering from this disorder generally struggle with emotional regulation, which results in intense emotional episodes and impulsive actions,” says psychologist Jasmine Arora. Such people are likely to have a distorted sense of self, fear of abandonment and difficulty in maintaining stable interpersonal relationships.

What are the symptoms of borderline personality disorder?

Symptoms of borderline personality disorder include:

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• Intense fear of abandonment or rejection Unstable interpersonal relationships
• Suicidal behaviours
• Rapidly, changing self-image and identity Chronic feelings of emptiness
• Intense anger, or difficulty in controlling anger

Also, people with this mental health condition are more likely to engage in self-harm, according to the US National Institute Of Mental Health.

What are the types of borderline personality disorder?

• Impulsive: People with this type of borderline personality disorder find it hard to control impulses. They may be at a higher risk of hurting themselves.
• Discouraged: Such people are extremely dependent on others. They may appear passive until they feel abandoned, and once they do, they may have difficulties in controlling anger and be emotionally unstable.
• Self-destructive: When it comes to this type of borderline personality disorder, people have strong feelings of self-hatred. “They may opt for substance use, or make suicidal threats,” says Arora.
• Petulant: They may feel unloved or not worthy and have outbursts of anger. They may feel the need to manipulate others.

What are the causes of borderline personality disorder?

• Genetics: “Having a family history of mental health disorders is likely to increase the chances of having BPD in a person,” says Arora.
• Issues with neurotransmitters: Neurotransmitters are the messenger chemicals that the brain uses to send signals between the cells in the brain. People with BPD may have issues with the neurotransmitters in their brain, especially serotonin, according to the UK’s National Health Service. Fluctuations in serotonin levels may lead to aggression and difficulty in controlling destructive urges, leading to BPD.
• Childhood trauma: Childhood trauma, including physical or emotional abuse, and neglect is likely to increase the chances of having BPD in adulthood. During a 2021 study, published in Frontiers In Psychiatry, researchers found that people with borderline personality disorder experienced childhood trauma more often.

How to diagnose borderline personality disorder?

It can be diagnosed through clinical evaluation by a mental health expert. Tools that are used to diagnose this borderline personality disorder include:

• Structured interviews and conversations about the BPD symptoms.
• Behavioural assessments by the mental health professional.

“Usually, these tools are used after a person turns 18 as the symptoms start showing in early adulthood only. A detailed history of symptoms and personal experiences is collected to make sure that the diagnosis is accurate,” says Dr Kalra.

What are the treatment options for borderline personality disorder?

Borderline personality disorder should not be left untreated as it can lead to difficulty in maintaining relationships, self-harm, substance, abuse, and job instability. “It is also likely to increase the risk of co-occurring conditions, including anxiety, depression, or eating disorders,” says Dr Kalra.

1. Psychotherapy

“Psychotherapy is one of the most effective treatment methods for BPD,” says Arora. Two commonly used approaches of this kind of therapy are:

• Dialectical Behaviour Therapy (DBT): It combines cognitive-behavioural techniques with mindfulness practices to help people in regulating strong emotions, reducing self-harm and suicidal behaviours. It also helps them in developing coping mechanisms for distressing situations and improving interpersonal relationships through effective communication. It typically includes individual therapy, and phone coaching.
• Cognitive Behavioural Therapy: Cognitive Behavioural Therapy or CBT focuses on identifying and changing negative thought patterns that cause emotional instability and impulsive behaviours. “It helps people suffering from borderline personality disorder in reframing distorted beliefs and manage symptoms like fear of abandonment,” says Dr Kalra.

2. Medications

There is no specifically approved medication for BPD, but there are certain drugs available that can help in managing symptoms like anxiety, or mood swings. “These may include antidepressants, mood stabilisers, and antipsychotics for severe emotional dysregulation,” says Arora. Prescribed drugs are often used along with psychotherapy rather, according to research published in Current Behavioral Neuroscience Reports in 2017.

3. Group therapy

You can always go to a therapist and have solo sessions. But group therapy can also help to manage the symptoms of borderline personality disorder. “It is an effective method as it helps in building interpersonal and social skills. Sharing experiences in a supportive group helps in preventing feelings of isolation,” says Dr Kalra.

4. Self-help strategies

Self-help strategies, including practicing mindfulness techniques, and building a strong support system to understand emotional triggers can significantly help in managing BPD. You can also go for journaling after a hectic day but don’t try these strategies without consulting with a mental health expert.

5. Schema-focused therapy

Schema-focused therapy addresses deep-rooted, dysfunctional patterns (schemas) formed during early life. It helps people in identifying and changing negative beliefs and behaviours that crop up from unmet emotional needs during childhood. “It focuses on reshaping unhealthy thought patterns, improving self-image, and building healthier interpersonal relationships,” says Arora.

6. Mentalisation-based therapy (MBT)

“It improves the ability to understand and interpret your own and others’ emotions, thoughts, and behaviours,” says Dr Kalra. It helps in regulating emotions, improve self-awareness, and build stronger relationships by reducing misunderstandings and emotional reactivity by reflecting on emotions and intentions, to reduce impulsivity and interpersonal conflicts.

Borderline personality disorder is a mental health condition that involves severe mood changes. There are effective therapies to manage symptoms of this personality disorder.