Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious and complex mental illness that affects 2 - 3% of the population. Once thought to be on the "border" of schizophrenia, BPD is now believed to be more closely related to mood disorders such as depression, or possibly to impulse control disorders such as Attention-Deficit/Hyperactivity Disorder. People with BPD have difficulty regulating their emotions and controlling their impulses. They often act out their emotions or impulses, either through intense inappropriate displays of anger, or through self-injuring or suicidal behavior. Although self-injury often occurs without suicidal intent, a number of people with BPD die by suicide.  

Depression and anxiety are common in people with BPD, and many also struggle with addiction problems. Individuals with BPD often need intensive mental health services, and they account for 20% of psychiatric hospitalizations. Despite the seriousness of the disorder, recent research indicates that treatment can lead to considerable improvement over time, and there is hope for recovery. 

What are the symptoms of BPD?

Individuals with BPD display a pattern of dramatic mood swings, irritability, and intense anger. Mood swings typically occur in response to stressful life situations, and in particular to difficulties in interpersonal relationships or interpersonal conflict. Individuals with BPD are intensely sensitive to rejection or perceived abandonment, and when they feel they are being abandoned they often respond with intense anger or with self-injuring or suicidal behavior. Because these behaviors take a toll on close interpersonal relationships, individuals with BPD sometimes provoke the very rejection and abandonment they fear. 

Other BPD symptoms include feelings of emptiness or boredom; identity confusion; and impulsive behavior such as over-spending, risky sex, substance abuse, reckless driving, or binge eating. BPD individuals sometimes display brief stress-related periods of paranoid or irrational thinking. They also tend to think in "black and white" terms, alternating between extremes of idealization (everything is wonderful) and devaluation (everything is terrible).

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What causes BPD?

At one point, BPD was believed to be caused by faulty parenting, and many families felt unfairly blamed. Our current understanding is that BPD has a strong biological component, and that it results from a combination of genetic and environmental factors. Recent research suggests that individuals suffering from BPD have imbalances in the neurotransmitters that regulate emotion and impulse control. Serotonin is one neurotransmitter believed to play a significant role in BPD. When individuals suffer from this type of an imbalance, life stresses can easily overwhelm their coping abilities.

Although BPD may develop purely as a result of a biological "vulnerability," research indicates that many individuals with BPD do have a history of traumatic early childhood experiences. About 50 - 70% of individuals with BPD report a history of childhood sexual abuse. Many also report histories of verbal or physical abuse. Often there is a pattern of inconsistent parenting and poorly met needs that may stem from parental addictions or mental illness. A history of early loss or traumatic abandonment is also common, possibly due to death of a parent or parental separation.

Because of their knowledge and expertise in family relationships, MFTs can help reduce the impact of BPD symptoms on family relationships, and improve overall marital and family functioning.

What is the effect of BPD on family members?

Family members often feel mystified and exhausted by their relative's illness. The intense mood swings and anger outbursts can be frightening and disruptive. Impulsive acting out in areas such as spending, substance abuse, or sex can be a major source of marital conflict. Relatives may be overwhelmed with worry regarding their loved one's safety following repeated suicide attempts or acts of self-mutilation. At times, partners and family members may feel manipulated by these suicidal or self-destructive behaviors, and feel torn between reaching out to their loved one, and setting personal limits and boundaries. It is not unusual for relatives and spouses of BPD individuals to feel depressed themselves, and to struggle with feelings of guilt, shame and helplessness.

What help is available?

A number of effective treatment options are emerging to help BPD individuals and their families. Some of these options include: 

Medication: Medications can be helpful in reducing symptoms of depression, anxiety, irritability and paranoid thoughts. Medications may also help improve emotional and impulse control, thereby reducing stress in marital or family relationships and making it easier to develop new interpersonal or stress management skills in psychotherapy. 

Individual Psychotherapy: Often, psychotherapy is required to achieve lasting personality change. Short-term or brief therapy may be helpful in stabilizing immediate crises. Psychodynamic therapy helps make connections between early traumatic experiences and ways that learned behavior patterns are repeated in current relationships. Cognitive-Behavioral Therapy, especially a version of it known as Dialectical Behavior Therapy(DBT), has proven helpful in altering negative patterns of thinking, and in learning new behaviors and coping strategies. 

Group Therapy: Group Therapy is often helpful in learning and practicing new interpersonal skills and increasing awareness of problematic interpersonal traits and behaviors. 

Brief Hospitalization: Hospitalization may be necessary to ensure safety during suicidal crises or episodes of self-injury. Some hospitals offer brief intensive treatment programs for BPD. 

Marital or Family Therapy: Marital Therapy can be helpful in stabilizing the marital relationship and in reducing marital conflict and stress that can worsen BPD symptoms. Family Therapy or Family Psychoeducation can help educate family members regarding BPD, improve family communication and problem solving, and provide support to family members in dealing with their loved one's illness. 

Marriage and Family Therapists (MFTs) can be excellent treatment providers for individuals and families who are struggling with the effects of BPD. MFTs are trained to recognize and treat BPD using many of the treatments described above. Because of their knowledge and expertise in family relationships, MFTs can help reduce the impact of BPD symptoms on family relationships, and improve overall marital and family functioning.


Edited by Malcolm MacFarlane, MA

Last updated October 2017