Like all personality disorders, Borderline Personality Disorder (BPD) exists on a continuum, from mild to severe. It affects women more than men and about two percent of the U.S. population. BPD is usually diagnosed in young adulthood when there has been a pattern of impulsivity and instability in relationships, self-image, and emotions. They may use alcohol, food, drugs, or other addiction to try to self-medicate their pain, but it only exacerbates it. To diagnose BPD, at least five of the following symptoms must be enduring and present in a variety of areas:
1. Frantic efforts to avoid real or imagined abandonment.
2. Unstable and intense personal relationships, marked by alternating idealization and devaluation.
3. Persistently unstable sense of self.
4. Risky, potentially self-damaging impulsivity in at least two areas (e.g., substance abuse, reckless behavior, sex, spending)
5. Recurrent self-mutilation or suicidal threats or behavior. (This doesn’t qualify for Nos. 1 or 4.) Around 8 to 10 percent actually commit suicide.
6. Mood swings (e.g. depressed, irritable, or anxious) mood, not lasting more than a few days.
7. Chronic feelings of emptiness.
8. Frequent, intense, inappropriate temper or anger.
9. Transient, stress-related paranoid thoughts or severe dissociative symptoms.
Causes and Treatment
The cause of BPD is not clearly known, but often there has been neglect, abandonment, or abuse in childhood and possibly genetic factors. People who have a first-degree relative with BPD are five times more likely to develop BPD themselves. (For more read here.) Research has shown brain changes in the ability to regulate emotions. For more, read here and here. Unlike narcissists who often avoid therapy, borderlines often welcome it; however, before recent treatment innovations, its effectiveness had been questioned, which led to stigmatization.
Today, BPD is no longer a life sentence. Studies have shown that some people recover on their own, some improve with weekly therapy, and some require hospitalization. Long-term treatment is required for maximum results, with symptom relief increasingly improving. A 10-year study showed substantial remission after ten years. The use of medication and DBT, CBT, schema therapy, and some other modalities have proven helpful. Most individuals with BPD have another co-occurring diagnosis, such as addiction and/or depression. Acute symptoms diminish more readily than temperamental ones, such as anger, loneliness, emptiness, and abandonment/dependency issues.
Loving someone with BPD can be a rollercoaster. (Read what it's like). Loved ones should know that borderlines need structure and a combination of knowing that they’re cared about plus boundaries that are communicated calmly and firmly. Learn to be assertive, and set boundaries. Get How to Speak Your Mind- Become Assertive and Set Limits (and webinar Be Assertive) It's also important for partners to seek therapy in order to raise their self-esteem. Get How to Raise Your Self-Esteem. See my blog on "How to Spot Manipulation" and my book, Dating, Loving, and Leaving a Narcissist: Essential Tools for Improving or Leaving Narcissistic and Abusive Relationships, which details all types of abuse and explains how to navigate and beneficially communicate and set boundaries this type of relationships. See my books and e-workbooks for helpful exercises.