If you have borderline personality disorder, everything can feel unstable—from your relationships, moods, thinking, and behavior to even your identity. But this guide to symptoms, treatment, and recovery can help.
Borderline personality disorder (BPD) is a mental health condition that is marked by instability in your moods, relationships, and even how you view yourself. If you have BPD, you probably feel like you’re on a rollercoaster, not just because of your intense emotions or turbulent relationships, but also the wavering sense of who you are. Your self-image, goals, and even your likes and dislikes may change frequently in ways that can feel confusing and unclear.
People with BPD tend to be extremely sensitive. Some describe it as like having an exposed nerve ending. Small things can trigger intense reactions. And once upset, you may have trouble calming down. It’s easy to understand how this emotional volatility and inability to self-soothe leads to relationship turmoil and impulsive—even reckless and self-destructive—behavior.
When you’re in the throes of overwhelming emotions, you may be unable to think straight or stay grounded. You might say hurtful things or act out in impulsive, dangerous, or inappropriate ways that later make you feel guilty or ashamed.
BPD is a cluster B personality disorder that is often misunderstood and misdiagnosed. It usually begins in late adolescence or early adulthood, but its symptoms can look very different from one person to the next. It also frequently co-occurs with other mental health issues, such as bipolar disorder, depression, anxiety, and substance abuse. This can make getting an accurate diagnosis very challenging.
However your symptoms present, though, having BPD can feel like a painful cycle that is impossible to escape. But it’s not. With the right support, BPD is treatable. By learning more about the symptoms and diagnosis of borderline personality disorder, you can find the most effective treatments and coping skills for you, and regain control of your thoughts, feelings, and actions.
A personality disorder means there’s something fundamentally wrong with who you are
A personality disorder is not a character judgment. In clinical terms, “personality disorder” means that your pattern of relating to the world is significantly different from the norm. (In other words, you don’t act in ways that most people expect). This causes consistent problems for you in many areas of your life, such as your relationships, career, and your feelings about yourself and others. But most importantly, these patterns can be changed!
People with BPD are always in crisis
When you have BPD, you’ll likely go through periods of calm broken up by episodes when your symptoms flare-up. A trigger such as criticism, rejection, or overwhelming stress could result in an episode of intense mood swings, depression, impulsive behavior, self-harming, dissociation, or splitting, where you view things as either all good or all bad, with no middle ground. These episodes usually last from a few hours to a few days, but can last longer, depending on the trigger and the severity of your symptoms.
People with BPD are selfish, manipulative attention-seekers
When someone with BPD behaves in a way that may seem manipulative or attention-seeking, it’s usually not deliberate. When stressed, someone with BPD may be so desperate for relief that they’ll do anything, including things they know they shouldn’t—such as cutting, reckless sex, or dangerous driving. People with BPD also tend to misread the thoughts and feelings of others and overlook how their behavior can affect others. It’s not that they’re selfish or don’t care, but when it comes to other people, they have a big blind spot.
Suicide threats from someone with BPD shouldn’t be taken seriously
Suicidal behavior is common in people with BPD and it’s estimated that up to 10 percent of people with BPD will die by suicide. If you or someone you love is feeling suicidal, please seek immediate help by calling a suicide prevention helpline.
The term “borderline personality” was coined by Adolph Stern in 1938 when describing those who didn’t fit into either the “neurotic” or “psychotic” groups of patients, but fell somewhere in-between. Since those terms are no longer used to describe mental health conditions today, many feel that borderline personality disorder is an outdated label. The word “borderline” may also add to the stigma of BPD. Some people mistakenly associate it with “borderline intelligence,” even though they’re unrelated.
Also, since BPD overlaps with many other disorders, there is a debate about whether it should be reclassified as a mood disorder or identity disorder, rather than a personality disorder. Whatever your thoughts on the terminology, the most important thing to remember is that with an accurate diagnosis and proper treatment, BPD is very treatable and you can go on to live a healthy, productive life.
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Take Assessment HelpGuide is user supported. We earn a commission if you sign up for BetterHelp’s services after clicking through from this site. Learn moreThe symptoms of BPD usually begin in adolescence and impact many areas of your life. You may not experience every symptom, but if you have borderline personality disorder, you’ll be familiar with at least five of the following BPD symptoms.
Extreme emotional swings. Unstable emotions and moods are common with BPD. One moment, you may feel happy, and the next, despondent. Little things that other people brush off can send you into an emotional tailspin. These abrupt mood swings—known as “affective instability”—are intense, but they tend to pass fairly quickly (unlike the emotional swings of depression or bipolar disorder), usually lasting just a few minutes or hours.
Chronic feelings of emptiness. People with BPD often talk about feeling empty, as if there’s a hole or a void inside them. At the extreme, you may feel as if you’re “nothing” or “nobody.” This feeling is uncomfortable, so you may try to fill the void with things like drugs, food, or sex. But nothing feels truly satisfying.
Unclear or shifting self-image. When you have BPD, your sense of self is typically unstable. Sometimes you may feel good about yourself, but other times you hate yourself, or even view yourself as evil. You probably don’t have a clear idea of who you are or what you want in life. As a result, you may frequently change jobs, friends, lovers, religion, values, goals, or even sexual identity.
Feeling paranoid, suspicious, or out of touch with reality. People with BPD often struggle with paranoia or suspicious thoughts about others’ motives. When under stress, you may even lose touch with reality—an experience known as dissociation. You may feel foggy, spaced out, or as if you’re outside your own body.
Impulsive, self-destructive behaviors. If you have BPD, you may engage in harmful, sensation-seeking behaviors, especially when you’re upset. You may impulsively spend money you can’t afford, binge eat, drive recklessly, shoplift, engage in risky sex, or overdo it with drugs or alcohol. These risky behaviors may help you feel better in the moment, but they hurt you and those around you over the long-term.
Explosive anger. If you have BPD, you may struggle with intense anger and a short temper. You may also have trouble controlling yourself once the fuse is lit—yelling, throwing things, or becoming completely consumed by rage. It’s important to note that this anger isn’t always directed outwards. You may spend a lot of time feeling angry at yourself.
Self-harm. Suicidal behavior and deliberate self-injury is common in people with BPD. Suicidal behavior includes thinking about suicide, making suicidal gestures or threats, or actually carrying out a suicide attempt. Self-harm encompasses all other attempts to hurt yourself without suicidal intent. Common forms of self-harm include cutting and burning.
Fear of abandonment. People with BPD are often terrified of being abandoned or left alone. Even something as innocuous as a loved one arriving home late from work or going away for the weekend may trigger intense fear. This can prompt frantic efforts to keep the other person close. You may beg, cling, start fights, track your loved one’s movements, or even physically block the person from leaving. Unfortunately, this behavior tends to have the opposite effect—driving others away.
Unstable relationships. People with BPD tend to have relationships that are intense and short-lived. You may fall in love quickly, believing that each new person is the one who will make you feel whole, only to be quickly disappointed. Your relationships either seem perfect or horrible, without any middle ground. Your lovers, friends, or family members may feel like they have emotional whiplash as a result of your rapid swings from idealization to devaluation, anger, and hate.
Borderline personality disorder can manifest in many different ways. For the purposes of diagnosis, the DSM-5, the handbook used by mental health professionals, requires that five or more of the nine symptoms discussed above are present:
If you think you may have BPD, you can take our borderline personality disorder test. However, to make an official diagnosis, a mental health professional will need to conduct a detailed interview with you to discuss your symptoms, review your medical history, and test you for co-occurring disorders. They may also use diagnostic tools such as:
BPD is more common than you may expect. Estimates suggest it affects about 1.6 percent of the population, although that figure may be substantially higher as many people remain undiagnosed or misdiagnosed. In fact, NAMI suggests the prevalence rate may be as high as 5.9 percent.
Far more women are diagnosed with BPD than men, about three times more according to some estimates. However, other research suggests that since the symptoms can look different in men, they may be underdiagnosed or misdiagnosed, with BPD in men sometimes mistaken for antisocial personality disorder.
There is no single cause of borderline personality disorder. Most mental health professionals believe that BPD is caused by a combination of inherited or internal biological factors and external environmental factors. Symptoms usually first appear in the teen years and tend to be more severe in young adulthood.
Studies have indicated that you have an elevated risk of developing borderline personality disorder if you have a family history of BPD, especially in close family, such as your parents or siblings.Having a parent who suffers from another type of mental health issue may also increase your risk of developing BPD.
Rather than being a purely genetic link, though, that may be because having a mother with depression, for example, can impair their ability to parent and contribute to a family environment that may put children at risk.
Other environmental factors that may also increase your risk of developing BPD could include:
Studies have shown that there are brain differences in people with BPD. There are many complex things happening in the brain of someone with BPD, and researchers are still untangling what it all means. But in essence, if you have BPD, your brain is on high alert. Things feel more scary and stressful to you than they do to other people. Your fight-or-flight switch is easily tripped, and once it’s on, it hijacks your rational brain, triggering primitive survival instincts that aren’t always appropriate to the situation at hand.
This may make it sound as if there’s nothing you can do. But the truth is that you can change your brain. Every time you practice a new coping response or self-soothing technique you are creating new neural pathways. Some treatments, such as mindfulness meditation, can even grow your brain matter. And the more you practice, the stronger and more automatic these pathways will become. So don’t give up! With time and dedication, you can change the way you think, feel, and act.
Borderline personality disorder is rarely diagnosed on its own. Common co-occurring disorders include:
Having any of these disorders alongside BPD can further complicate diagnosis and treatment. However, when BPD is successfully treated, the other disorders often improve, too. But the reverse isn’t always true. For example, you may successfully treat symptoms of depression and still struggle with BPD.
If you think that you may be suffering from BPD, it’s best to seek professional help, ideally from a mental health professional with experience diagnosing and treating BPD. While there is no one-size-fits-all treatment for BPD, therapy tends to be the cornerstone of treatment. Several different types of group and individual therapy can be effective in managing BPD symptoms.
Lifestyle changes and family and peer support can also be important parts of treatment. Medication, however, is usually only used to treat co-occurring disorders, such as depression.
The different treatments for BPD include:
| Dialectical behavior therapy (DBT) | Focuses on: Emotional regulation, distress tolerance, mindfulness, building healthier relationships. How it works: Uses individual and group talk therapy to teach you practical skills for managing difficult emotions, avoiding harmful and destructive behavior, and coping with emotional swings. Key benefits: DBT was developed specifically for the treatment of BPD. Numerous studies have found it highly effective, especially in reducing self-harm and suicidal behavior. |
| Schema therapy (ST) | Focuses on: Changing ingrained patterns of thinking. How it works: Uses elements of CBT and other types of psychotherapy to replace the negative patterns of coping formed in childhood with healthier, more productive ways of thinking and behaving. Key benefits: One small study found that after one year of ST, 70 percent of BPD patients reported a significant reduction in symptoms such as thinking less frequently about suicide and more better regulating their emotions. |
| Mentalization-based therapy (MBT) | Focuses on: Curbing impulsiveness and improving relationships by better understanding your own and others’ thoughts and feelings. How it works: Helps you recognise how you may be misinterpreting your own and other people’s mental states. By learning to “step back” and examine your thoughts to see if they’re valid, you can avoid rash behavior that’s destructive to you and your relationships. Key benefits: Research indicates that MBT can have a positive impact on dysregulation, impulsivity, and unstable relationships. |
| Transference-focused psychotherapy (TFP) | Focuses on: Using the relationship between you and your therapist to address issues with your relationships in the real world. How it works: Transference occurs when emotions you originally felt in childhood are now directed at your therapist. This enables the therapist to understand the issues you’re experiencing in your real-world relationships and help you build healthier ones. Key benefits: Rooted in psychoanalysis, TFP may help you understand how your thoughts impact your behaviors and relationships. |
| Medications | Focuses on: Relief of symptoms and co-occurring disorders, such as depression or anxiety. How it works: BPD rarely occurs on its own. Medication, such as bipolar medication, anxiety medication, or antidepressants, is tailored to your specific symptoms or co-occurring conditions. Key benefits: While not a primary treatment, medication is often used alongside therapy. Relieving specific symptoms may help to improve the outcome of therapy. |
The support and guidance of a qualified therapist can make a huge difference in BPD treatment and recovery. In-person or online therapy can serve as a safe space where you can start working through your relationship and trust issues and “try on” new coping techniques for dealing with the emotional pain.
An experienced professional will be familiar with BPD therapies such as dialectical behavior therapy (DBT) and schema-focused therapy. But while these therapies have proven to be helpful, it’s not always necessary to follow a specific treatment approach. Many experts believe that weekly therapy involving education about the disorder, family support, and social and emotional skills training can treat most BPD cases.
It’s important to find a therapist you feel safe with—someone who seems to get you and makes you feel accepted and understood. Once you find the right therapist, it’s then crucial that you make a commitment to therapy.
You may start out thinking that your therapist is going to be your savior, only to become disillusioned and feel like they have nothing to offer. Remember that these swings from idealization to demonization are a symptom of BPD. Try to stick it out with your therapist and allow the relationship to grow. And keep in mind that change, by its very nature, is uncomfortable. If you don’t ever feel uncomfortable in therapy, you’re probably not progressing.
BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.
Take Assessment HelpGuide is user supported. We earn a commission if you sign up for BetterHelp’s services after clicking through from this site. Learn moreAlthough many people with BPD take medication, the fact is that there is very little research showing that it is helpful. What’s more, in the U.S., the Food and Drug Administration (FDA) has not approved any medications for the treatment of BPD. This doesn’t mean that medication is never helpful—especially if you suffer from co-occurring problems such as depression or anxiety—but it is not a cure for BPD itself.
When it comes to BPD, therapy is much more effective. You just have to give it time. However, your doctor may consider medication if:
Coping with BPD is often a matter of breaking the dysfunctional patterns of thinking, feeling, and behaving that are causing you distress. It’s not easy to change lifelong habits. Choosing to pause, reflect, and then act in new ways may feel unnatural and uncomfortable at first. But with time you can form new habits that help you maintain your emotional balance and stay in control.
Even without a formal diagnosis, you may find the following self-help tips helpful for calming your inner emotional turmoil and learning to control self-damaging impulses.
As someone with BPD, you’ve probably spent a lot of time fighting your impulses and emotions, so acceptance can be a tough thing to wrap your mind around. But accepting your emotions doesn’t mean approving of them or resigning yourself to suffering. All it means is that you stop trying to fight, avoid, suppress, or deny what you’re feeling. Giving yourself permission to have these feelings can take away a lot of their power.
Try to simply experience your feelings without judgment or criticism. Let go of the past and the future and focus exclusively on the present moment. Mindfulness techniques can be very effective in this regard.
[Listen: Eye of the Storm Meditation]
Do something that stimulates one or more of your senses. Engaging your senses is one of the quickest and easiest ways to self-soothe. You will need to experiment to find out which sensory-based stimulation works best for you. You’ll also need different strategies for different moods. What helps when you’re angry or agitated may be very different from what helps when you’re numb or depressed. Here are some ideas to get started:
Reduce your emotional vulnerability. You’re more likely to experience negative emotions when you’re run down and under stress. That’s why it’s very important to practice self-care tips, such as eating a healthy diet, getting plenty of sleep and exercise, limiting drugs and alcohol, and managing stress.
Impulsive behaviors such as self-harming, dangerous driving, and binge drinking are coping mechanisms for dealing with distress. They make you feel better, even if just for a brief moment. But the long-term costs can be extremely high.
Regaining control of your behavior starts with learning to tolerate distress. It’s the key to changing the destructive patterns of BPD. The ability to tolerate distress will help you press pause when you have the urge to act out. Instead of reacting to difficult emotions with self-destructive behaviors, you will learn to ride them out while remaining in control of the experience.
For a step-by-step, self-guided program that will teach you how to ride the “wild horse” of overwhelming feelings, check out our free Emotional Intelligence Toolkit. The toolkit can teach you how to tolerate distress and move from being emotionally shut down to experiencing your emotions fully. This allows you to experience the full range of positive emotions such as joy, peace, and fulfillment that are also cut off when you attempt to avoid negative feelings.
A grounding exercise to help you pause and regain control. Once the fight-or-flight response is triggered, there is no way to “think yourself” calm. Instead of focusing on your thoughts, focus on what you’re feeling in your body. The following grounding exercise is a simple, quick way to put the brakes on impulsivity, calm down, and regain control. It can make a big difference in just a few short minutes.
In case of emergency, distract yourself. If your attempts to calm down aren’t working and you start to feel overwhelmed by destructive urges, distracting yourself may help. All you need is something to capture your focus long enough for the negative impulse to go away. In addition to the sensory-based strategies mentioned previously, here are some things you might try:
If you have borderline personality disorder, you’ve probably struggled with maintaining stable, satisfying interpersonal relationships with lovers, co-workers, and friends. This is because you have trouble stepping back and seeing things from other people’s perspective. Recognizing this “interpersonal blind spot” is the first step. When you stop blaming others, you can start taking steps to improve your relationships and your social skills.
Check your assumptions. When you’re derailed by stress and negativity, it’s easy to misread the intentions of others. If you’re aware of this tendency, check your assumptions. Remember, you’re not a mind reader! Instead of jumping to negative conclusions, consider alternative motivations. As an example, let’s say that your partner was abrupt with you on the phone and now you’re feeling insecure and afraid they’ve lost interest in you. Before you act on those feelings:
Stop to consider the different possibilities. Maybe your partner is under pressure at work. Maybe they’re having a stressful day or haven’t had their coffee yet. There are many alternative explanations for their behavior.
Ask the person to clarify their intentions. One of the simplest ways to check your assumptions is to ask the other person what they’re thinking or feeling. Double check what they meant by their words or actions. Instead of asking in an accusatory manner, try a softer approach: “I could be wrong, but it feels like…” or “Maybe I’m being overly sensitive, but I get the sense that…“
Put a stop to projection. Do you have a tendency to take your negative feelings and project them on to other people? Do you lash out at others when you’re feeling bad about yourself? Does feedback or constructive criticism feel like a personal attack? If so, you may have a problem with projection.
To fight projection, you’ll need to learn to apply the brakes—just like you did to curb your impulsive behaviors. Tune in to your emotions and the physical sensations in your body. Take note of signs of stress, such as rapid heart rate, muscle tension, sweating, nausea, or light-headedness. When you’re feeling this way, you’re likely to go on the attack and say something you’ll regret later. Pause and take a few slow deep breaths. Then ask yourself the following three questions:
If the answer is yes, take a conversation break. Tell the other person that you’re feeling emotional and would like some time to think before discussing things further.
Take responsibility for the role you play in your relationships. Ask yourself how your actions might contribute to problems. How do your words and behaviors make your loved ones feel? Are you falling into the trap of seeing the other person as either all good or all bad? As you make an effort to put yourself in other people’s shoes, give them the benefit of the doubt, and reduce your defensiveness, you’ll start to notice a difference in the quality of your relationships.
Having a family member or loved one with borderline personality disorder can feel like being on an emotional roller coaster. You may be constantly on edge waiting for their next mood swing, emotional outburst, or irrational act to throw you off balance. Their destructive and hurtful behaviors are enough to leave anyone feeling abused and helpless. However, you’re not totally powerless in the face of your loved one’s symptoms.
The first thing to remember is that your loved one’s distressing or manipulative behavior is a result of their deep emotional pain, not a reflection of you. Secondly, your support can make a huge difference in their recovery.
Even if the person with BPD isn’t willing to seek treatment, there are ways to bring more stability to your relationship through improved communication, firmer boundaries, and changing your own reactions. To learn how to manage BPD in a relationship, read Dealing with BPD in Relationships.
Call the NAMI HelpLine at 1-800-950-6264
Call the the Mind infoline at 0300 123 3393
Find Your CMHA for a helpline near you
Call the Vandrevala Foundation Helpline at 1860 2662 345 or 1800 2333 3
Take this short quiz if you think you have BPD
How to recognize BPD in a loved one and improve your relationship
Tips for spotting and coping with a narcissist
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