Borderline personality disorder (BPD) is a serious mental illness characterized by patterns of unstable moods, relationships, self-image, and behavior. People with BPD experience intense and frequent emotional reactions that often seem out of proportion to the situation. This instability in mood and behavior can negatively impact relationships, career, and sense of self.
What are the symptoms of BPD?
There are nine main symptoms used to diagnose BPD:
- Intense fear of abandonment, real or imagined
- Unstable relationships that alternate between idealization and devaluation
- Distorted and unstable self-image or sense of self
- Impulsive and risky behaviors like substance abuse, unsafe sex, reckless driving, and binge eating
- Self-harming behaviors like cutting or suicidal threats or gestures
- Extreme emotional swings
- Chronic feelings of emptiness
- Explosive anger or difficulty controlling anger
- Feelings of paranoia or dissociation under stress
People with BPD experience at least 5 of these symptoms consistently. The symptoms can range from mild to severe and occur across different situations and relationships.
What causes BPD?
The exact causes of BPD are unknown, but research suggests a combination of genetic, environmental, and neurological factors contribute to its development. Risk factors include:
- Genetics – BPD seems to run in families, so genetics likely play a role.
- Brain abnormalities – Differences in brain structure and function have been noted, especially in areas that control emotions.
- Childhood trauma – Many people with BPD report experiencing emotional, physical, or sexual abuse in childhood.
- Neglect – Inconsistent nurturing or abandonment in childhood may also contribute.
Ultimately, BPD seems to arise from a complex interplay between biological vulnerabilities and environmental stressors early in life.
What is it like to live with BPD day-to-day?
Living with BPD can be extremely challenging. People describe feeling like they are on an emotional rollercoaster with little control. Some of the common experiences include:
- Intense emotions – Emotions are felt deeply and can spiral out of control. Moods shift rapidly and seemingly minor things can trigger disproportionate reactions like rage, despair, or panic.
- Black-and-white thinking – People with BPD tend to think in extremes, categorizing everything as either good or bad. This fuels relationship problems and emotional swings.
- Emptiness – Many people with BPD describe chronic feelings of loneliness, hollowness, and self-loathing even if their life seems fine from the outside.
- Paranoia – Stressful situations may spur feelings of distrust, suspicion, or isolation from others.
- Impulsivity – Urges to self-harm, attempt suicide, drive recklessly, binge eat or spend, etc often feel uncontrollable in the moment.
- Dissociation – In some cases, people detach from reality as a coping mechanism during times of stress.
Juggling these intense emotions day after day and trying to maintain relationships and a career can feel impossible. Many people with BPD describe living in a constant state of crisis.
How does BPD impact relationships?
BPD can profoundly impact relationships with partners, friends, and family members. Some common relationship challenges include:
- Fear of abandonment – People with BPD desperately fear rejection. They may perceive relationship conflict as a threat to the relationship.
- Love-hate relationships – Some relationships alternate between overidealizing someone and then suddenly feeling they are cruel or evil. This creates a rocky dynamic.
- Clinginess – The fear of abandonment can fuel anxious attachment behaviors like constantly texting or needing reassurance.
- Isolation – During times of stress, people with BPD may push others away or retreat socially.
- Anger issues – Anger or rage can be a common reaction to feeling rejected. This can damage relationships.
- Distrust – Black-and-white thinking may fuel distrust or suspicion of friends’ or partner’s motives.
- Difficulty empathizing – The all-consuming nature of BPD may make it hard for sufferers to recognize others’ perspectives or feelings.
These relationship challenges make it hard for people with BPD to maintain healthy long-term relationships without treatment. Family members also often struggle to understand their loved one’s BPD moods and behaviors.
What areas of life are commonly impacted?
BPD can disrupt many areas of functioning. Some of the most affected include:
- Work – Employment may suffer due to emotional outbursts, conflict, or dissociation on the job. Many people with BPD change jobs frequently.
- Education – BPD symptoms often emerge in the teens or 20s when schooling is disrupted. Only about 20% of people with BPD are able to complete college.
- Finances – Impulsive spending or reckless decisions can deplete savings and create debt. Changing jobs frequently also reduces lifetime earnings.
- Self-image – Shifting sense of identity and chronic emptiness may make it difficult to know one’s true self.
- Legal Issues – Reckless behaviors like substance abuse, stealing, or violent outbursts can result in legal charges and trouble with the law.
- Mental Health – Conditions like depression, anxiety, PTSD, eating disorders, and substance abuse disorders commonly co-occur with BPD.
Without proper treatment, BPD can severely reduce quality of life across many domains of functioning.
What treatments are available?
BPD is highly treatable with professional interventions like psychotherapy and medication management. Some effective treatment options include:
- Dialectical Behavior Therapy (DBT) – This is the gold standard therapy for BPD focused on emotional regulation, distress tolerance, and interpersonal skills.
- Schema Therapy – This approach helps identify and change maladaptive schemas or lifelong patterns.
- Transference-focused psychotherapy – This therapy aims to resolve difficulties with a parent or caregiver through the client-therapist relationship.
- Medications – No medications treat BPD specifically, but antidepressants, mood stabilizers, and antipsychotic medications can help manage symptoms.
- Mentalization-based therapy – This therapy builds skills in understanding one’s own and others’ thoughts and feelings.
Treatment is usually long-term, lasting at least a year. But with skilled professional help, many people with BPD experience fewer symptoms, improved functioning, and an enhanced quality of life.
What is the prognosis and outlook?
With intensive treatment, the prognosis for BPD is better today than in the past. Research shows:
- With treatment, over 90% of people with BPD experience fewer or remitting symptoms after 10 years.
- After 2 years of DBT, up to 75% of individuals no longer meet BPD diagnostic criteria.
- Many people report improved relationships, work functioning, diminished impulsivity, and hope for the future after seeking help.
Without treatment, the course of BPD tends to be unstable throughout life with worsening of symptoms during times of stress. But most people with BPD have a positive prognosis when they engage in long-term professional care and self-care practices.
How can loved ones support someone with BPD?
Caring for someone with BPD can be challenging. Here are some tips for providing support:
- Educate yourself on BPD through reputable resources to gain understanding.
- Encourage your loved one to seek professional treatment which offers the best chance of improvement.
- Set healthy boundaries while also offering emotional support.
- Avoid taking their negative behaviors personally and reacting with anger or hurt.
- Provide reassurance of your commitment to the relationship during times of need.
- Encourage positive coping skills like journaling, relaxation techniques, or creative hobbies.
- Suggest joining a BPD support group to reduce isolation.
- Take care of your own mental health needs through self-care, therapy, or joining a family support group.
Loved ones play an integral role in the healing process for those with BPD. Offering compassion while maintaining boundaries and encouraging professional treatment can aid recovery.
What are some self-care tips for people with BPD?
In addition to professional treatment, individuals with BPD can benefit from adopting regular self-care practices. Some tips include:
- Keep a journal to track moods and behaviors to gain more insight.
- Practice mindfulness and grounding techniques to reduce overwhelm.
- Develop a safety plan for when suicidal thoughts arise.
- Identify triggers that lead to escalation and work to avoid them.
- Surround yourself with a strong support system.
- Limit alcohol and drug use which tend to destabilize emotions.
- Make time for hobbies and activities unrelated to the disorder.
- Learn to identify and reality test thought distortions.
- Communicate needs assertively and set boundaries in relationships.
- Get adequate sleep, nutrition, and exercise to reduce stress.
Self-care allows people with BPD to take back some personal control over their recovery journey. Combined with professional treatment, these strategies provide the best chance of overcoming BPD.
What are some famous people with BPD?
Many celebrities have publicly discussed their experiences living with BPD, helping to raise awareness. Some include:
| Name | Profession |
|---|---|
| Marilyn Monroe | Actress |
| Amy Winehouse | Singer |
| Pete Davidson | Comedian |
| Frances Bean Cobain | Visual artist |
| Catherine Zeta-Jones | Actress |
| Trisha Paytas | YouTube personality |
Hearing celebrities share their personal struggles with BPD can help validate and destigmatize the disorder for the millions also living with it.
Conclusion
In summary, borderline personality disorder is a serious but treatable mental illness marked by severe mood instability, turbulent relationships, and impulsive behavior. The exact cause is unclear but likely involves genetic and environmental factors. From emotional rollercoasters to relationship turmoil, BPD can profoundly impact quality of life across many domains of functioning.
With intensive psychotherapy and self-care, the long-term prognosis for BPD is better today than ever before. Most people achieve symptom remission within 10 years of treatment. Loved ones play an important role through education, encouragement, and setting healthy boundaries. While living with BPD presents daily challenges, recovery is absolutely possible with professional support.