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What Can Happen When You Have Borderline Personality Disorder

Borderline personality disorder (BPD) is a behavioral health disorder where your emotions, mood, behavior, relationships, impulse control and self-image can be unstable. It’s a connection between anxiety and psychosis where you have irrational or false beliefs. Its symptoms can make it challenging to manage for people who have it as well as their loved ones.

What are some signs of borderline personality disorder?

People with BPD often have these traits:

  • Fear of abandonment. “This fear can be real or imagined,” said Srinivas Dannaram, MD, a psychiatrist with Banner Thunderbird Medical Center. They may make frantic efforts to avoid abandonment, and their intense fears can occur even when they’ve been prepared for a separation. For example, someone with BPD may panic or get angry when their therapist goes out of town, even though they knew a vacation was scheduled and they had backup plans for their care.
  • Relationship changes. They often have frequent, intense changes in their relationships. “They will deeply love, then strongly hate, partners, relatives, doctors and others,” Dr. Dannaram said.
  • Identity problems. People with BPD may have a weak or distorted sense of self. That may lead them to change their interests, goals or values dramatically.
  • A tendency to undermine their efforts. For example, they may destroy healthy relationships or quit school right before graduation.
  • Impulsive behavior. They might abuse alcohol or drugs, drive recklessly, gamble, binge eat, have unsafe sex or squander money.
  • A sense of emptiness and self-harm. Feeling empty may lead to self-harming behaviors such as cutting, picking or burning, and accidental suicide. Suicidal thoughts, threats and behaviors are also common. “Although self-harm and suicidal behaviors can be genuine, and you should take them seriously, they can also be used as frantic efforts to avoid abandonment and can be impulsive,” Dr. Dannaram said.
  • Struggles with controlling emotions. They may feel disproportionate or inappropriate anger, display their temper or get into physical fights.
  • Dissociative symptoms. They may feel detached, as if they are outside of their body, or experience memory loss.
  • Paranoia. They may feel threatened with little or no reason for those thoughts.

What challenges do family members of people with BPD face?

Dealing with a loved one who has BPD can be challenging and lead to burnout. “Family members have first-hand experience with the changing emotions,” Dr. Dannaram said. “Trying to cope and support people with borderline personality disorder could lead to intense stress and take away the time you need to recover from your own emotions.”

People with BPD who feel anger or rage can behave dangerously. Family members must identify the right time to react and respond, so they stay safe. Talking about issues may need to wait for the right time when the person is receptive to that conversation.

What causes borderline personality disorder?

BPD often starts in early adulthood, and like most mental illnesses, it can be caused by genetic and environmental factors. “For someone with a genetic predisposition for borderline personality disorder, experiencing stress, particularly childhood trauma, can trigger symptoms,” Dr. Dannaram said.

How can borderline personality disorder be diagnosed?

A psychiatrist or psychologist can perform a comprehensive psychiatric evaluation to diagnose BPD. It’s more prevalent in women than men but more severe and harder to treat in men.

There are several options for treatment:

  • Dialectical behavior therapy (DBT), which combines cognitive behavioral therapy and mindfulness practice. It is based on a theory that problems managing emotions come from the interaction of biology, physiology and environmental factors. “DBT therapists take a compassionate view, accepting you for who you are while helping you change and work toward your goals,” Dr. Dannaram said. Dialectical behavior therapy is an effective treatment for people who struggle to manage their emotions, stress, relationships and impulsive behaviors.
  • Mentalization-based treatment (MBT) is an evidence-based approach that helps people understand the emotions, beliefs, desires and intentions that underlie interpersonal interactions.
  • Transference-focused psychotherapy is the theoretical process of transferring emotions from one person to another. “The therapist can see how someone interacts with people through transference and then use this information to help them build healthier relationships,” Dr. Dannaram said.
  • Medications, which help manage emotions as symptoms. Antipsychotics can help with anger and irritability, mood stabilizers can balance mood, antidepressants treat depression, and anxiolytics help with anxiety.

The bottom line

With borderline personality disorder, people can have unstable thoughts, irrational beliefs and difficulty maintaining relationships. It’s a challenging mental health issue for both people who have it and their loved ones, but treatment can help. To learn more about BPD and other behavioral health issues, contact a health care provider at Banner Health.

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