Borderline Personality Disorder: What are the Signs and Symptoms?

Borderline personality disorder (BPD) is a serious mental health condition characterized by unstable moods, unstable relationships, extreme emotions, fear of abandonment, self-harm and risky behaviors, intense anger, and being out of touch with reality. Although this is a serious condition without a cure, it is treatable. Therapy is particularly helpful in teaching someone with BPD how to control their emotions and moods while strengthening relationships. Borderline personality disorder treatment first requires a diagnosis. It is important to recognize the signs of this condition in order to get much-needed help.

There are several characteristic signs of borderline personality disorder, although each individual experiences this condition in ways that are unique. For instance, one person may have more anxiety symptoms while another has intense signs of depression during mood swings. Mental disorders are experienced in an individual way, and yet there are characteristics that give every person with BPD a shared experience:

• Instability in many areas of life, from relationships to work and activities
• Extreme emotional reactions
• An inability to recover after an extreme reaction
• A strong need for validation from others, especially in relationships, based on an intense fear of being left by loved ones
• Risky and impulsive behaviors, like experimenting with drugs, having unprotected sex, or overspending
• Mood swings that can change quickly from one extreme to another, such as major depression to energetic happiness
• Paranoia, especially when under stress
• Self-harm or suicidal behaviors, often in response to a fear of being abandoned
• Viewing things or people as all good or all bad
• A fear of being alone
• Inappropriate anger or periods of rage

It is often much easier to see the signs and symptoms of a mental illness like BPD in someone else than in oneself. A person with a diagnosable condition may feel as if something isn’t right but may not know what to do about it or even if those unusual feelings are serious enough to warrant asking for help.

People with borderline personality disorder commonly describe feeling constantly unstable, in many areas of their lives, from their own identity to their relationships with others. As if standing on shifting sand, they often have an uncomfortable sense that things are always changing, and that can be scary. It can also lead to some of the unusual behaviors and reactions that people with BPD exhibit. Here are some other specific ways people describe experiencing life with this condition:

• Like being on a roller coaster, with everything always changing
• Feeling extremely sensitive and having intense reactions to what others consider to be small things
• Being unable to calm down or self-soothe after one of these intense reactions
• Feelings of guilt and shame later, after lashing out or doing something regretful
• Always feeling as if loved ones will leave and needing constant reassurance
• Feeling empty inside and often bored
• Being passionately in love with someone one day and hating him or her the next
• A feeling of being broken and unfixable
• Relationships and the feeling of being in love often seem addictive

To be diagnosed with BPD a person must see a mental health professional, preferably a psychiatrist, for a mental health evaluation. The professional will interview the patient, observe his or her behaviors and thoughts, and talk to family to determine if he or she meets the official diagnostic criteria for BPD based on experienced symptoms and their duration. To make a diagnosis of BPD, the psychiatrist must see that the patient has experienced at least five of nine symptoms that affect multiple areas of the patient’s life and that have been present in his or her life for a long period of time:

• A fear of abandonment. People with BPD live with a near-constant fear that loved ones, partners, or friends will abandon them. This leads to needy behaviors, frantic attempts to prevent abandonment, a strong need for validation, and jealous behaviors. Rather than keeping people close, though, this tends to drive them away.
• Difficulty with self-image. Most people with BPD have a very hard time developing a self-image, and what self-image they do have is unstable. A person may range from feeling good about who he is to hating himself or even believing he is all bad or evil. This shifting sense of self leads a person to change behaviors, jobs, activities, relationships, and other aspects of life often. It also causes a person to look externally for validation from others.
• Self-destructive and impulsive behaviors. A person with BPD may also engage in risky behaviors on an impulse, and they are often self-destructive: compulsive shopping or gambling, overeating, unprotected sex, drinking and driving, or using drugs.
• Unstable relationships. The instability in a person’s life and mind typically leads to unstable relationships with others. A person with BPD tends to fall in love quickly and passionately, but these relationships usually crash and burn. Relationships are either perfect and amazing or painful and horrible, with nothing in between.
• Extreme mood swings and emotions. Emotional instability is very common with BPD. This may manifest as extreme reactions to something minor and as mood swings from one extreme to another. Signs of depression can quickly lead to elation or anger and back to extreme sadness. Recovering from an emotional reaction or outburst can take a long time.
• Self-harm and suicide. Cutting, burning, and other self-injuries are not uncommon with BPD. Also typical are suicidal behaviors and threats and even suicide attempts.
• A chronic sense of emptiness. Many people with BPD feel a sense of emptiness that persists and is nearly impossible to overcome. Sometimes this manifests as boredom or as a feeling of being nobody. This feeling for many people is what leads to some of the risky behaviors characteristic of BPD. A person may seek out excitement or feelings of euphoria to fill the emptiness.
• Inappropriate anger. Among the many possible mood swings and emotional reactions, some people with BPD will experience intense periods of rage and anger. This usually includes inappropriate behaviors that are nearly impossible to control. The anger may be directed at others, but it is often directed internally.
• Losing touch with reality. Someone with BPD may also experience symptoms of psychosis, or losing touch with reality. It typically manifests as suspicion or paranoia. In some cases a person may experience dissociation, which is a sense of being unconnected to one’s body.

It is common for someone with BPD to have co-occurring mental illnesses. The symptoms of these often overlap with those of borderline personality disorder and can make diagnosis more difficult:

• Major depression
• Anxiety disorders, like obsessive compulsive disorder
• Substance use disorders
• Eating disorders
• Bipolar disorder
• Post-traumatic stress disorder
• Attention deficit hyperactivity disorder

BPD can also be confused with other personality disorders, particularly narcissistic personality disorder. Diagnostically, these two conditions are grouped together under the category of disorders that cause erratic, emotional, and dramatic behaviors. Similarities between a narcissist and someone with BPD include fear of abandonment and a need for attention, difficult relationships, and extreme emotions and mood swings.

The narcissist definition, however, also has some important differences from defining BPD. For instance, a narcissist has an inflated sense of self-worth and importance, exaggerates achievements, takes advantage of other people to get ahead, and needs praise and admiration.

When to Get or Offer Help

Knowing and being able to recognize the signs of BPD is so important because it allows someone to reach out for help or offer it to someone else in need. Anytime someone sees troubling behaviors like these in a loved one, it is crucial to try to get that person professional mental health assistance. Whether the diagnosis turns out to be BPD or something else, only a diagnosis will lead to the right, effective treatment.

While it is more difficult to recognize symptoms in oneself, individuals can reach out for help when experiencing troubling thoughts. Therapies, like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are particularly helpful. A trained therapist can help someone with BPD learn to manage emotions and live a life that is more stable and enjoyable. Medications can also be an important type of treatment.

Borderline personality disorder can cause many and varied symptoms that are troubling, uncomfortable, and destructive. The good news is that these symptoms can be managed if the patient is willing to put in the hard work in BPD treatment with a therapist. Over time, he or she can learn to manage the emotions and difficult thoughts caused by this condition and to live a useful and productive life.

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