Borderline personality disorder (BPD) is a serious mental illness characterized by a pervasive instability in self-identity and self-image, which causes drastic mood swings, erratic behaviors and problematic personal relationships. People with BPD frequently struggle with suicidal thoughts, co-occurring mental illnesses — like anxiety and depression — and drug or alcohol use disorders as well.
The weight of these conditions can deeply disrupt an individual’s sense of identity and the daily struggle with intense and painful emotions can make achieving consistency in their personal and professional lives seem impossible. However, BPD can be managed through a variety of therapy methods, and borderline personality disorder treatment can be effective for people who struggle with BPD.
Whether or not you have BPD, if you are considering suicide, you’re not alone. There are people who can help you work through these difficult thoughts. Call the National Suicide Prevention Hotline at 1-800-273-TALK (8255) or text the Crisis Text Line (text HOME to 741741) at any time of the day or night to speak with someone who cares.
What Is Borderline Personality Disorder?
Given the abundance of misinformation about BPD, many people turn to the internet for the answers to questions like, “What is borderline personality disorder?” and “What is BPD?” Put simply, BPD is a severe mental illness that can affect every aspect of someone’s life, from disrupting their sense of self to distorting their view of the people they love and the world.
People who have BPD struggle with regulating their overwhelming emotions, including any suicidal thoughts, and often engage in self-harming behaviors as a result. A complex condition, borderline personality disorder affects only 2 percent of adults in the United States, but of all diagnosed cases, 75 percent occur in women.
Three defining behavioral qualities of BPD, or borderline personality disorder symptoms, are the experience of extreme emotions, an unstable sense of identity and interpersonal relationship difficulties.
Extreme Emotional Experiences
BPD is characterized by intense emotions and a decreased ability to control them. People who have BPD experience frequent mood swings, and their daily emotions can be unpredictable, extreme and their reactions can be seemingly unprovoked. Overwhelming feelings of anger, emptiness, detachment, anxiety, paranoia, abandonment and despair are all common for people who have BPD. The individual’s impaired ability to regulate these difficult emotions only exacerbates their emotional and mental well-being.
Shifting Self-Image and Sense of Identity
The self-image of a person with BPD is particularly fragile and vulnerable. The instability is witnessed in various ways, including shifts in opinions, sexual identity, career goals, values and the types of friends they choose. It may seem as if the person with BPD can change their personality on a whim, which can repeatedly throw their entire identity into question. For instance, a person with BPD may behave submissively (seeming to have a needy personality) toward a caregiver and then, suddenly, become highly assertive to avenge a perceived wrong. The internal emotional shifts of a person with BPD and the resulting changes in outward behavior make it difficult to pinpoint the person’s core character.
Individuals with BPD usually do not possess a refined level of innate interpersonal skills. Relationships require time to build trust and understanding, but a person with BPD most often has their own relationship timeline, and it is usually one that does not sync with reality or human nature.
People with BPD are prone to see the world, and people, in terms of black and white, missing the many shades and nuances of human interaction. This process is called “splitting.” Someone with BPD may adore, and then demonize, their loved ones, and “split” them into two categories. This can push friends and family members away and leave the person with BPD with feelings of frustration and social isolation. These “splits” can hinder the formation of new relationships and friendships for people with BPD, and the cycle of overwhelming (and often unwelcome) feelings and isolation from loved ones only worsens someone’s BPD symptoms.
For instance, a person with BPD will idealize a person in the earliest stages of interaction and demand excessive time and attention. When this attention is not provided, which is most often inevitable, the person with BPD is apt to feel abandoned and demonize the person who has disappointed them. The individual will likely broadcast these feelings, making calls, sending texts, emails and other forms of communication to convey their adoration, and then their acute disappointment. This pattern tends to repeat from person to person, making it clear that these emotions are not a response to the real relationship dynamic, but a sign of internal disordered thinking.
Borderline Personality Disorder Symptoms
There are numerous borderline personality disorder symptoms, but its main hallmarks are intense emotional displays and impulsive acts like self-harm and suicide attempts. The full range of BPD symptoms may include:
- Shifting sense of self-identity
- Self-injury behaviors
- Instability in interpersonal relationships
- Rapid mood fluctuations
- Inability to control emotional outbursts
- Frequent bouts of anger or aggression
- Stress-related paranoia
- Feelings of emptiness
- Intense fear of abandonment
- Feelings of loneliness and social isolation
- Impulsive behaviors
- Risky behaviors, like promiscuity and drug use
- Suicidal thoughts or attempts
Not everyone who faces BPD will experience each of these symptoms, and like most personality disorders, the intensity of the symptoms will decrease with age. People who have BPD and are in their 40s and 50s will likely experience the least severe symptoms.
Types of Borderline Personality Disorder
There are at least four different types of borderline personality disorder, each with their own set of defining characteristics.
The discouraged borderline type of BPD is defined by excessive dependence on others, avoidant behavior and recurring cycles of depression, aloofness, paranoia and irresponsible behavior. People who struggle with this type of BPD also face overwhelming feelings of abandonment by others, which can trigger self-persecution behaviors, psychotic episodes and suicide attempts.
Borderline Impulsive Type
Two defining characteristics of the borderline impulsive type of BPD are antisocial tendencies and approval-seeking behaviors. People with this specific type of BPD are often described as being in constant conflict with society and are prone to unprovoked outbursts of violence. They may feel simultaneously desperate for attention as well as antisocial and may be convinced that other people need to be punished for the mental anguish they experience.
Individuals who struggle with the petulant borderline subset of BPD typically engage in passive-aggressive behaviors, guilting and manipulating their loved ones to get what they want, without recognizing this as unhealthy. Unable to express their needs in a healthy way, people with petulant borderline may injure themselves to garner attention and may not take responsibility for their actions or their interpersonal relationship issues.
Self-injury and severe depression are the two defining features of the self-destructive borderline subset of BPD. Someone with self-destructive borderline may loathe themselves and others, and struggle with various types of self-harming behaviors. These individuals may feel that no one cares about their well-being, and in turn, they inflict injuries upon themselves, preferring to feel physical pain instead of feelings of abandonment.
Diagnosing Borderline Personality Disorder
Most often, a BPD diagnosis occurs in early adulthood, but many people struggle with borderline personality disorder symptoms for several years before they receive a formal diagnosis, or any kind of BPD treatment. A licensed mental health professional (psychiatrist, psychologist, etc.) can diagnose BPD in several ways, including:
- Thorough interviews, where the client’s daily symptoms are discussed in depth
- Comprehensive clinical exams, which can rule out other illnesses
- Reviews of family medical history, to identify a generational line of mental illness
Diagnosing BPD can be particularly challenging as borderline personality disorder can be intertwined with similar conditions, like anxiety, depression, bipolar disorder, eating disorders and substance use disorders.
What Causes Borderline Personality Disorder?
Despite the efforts of numerous clinical psychologists and researchers, it remains unclear what causes borderline personality disorder. However, many individuals with BPD have a history of abuse, trauma and neglect. Researchers believe that along with these factors, a family history of BPD may be one of the most significant borderline personality disorder causes. In fact, BPD is almost five times more common among individuals who have an immediate family member with BPD. Other theories about what causes borderline personality disorder include an increased vulnerability to environmental stress as well as poor lifestyle choices made by the individual with BPD.
BPD Risk Factors
The exact cause of BPD remains unclear, but research suggests that a collection of biological and environmental factors influence someone’s risk of developing BPD. Some BPD risk factors can include:
- Environmental factors: Traumatic life events, abuse, abandonment, unstable living situations and more negative cultural or social situations can raise someone’s risk of developing BPD.
- Changes in brain chemistry: While the research on brain chemistry and BPD is still emerging, research shows that the areas of the brain that regulate impulses and emotions may be impaired in people who have BPD.
- Familial history of mental illness: People whose parent(s) or sibling(s) struggle with BPD or another form of mental illness may risk developing BPD themselves.
The presence of these risk factors does not mean someone will develop BPD, and likewise, people who never face these factors may still experience BPD.
BPD and Substance Abuse
Unfortunately, borderline personality disorder and substance abuse often go hand in hand, but what is it about borderline personality disorder that makes it easier to misuse alcohol or drugs? While BPD is a complicated mental illness, the impulsivity that characterizes it also contributes to substance abuse. Individuals with BPD are particularly prone to engage in risky and self-injurious behavior. The tendencies of this disorder perversely dovetail into the conditions that are conducive to substance abuse. People with BPD may also over-spend, binge eat and engage in promiscuous sexual behaviors. Like substance misuse, these are pleasure-seeking behaviors that involve short-term thinking and do not consider long-term consequences.
According to a review of relevant research published in the scholarly journal Innovations in Clinical Neuroscience, having one or more psychiatric disorders increases the likelihood of also misusing drugs or alcohol. This association is especially strong when the psychiatric disorder is BPD. As almost 40 percent of people who have BPD may also have a substance use disorder, a screening for drug misuse should likely co-occur with a diagnosis of BPD. Further, it’s imperative that borderline personality disorder treatment incorporates specific therapy options to address both borderline personality disorder and substance abuse.
The statistics surrounding borderline personality disorder reveal the unfortunate realities of this condition and the common struggles people with BPD face.
- BPD affects almost 2 percent of American adults.
- Up to 80 percent of people with BPD attempt suicide at least once.
- Almost 75 percent of all BPD cases occur in women.
- Approximately 20 percent of all inpatient psychiatric admissions are for BPD.
- Almost 38 percent of people with BPD met the criteria for a drug use disorder.
- Up to 71 percent of people in treatment for BPD report sexual abuse by a non-caregiver.
Borderline Personality Disorder Treatment
Borderline personality disorder treatment should include evidence-based, personalized care from a licensed mental health provider skilled in treating BPD. Psychotherapy is often the most effective form BPD treatment, and can include:
Dialectical Behavioral Therapy
Dialectical behavioral therapy (DBT) is one of the most common, and effective, treatments for BPD. An evidence-based type of psychotherapy, DBT involves “talk therapy,” formulating behavior strategies and intensive skills training to build healthy coping mechanisms for everyday life. The four main tenets of DBT focus on mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. People with BPD can meet one-on-one with a mental health counselor certified in DBT treatment and practice adaptive behaviors in group therapy sessions for a well-rounded therapeutic experience.
Cognitive Behavioral Therapy
Another type of psychotherapy that is beneficial in treating BPD, cognitive behavioral therapy (CBT) focuses on the relationships between someone’s thoughts, feelings and behaviors. In CBT, a mental health professional can help people with BPD understand the connection between unhealthy thoughts patterns and self-destructive behaviors and how to develop constructive thoughts, beliefs and actions.
One of the most common misconceptions about BPD is that it can be treated with medication. This condition is not a mental illness that can be medicated, and the Food and Drug Administration has not approved any specific type of BPD medication. However, borderline personality disorder symptoms and side effects, such as depression, can be mitigated with some medications. Which medications are most beneficial to treat BPD symptoms depends on the person with BPD and can be determined by a psychiatrist.
Borderline Personality Disorder and Substance Abuse Treatment
From a treatment perspective, people with BPD may face numerous complications in drug or alcohol rehab. Given their extreme mood swings, they may simultaneously demand and reject treatment, or switch between appreciating their doctors and vilifying them. This behavior makes BPD and substance use disorder treatment particularly challenging, for both the client and their medical team. Additional challenges with BPD and substance use disorder treatment may include:
- Interpersonal problems with the therapist, which only the most qualified and experienced therapists may be able to successfully work through
- Difficulty in a group therapy setting, which is a cornerstone of treatment
- Aftercare plans may be more difficult to develop, and must be nuanced and comprehensive enough to address not only substance abuse but also risky behaviors, like refusing to take prescribed psychiatric medications
In view of the many needs of people who struggle with BPD and addiction, it is especially necessary that they seek out a dual diagnosis treatment center, like The Recovery Village. In rehab centers that offer dual diagnosis treatment, the client can receive BPD treatment on site. As medications will likely be prescribed to treat the BPD, the overseeing psychiatrist will be able to treat this disorder while addiction specialists (doctors, counselors and psychotherapists) treat the substance use disorder. A person with a dual diagnosis, or who struggles with borderline personality disorder and substance abuse, may enroll in rehab treatment that includes:
- Medical detox, inpatient treatment and outpatient
- Individual psychotherapy and group therapy
- Complementary therapy options, such as yoga and nutritional counseling
- Aftercare planning
Both BPD and substance use disorders are treatable, and effective treatment may be closer than you think. The Recovery Village is exceptionally well equipped to help people heal from substance use disorders and mental health disorders like BPD. Call The Recovery Village today at 352.771.2700 to learn more.