What Does Borderline Personality Disorder Look Like?
You’re concerned about what you’ve been seeing in your spouse, child, friend, or other loved one. What does borderline personality disorder (BPD) look like, and how can it change a person’s behavior?
1. Difficulty Maintaining Responsibilities
BPD often causes people to have an unstable sense of self. This can mean sudden and major shifts in hobbies, career choices, types of friends, and priorities. These shifts in values can trigger dramatic changes in performance at work or school in a short time. A review in Innovations in Clinical Neuroscience found that about half of people with BPD are unemployed, and many live on disability.
2. Black-and-White or Extreme Thinking
People with BPD can experience the world around them as a series of extremes – black and white, good and bad. These evaluations can vary rapidly, such as cycling between viewing a friend as a savior one week and as a traitor the next. Appreciating shades of grey and subtle differences, especially in interpersonal situations, may be very difficult for people with BPD. Instead, they may view people, circumstances, or influences as all good (idealization) or all bad (devaluation).
According to the National Institute of Mental Health (NIMH), these changes may be the result of how the BPD brain processes information coming in from the world. They found that people with BPD are more likely to read a neutral face as angry and to have more powerful reactions to negative words than people without BPD.
3. Mood Swings
BPD can cause a baseline depressed mood that easily swings to hollowness, detachment, irritability, or anxiety, which can last for hours to days. Sometimes these can spike to extremes such as anger, paranoia, panic, or despair. This can make it difficult to predict how someone with BPD will react to a situation; they may be more powerfully guided by their internal state than by what’s going on in the world around them. Other times, these emotions can be powerful overreactions to the stresses at hand.
4. Outbursts of Anger and Aggression
Sudden surges of anger can take the form of verbal outbursts, loss of temper, and antagonistic behavior. Sarcasm or bitterness is common. If anger is focused on a particular person, arguments might even escalate into physical fights. In extreme case, aggression can even fuel violence; an analysis in Innovations in Clinical Neuroscience found that BPD predicts psychological, physical, and sexual aggression, and it is linked to violent crime.
5. Unstable Behavior and Attitudes in Relationships
Because of rapidly shifting views and emotions, people with BPD often struggle to maintain relationships. These relationships might feel like they have two settings: on and off, with no in between. At times, the person may view you as their best friend and confidant, sharing a torrent of personal details and wanting to spend hours and hours together. This may abruptly change, with the person thinking that you don’t care or don’t offer enough, or that you are actively working to hurt or torment them. These feelings can make the person lash out. Another possibility is that the person may present himself as a source of available emotional support in a relationship, only to demand in return that you are constantly on call to tend to his needs.
These stresses take their toll on relationships. The Journal of Family Psychology reports that BPD is linked with low relationship satisfaction, marital distress, separation, and divorce.
6. Intense or Unreasonable Fears of Abandonment
People with BPD often find that their self-image or self-worth has become entangled in their relationships with others. This can create an intense, irrational fear of abandonment – if someone leaves a person with BPD, she might conclude that it means she is a worthless or terrible person. Thoughts of being abandoned can provoke fury, panic, or despair. Even pre-appointed separations, such as the end of a therapy appointment, can be enough to trigger these feelings. People with BPD may go to great lengths to keep others near, engaging in desperate acts like manipulating, lashing out, destroying property, self-mutilation, or even threatening suicide.
7. Risky and Impulsive Behavior
BPD makes people more likely to engage in impulsive or risky behaviors, such as:
8. Self-Injury and Suicide
The raging emotions that people with BPD experience can be difficult control, and anything that offers a release can seem appealing. This can include self-injury (such as cutting, hitting, burning, hair pulling, or head banging), or even suicide. NIMH reports that as many as 80 percent of people who live with BPD have engaged in self-injury or attempted suicide and between 4 and 9 percent of people with BPD succeed in committing suicide.
A paper in the Journal of Abnormal Psychology found the reasons women with BPD reported for engaging in self-injury included:
- To express anger
- To punish themselves
- To try to generate normal feelings
- To distract themselves
- To relieve negative emotions
By contrast, the two main reasons for attempting suicide were to escape negative emotions and to make others better off.
Behaviors Caused by Co-Occurring Mental Disorders
- 60 percent of people with BPD also experience major depressive disorder
- 70 percent of people with BPD also experience dysthymia (chronic, mild to moderate depression)
- 25 percent of people with BPD also experience eating disorders
- 25 percent of people with BPD also experience antisocial personality disorder
- 25 percent of people with BPD also experience narcissistic personality disorder
- 15 percent of people with BPD also experience bipolar disorder
These disorders can cause a wide range of other behaviors that are not directly attributable to the BPD itself.
BPD with Co-Occurring Drug & Alcohol Addiction
A person with the co-occurring disorders of substance abuse addiction and BPD have some unique challenges.
• Nearly half of people with BPD have a history of prescription drug abuse.
• 50.7% of people diagnosed with BPD also had a diagnosis of a substance use disorder over the last 12 months.
• Individuals with BPD experience higher rates of substance use disorder onset even when their BPD symptoms improve.
Another study found that:
- 57 percent of people with BPD also received a diagnosis of a substance use disorder (SUD)
- 49 percent of people with BPD met criteria for alcohol use disorder
- 38 percent of people with BPD met criteria for a drug use disorder
- 25 percent of people with any SUD met criteria for BPD – by comparison, BPD only affects about 1 to 2 percent of Americans, reports the National Alliance on Mental Illness (NAMI)
- 14 percent of people with alcohol abuse or dependence met criteria for BPD
- 22 percent of people with cocaine abuse or dependence met criteria for BPD
- 34 percent of people with opioid abuse or dependence met criteria for BPD
Alcohol and drugs can exacerbate the impulsivity, suicidal, and self-harm risks associated with BPD. The presence of BPD can also worsen the symptoms and behavior related to addiction.
Additionally, people with dual diagnosis are at a higher risk for relapse. Relapse prevention must focus on abstinence from substances, freedom from self-harm and any other risky behaviors.
If a person with BPD displays symptoms of drug or alcohol addiction, it is critical that this individual is assessed for a co-occurring substance use disorder.
Evaluation and treatment for BPD, when it includes a co-occurring substance use disorder, requires the expertise and guidance of a professional team that specializes in dual-diagnosis and treating co-occurring disorders through a holistic approach.
This team can include an individual therapist, a group therapist, a substance abuse counselor, a psychiatrist, and a primary care provider.
Treatment is a coordinated effort amongst all of the providers to ensure everyone is working towards the same, individualized goals for the patient.
Getting Help for a Loved One with BPD
Fortunately, there is help available for borderline personality disorder. A combination of therapy and medication can be effective in treating BPD. At The Recovery Village, we can help you get your loved one the treatment they need. There is hope – find out more by calling us today at 352.771.2700
Sansone, Randy MD. “Employment in Borderline Personality Disorder.” Innovations in Clinical Neuroscience, September 9, 2012. Accessed March 11, 2019.
National Institute of Mental Health. “Borderline Personality Disorder.” December 2017. Accessed March 11, 2019.
Sansone, Randy MD. “Borderline Personality and Externalized Aggression.” Innovations in Clinical Neuroscience, March 9, 2012. Accessed March 11, 2019.
Disney Krystle, Weinstein Yana, Oltmanns Thomas. “Personality Disorder Symptoms Are Differentially Related to Divorce Frequency.” Journal of Family Psychology, December 26, 2012. Accessed March 11, 2019.
Brown, Milton Z., Comtois, Katherine Anne, Linehan, Marsha M. “Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder.” Journal of Abnormal Psychology, Feb 2002. Accessed March 11, 2019.
SAMHSA. “An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders.” 2014. Accessed March 11, 2019.
NAMI Michigan. “Borderline Personality Disorder.” (n.d.) Accessed March 11, 2019.
Trull Trull, Freeman Lindsey, Vebares Tayler, Choate Alexandria, Helle Ashley, Wycoff Andrea. “Borderline personality disorder and substance use disorders: an updated review.” Borderline Personality Disorder and Emotion Dysregulation, Sep 19, 2018. Accessed March 11, 2019.