Borderline Personality Disorder

Overview

Borderline personality disorder is a mental illness that affects how a person feels about themselves and others and makes it hard to function in everyday life. People with this disorder often have difficulty regulating emotions, leading to impulsivity, an unstable or often changing sense of self, and troubled relationships with others.

There are effective treatments for borderline personality disorder that can help people manage their symptoms, support well-being, and improve daily functioning.

Signs and Symptoms

People with borderline personality disorder may experience intense and sudden changes in interests, values, and feelings. They also tend to view things as extremes, such as all good or all bad. This is often seen in social interactions, which may swing from extreme closeness to extreme dislike, resulting in unstable relationships and emotional pain.

Other symptoms can include:

• Avoiding real or perceived abandonment, such as by jumping into or out of relationships quickly
• A pattern of intense and unstable relationships with family, friends, and loved ones
• High sensitivity to rejection and feelings of alienation or isolation
• A distorted and unstable self-image or sense of self
• Intense and highly variable moods, with episodes lasting from a few hours to a few days
• Chronic feelings of emptiness
• Inappropriate, intense anger or problems controlling anger
• Feelings of dissociation, such as being cut off from oneself, observing oneself from outside the body, or feeling disconnected from one’s surroundings
• Self-harming behavior, such as cutting
• Recurring thoughts of suicide, talking about threats suicide, or suicidal behaviors

Not everyone with borderline personality disorder experiences all these symptoms. The severity, frequency, and duration of symptoms vary depending on the person.

Important note: People with borderline personality disorder have a significantly higher rate of self-harm and suicidal thoughts and behavior than the general population. Anyone thinking of harming themselves or attempting suicide needs help right away. Encourage prompt contact with a mental health professional or the 988 Suicide & Crisis Lifeline by calling or texting 988, if necessary.

Related Health Effects

Most people with borderline personality disorder have at least one other mental disorder. Common, co-occurring mental disorders include:

• Anxiety disorders
• Impulse-control disorders
• Substance use disorders
• Depression or other mood disorders
• Post-traumatic stress disorder (PTSD)
• Bipolar disorder
• Eating disorders

People with borderline personality disorders also have a higher prevalence of metabolic disorders, such as diabetes and obesity.

These challenges can lead to significant distress and a lower quality of life.

Causes and Risk Factors

Although the exact cause of borderline personality disorder is unknown, research suggests that genetic, physical, environmental, and social factors may increase the risk of developing the disorder. These include the following risk factors:

• Family history: People with a close family member (such as a parent or sibling) with the disorder may be at a higher risk of developing borderline personality disorder.
• Brain structure and function: Research shows that people with borderline personality disorder may have structural and functional changes in the brain, especially in areas that control impulses and regulate emotions. However, it is unclear whether these brain changes are risk factors for the disorder or a product of having the disorder.
• Environmental, cultural, and social factors: Many people with borderline personality disorder report experiencing traumatic life events, such as abuse, neglect, maltreatment, abandonment, or hardship during childhood. Others may have been exposed to unstable, invalidating relationships or frequent interpersonal conflicts.

Although these factors may increase the risk for borderline personality disorder, experiencing them doesn’t mean a person will develop the disorder. Likewise, people without these risk factors can have the disorder as well.

Diagnosis

A licensed mental health professional can diagnose borderline personality disorder based on a thorough discussion of symptoms and personal and family history, including history of mental illness. A medical exam can further rule out other possible causes.

Borderline personality disorder is usually diagnosed in late adolescence or early adulthood. Occasionally, a person younger than 18 years may meet full criteria for the disorder.

Treatment and Management

Evidence-based treatments have been shown to help many people with borderline personality disorder experience fewer and less severe symptoms, improve their functioning, and have a better quality of life. People with the disorder should receive treatment from a licensed mental health professional.

Many factors affect how long symptoms take to improve once treatment begins. It is also important to not only seek out but also stick with treatment. National Institutes of Health (NIH) research shows that people with borderline personality disorder who do not receive adequate treatment are more likely to develop other chronic illnesses and are less likely to make healthy lifestyle choices.

Psychotherapy

Psychotherapy, or talk therapy, is the primary treatment for borderline personality disorder. Most psychotherapy occurs with a mental health professional in one-on-one sessions or with other people in group settings. Group sessions may help people with the disorder learn to interact more constructively with others and express themselves more effectively.

Psychotherapies used to treat borderline personality disorder include:

• Dialectical behavior therapy: This treatment uses mindfulness or awareness of one’s present situation and emotional state. It also teaches skills to help people control intense emotions, reduce self-destructive behaviors, and improve relationships.
• Cognitive behavioral therapy: This treatment helps people identify and change core beliefs and behaviors that come from false perceptions of themselves and others and improve interactions with others. It can help reduce mood swings, anxiety, and self-harming or suicidal behaviors.

Studies of other mental disorders show that including family members in therapy can help support a person’s treatment, but more research is needed to determine how much family therapy helps with borderline personality disorder.

Medicine

Medicine is not a first-line treatment for borderline personality disorder, and the benefits of medicine are unclear. In some cases, a healthcare provider may recommend medicine as an add-on to psychotherapy to treat specific symptoms or co-occurring conditions, such as mood swings or depression. Treatment with medicine may require coordinated care from more than one provider.

Living With Borderline Personality Disorder

Here are some ways to help a friend or family member with borderline personality disorder:

• Learn about the disorder to better understand what your loved one is experiencing.
• Change can be difficult and frightening for people with borderline personality disorder, but things can improve with time. Offer emotional support, validation, understanding, patience, and encouragement.
• Encourage your loved one to ask about family therapy. It is also important that they receive appropriate treatment for any co-occurring mental and physical conditions.
• Help your loved one take their medicines as prescribed and encourage them to discuss problems or concerns with their healthcare provider before stopping a medicine or making any changes.
• Learn about your loved one’s treatment plan and find ways to help support their goals. Be open to learning new ways to offer support that are consistent with treatment goals.
• Encourage structure through daily scheduling and prioritizing a healthy lifestyle.
• Take comments about possible self-harm or suicide seriously. Encourage prompt contact with a mental health professional or the 988 Suicide & Crisis Lifeline by calling or texting 988, if necessary.

Overall, take your cue from your loved one as to how much they wish you to be involved with their treatment and help them reach their short- and long-term goals.

Support for Family Members

Having a loved one with borderline personality disorder can be stressful. Therapy for caregivers and family members is often helpful and is integrated into some dialectical behavioral therapy treatment programs, especially for young people. Families and caregivers can benefit from therapy by:

• Choosing a different therapist than the one your friend or family member is seeing
• Learning more about the disorder, such as how to avoid unintentionally acting in ways that worsen symptoms
• Developing skills to understand and support a person with borderline personality disorder
• Learning about the needs and obstacles they face in caring for someone with the disorder and developing strategies to overcome them

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on borderline personality disorder.

Find Treatment

To find help, talk to a primary care provider. They can refer you to a qualified mental health professional or clinical social worker to help figure out next steps.

You can find support and locate mental health services in your area on the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

Community Support

For information and support:

• The National Alliance on Mental Illness (NAMI) offers support groups and family education programs for people with an anxiety disorder and their loved ones. The NAMI HelpLine can connect you with the NAMI office in your state and help you find programs close to home.
• Mental Health America is the nation’s leading nonprofit dedicated to the promotion of mental health, well-being, and condition prevention. They provide resources for understanding your mental health, helping loved ones, or accessing information for personal, academic, or professional purposes.
• SAMHSA provides information about causes, signs and symptoms, and treatment options for Borderline Personality Disorder.

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH supports research to explore how a person’s biology and environment contribute to borderline personality disorder. Researchers are studying the influence of genetic and brain-based differences, and the impact of cultural and social factors.

NIH also supports research on how well treatments work, and whether emerging therapies and medicine can help. NIH is pursuing promising avenues for improving early intervention and personalized treatment strategies.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.