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Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image and functioning. These experiences often result in impulsive actions and unstable relationships. A person with BPD may experience intense episodes of anger, depression and anxiety that may last from only a few hours to days.

Some people with BPD also have high rates of co-occurring mental disorders, such as mood disorders, anxiety disorders and eating disorders, along with substance abuse, self-harm, suicidal thinking and behaviors, and suicide.

While mental health experts now generally agree that the label "borderline personality disorder" is very misleading, a more accurate term does not exist yet.

Signs and Symptoms

People with BPD may experience extreme mood swings and can display uncertainty about who they are. As a result, their interests and values can change rapidly.

Other symptoms include:

• Frantic efforts to avoid real or imagined abandonment.
• A pattern of intense and unstable relationships with family, friends and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation).
• Distorted and unstable self-image or sense of self.
• Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving and binge eating.
• Recurring suicidal behaviors or threats or self-harming behavior, such as cutting.
• Intense and highly changeable moods, with each episode lasting from a few hours to a few days.
• Chronic feelings of emptiness.
• Inappropriate, intense anger or problems controlling anger.
• Having stress-related paranoid thoughts.
• Having severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body or losing touch with reality.

Seemingly ordinary events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations — such as vacations, business trips or sudden changes of plans — from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Some of these signs and symptoms may be experienced by people with other mental health problems — and even by people without mental illness — and do not necessarily mean that they have BPD. It is important that a qualified and licensed mental health professional conduct a thorough assessment to determine whether or not a diagnosis of BPD or other mental disorder is warranted, and to help guide treatment options when appropriate.

Tests and Diagnosis

Unfortunately, BPD is often underdiagnosed or misdiagnosed. A licensed mental health professional experienced in diagnosing and treating mental disorders — such as a psychiatrist, psychologist or clinical social worker — can diagnose BPD based on a thorough interview and a comprehensive medical exam, which can help rule out other possible causes of symptoms.

The licensed mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish BPD from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional's attention.

Research is underway to look for ways to improve diagnosis of and treatments for BPD, and to understand the various components of BPD and other personality disorders such as impulsivity, relationship problems and emotional instability.

Risk Factors

The causes of BPD are not yet clear, but research suggests that genetic, brain, environmental and social factors are likely to be involved:

• Genetics: BPD is about five times more likely to occur if a person has a close family member (first-degree biological relative) with the disorder.
• Environmental and social factors: Many people with BPD report experiencing traumatic life events, such as abuse or abandonment during childhood. Others may have been exposed to unstable relationships and hostile conflicts. However, some people with BPD do not have a history of trauma, and many people with a history of traumatic life events do not have BPD.
• Brain factors: Studies show that people with BPD have structural and functional changes in the brain, especially in the areas that control impulses and emotional regulation. However, some people with similar changes in the brain do not have BPD. More research is needed to understand the relationship between brain structure and function and BPD.

Research on BPD is focused on examining biological and environmental risk factors, with special attention on whether early symptoms may emerge at a younger age than previously thought. Scientists are also studying ways to identify the disorder earlier in adolescents.