Borderline Personality Disorder: Symptoms, Causes & Treatment

What are the symptoms of borderline personality disorder?

Borderline personality disorder (BPD) is a serious mental illness characterized by difficulties with regulating emotions. The main symptoms include:

  1. Unstable personal relationships
  • Intense fear of abandonment, real or imagined
  • Rapidly shifting from idealization to devaluation of others
  • Going to extreme measures to avoid real or perceived abandonment
  1. Disturbed sense of self
  • Persistently unstable self-image or sense of identity
  • Sudden changes in values, goals, career plans, etc.
  1. Impulsive and risky behaviors
  • Impulsive spending, unsafe sex, substance abuse, reckless driving
  • Self-harming behavior like cutting
  • Recurrent suicidal threats or gestures
  1. Extreme emotions and mood swings
  • Intense mood swings lasting hours to days (e.g. anxiety, irritability, dysphoria)
  • Feelings easily triggered by events or situations
  • Chronic feelings of emptiness
  1. Unstable sense of reality
  • Paranoid thoughts when under stress
  • Dissociative symptoms like feeling cut off from yourself
  1. Intense anger and difficulty controlling anger
  • Frequent displays of inappropriate, intense anger
  • Bitter, sarcastic humor during anger episodes

Symptoms typically emerge during adolescence or early adulthood and tend to be long-lasting. A pattern of instability in relationships, self-image, emotions and impulsivity is the hallmark. Treatment often involves psychotherapy and may include medications in some cases. With treatment, many are able to achieve remission and better quality of life.

What are the causes of borderline personality disorder?

The exact causes of borderline personality disorder (BPD) are not fully understood, but it is believed to result from a combination of the following factors:

Genetic Factors:

  • Studies suggest that people with BPD may have a genetic predisposition that makes them more susceptible to environmental triggers.
  • First-degree relatives of those with BPD are about 5 times more likely to develop the disorder.

Brain Factors:

  • Differences in the size and activity of certain brain regions involved in regulating emotions, impulsivity, and aggression have been observed in people with BPD.
  • These abnormalities may impact neurotransmitter systems like serotonin.

Environmental Factors:

  • Childhood trauma or abuse (sexual, physical, emotional)
  • Neglect or separation from caregivers
  • Disruptive family life or unstable home environment
  • Parental loss or illness at an early age

These adverse experiences, especially during critical periods of brain development, may play a key role in the development of BPD.

Neurobiological Factors:

  • BPD may involve dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which controls the stress response.
  • Issues with impulse control and emotional regulation may stem from abnormalities in the frontolimbic brain networks.

While no single cause is definitive, BPD likely arises from this combination of genetic vulnerabilities and environmental stressors that impact brain development and functioning. More research is still needed on the complex interplay of factors involved.

What is the treatment for borderline personality disorder?

The treatment for borderline personality disorder (BPD) typically involves a combination of psychotherapy and medication in some cases. The main treatment approaches include:


  • Dialectical Behavior Therapy (DBT) – This is one of the most effective treatments. It focuses on mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance skills.
  • Cognitive Behavioral Therapy (CBT) – Helps identify and change negative thought patterns and behaviors.
  • Schema-Focused Therapy – Addresses negative beliefs and patterns originating from childhood experiences.
  • Mentalization-Based Treatment (MBT) – Improves the ability to understand one’s own and others’ mental states.
  • Systems Training for Emotional Predictability and Problem Solving (STEPPS)


  • While there are no medications specifically for BPD, certain drugs may help treat specific symptoms:
  • Antidepressants (SSRIs, SNRIs) for associated depression, anxiety
  • Mood stabilizers like lamotrigine for mood swings
  • Antipsychotics for impulsivity, emotional dysregulation
  • Anti-anxiety medications for anxiety symptoms

Other Treatments:

  • Family therapy and psychoeducation for family members
  • Hospitalization for short periods during times of crisis
  • Treatment for any co-occurring conditions like substance abuse, eating disorders such as bulimia or anorexia nervosa etc.

The psychotherapeutic component is crucial for building emotional regulation skills and addressing the core problems of BPD. Medications play more of an adjunctive role in managing specific symptoms.

Treatment is long-term and can be very challenging, but many are able to achieve remission over time with appropriate, evidence-based treatment approaches tailored to their needs.

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About the Author: John Scott

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