12 Signs of Borderline Personality Disorder, According to Therapists
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EVERYONE FEELS INTENSE emotions from time to time, especially in stressful situations. But, some people struggle to regulate their emotions—so much so that their mood can change in split second, and they might act impulsively. And, because of it, they often have relationship problems.
If these behaviors sound familiar, you or someone you love might have borderline personality disorder (BPD).
BPD is a mental health condition where self-regulation of emotions is difficult. People “feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event,” according to the National Alliance on Mental Illness (NAMI).
“The disorder causes dysfunction in everyday living for individuals, as it impacts the way they think and feel about themselves, others, and the world,” says Anna Claire Seanor, M.Ed., APC, NCC, a clinician at The Berman Center, a mental health and substance abuse treatment center in Atlanta.
People with the disorder find it challenging to respond to situations in emotionally appropriate and acceptable ways, Seanor says. This can lead to impulsivity, poor self-image, unstable relationships, and sometimes self-harm.
Overall, the condition is rare, affecting about 1.4 percent of American adults, and most of those diagnosed have historically been women. However, according to NAMI, men are likely equally affected, but their BPD may be misdiagnosed.
Still, BPD can take a toll on individuals with the condition and their loved ones. “If left untreated, individuals with an inability to regulate emotions will experience dysfunction in areas of life including work, school, relationships, and social interactions, which negatively impacts holistic wellness and quality of life,” Seanor says.
What is borderline personality disorder?
BPD can be an “enigma,” says Elizabeth Keohan, LCSW-C, a licensed Talkspace therapist. “It's often marked by an extreme fear of abandonment, intense anger, and a pronounced difficulty within relationships.”
Relationships are chaotic and unstable because people with BPD often suddenly and dramatically change their views of others, according to Cleveland Clinic. They might idealize someone one day, and despise them the next.
Also, people with BPD exhibit mood fluctuations and impulsive behaviors, and routinely threaten self-harm.
Individuals also tend to have an unstable, distorted, or unclear self-image. They regularly feel shame and often perceive themselves as “bad,” according to Cleveland Clinic. So they might suddenly change their goals, careers, or friends, and sabotage their own success, such as by getting fired from jobs or ruining relationships.
What causes BPD isn’t fully understood, but most experts agree that it’s likely a mix of factors, including genetics, brain function, and traumatic events like childhood physical or sexual abuse and neglect, separation, or poor boundaries with parents.
Who’s most likely to have BPD?
Women have historically been diagnosed with BPD more frequently, but Keohan believes it’s a “diagnostic bias.” Research suggests that all genders likely experience BPD equally.
The condition sometimes presents differently in men vs. women, though. Seanor says men with BPD may display a history of substance abuse, explosive temperaments, and antisocial behaviors. Women may show eating, mood, anxiety, and post-traumatic stress disorders.
“This distinction is important to recognize when examining gender discrepancies in the diagnosis of BPD,” she says.
Women also may be more likely to seek psychotherapy and receive a BPD diagnosis. Men might more commonly use rehab and addiction treatments for substance abuse, and may be misdiagnosed as having post-traumatic stress disorder (PTSD) or depression.
“It’s also significant to note that as a result of their explosive and antisocial tendencies, men are more likely to be incarcerated and not have access to mental health treatment, causing them to be more underrepresented,” Seanor says.
Signs of borderline personality disorder
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), signs of BPD include:
Patterns of unstable or changing relationships—that alternate between idealization and devaluation of someone
Fear of abandonment
Unstable self-image
Struggles with identity or sense of self
Impulsive or self-damaging behaviors—like excessive spending, substance abuse, reckless driving, or unsafe sex
Self-harm, including suicidal threats or attempts
Mood swings—periods of intense anxiety, depressed moods, or irritability that last for hours or days
Constant feelings of worthlessness or sadness
Inappropriate, intense, or uncontrollable anger—that’s sometimes followed by shame or guilty feelings
Paranoia or loss of grasp of reality, caused by stress
Persistent feelings of boredom, emptiness, or dissatisfaction
Dissociative feelings, where someone disconnects from their thoughts or sense of identity
How loving someone with BPD affects you
Relationships are difficult for people with BPD. That’s because they have a serious fear of abandonment, struggle to regulate emotions, and act impulsively and recklessly, according to Cleveland Clinic. They’re prone to angry outbursts and rapid mood swings, too.
“These symptoms can push loved ones away—causing those with BPD to have more instability with increased sadness, worthlessness, and fear,” Seanor says. “This cycle is difficult for anyone close to individuals with BPD.”
The intense emotions and a strong sense of abandonment lead people with BPD to believe their partners or loved ones will leave them, so they often want a constant validation of their commitment, Keohan says
Still, “Loving someone with BPD isn’t an impossible task,” she says. Informing yourself about the condition is an essential step in navigating the relationship and dealing with the challenges.
“We don’t ever want to see our loved ones suffer, and that can be the challenge here,” Keohan says. “Though at the end of the day, we can never maintain a healthy relationship if we don’t take time for ourselves.”
Is BPD treatable?
People living with BPD don’t always know they have the condition or realize that healthier ways of handling emotions and relating to others exist.
Psychotherapy and medication are common treatments for BPD, according to NAMI. Another is dialectical behavior therapy, which educates people on life skills and emotional regulation, Keohan says.
However, seeking treatment may be difficult for people with BPD, she explains. “Therapy can be a type of relationship, too, and still in modern times, feel and be perceived as stigmatic. Discourse can be a challenge in terms of establishing rapport and trust.”
Trying to push a loved one into getting treatment might thrust them deeper into their illness, Seanor says. “It’s important for loved ones to point out signs in a caring, supportive, and nonjudgmental manner while also attuning to their own needs.”
What to do when a partner or loved one has BPD
Relationships aren’t just difficult for people with BPD. The condition affects everyone around them.
Seanor says research shows that validating a person with BPD’s feelings and emotions—not agreeing with them—can help de-escalate, ground, and calm them down. “This can be difficult, as the emotional reaction often doesn't make sense to those not affected by the disorder,” she adds.
Setting boundaries can help, too. Seanor says boundaries create structure and accountability. “Holding individuals accountable for their emotional reactions helps prevent close ones from enduring unacceptable and potentially harmful behaviors,” she says, and it creates room for growth and healing for everyone in the relationship.
Seek out a mental health professional if it all gets to be too much. Keohan says this will help you learn how to cope with your relationship and how best to move forward.
“BPD is treatable, and if your partner has been diagnosed with it, it doesn’t necessarily change who they are or why they love you,” she says. “Leaving prematurely can be damaging to both of you, but certainly, it can impact any future trust issues.”
But if the relationship is harmful to you—mentally, emotionally, or physically—Seanor says it’s usually best to end things.
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