Borderline personality disorder (BPD) is often talked about in extremes in terms of intense emotions, impulsive behavior, and rocky relationships. However, what does it actually mean to live with BPD? While everyone faces emotional ups and downs, those with BPD may feel like they’re on a constant roller coaster.
Despite being challenging, BPD is not a life sentence. Many people with the disorder are able to find stability, growth, and meaningful connections with the right support and treatment. Here’s everything you need to know about borderline personality disorder, including what it is, what causes it, and treatment options.
Borderline personality disorder is a mental health condition that affects a person’s emotions, relationships, and self-identity. People with BPD struggle with:
Essentially, the brain processes emotions differently in those with BPD, which makes it harder to regulate feelings or handle stress in an appropriate way. For example, small disagreements can make you feel like you are being abandoned, even if the other person didn’t intend to cause harm.
BPD and bipolar disorder (BD) can look similar on the surface, which is why they are frequently confused. Here’s a comparison between the two conditions:
Borderline Personality Disorder vs. Bipolar Disorder | |
Borderline Personality Disorder | Bipolar Disorder |
Emotions change quickly, sometimes within minutes or hours, and are triggered by external events. | Mood episodes can last for days, weeks, or months, and they happen independently of specific life events. |
Activity levels are stable, and there are no drastic fluctuations in energy. | During mania or hypomania, a person may feel restless or impulsive. Depressive episodes can cause extreme fatigue and withdrawal. |
Impulsivity is emotionally driven as a way to cope with difficult emotions. | Impulsivity happens during manic or hypomanic episodes due to poor decision-making. |
Unstable and intense relationships are common and fueled by a deep fear of abandonment. | Relationships can be affected by mood episodes but are not inherently unstable. |
BPD may involve dissociation under stress, but hallucinations and delusions are rare. | Bipolar I includes psychotic symptoms during manic episodes (e.g., paranoia). |
Mood shifts are reactive and happen in response to interpersonal stress or emotional distress. | Mood shifts happen independently and follow a cycle rather than external triggers. |
As you can see, both conditions are characterized by emotional instability, impulsivity, and self-destructive behaviors, making diagnosis challenging. However, differentiating between Bipolar I and Bipolar II can help.
Bipolar I is easier to identify because manic episodes include psychotic symptoms, which do not occur in BPD. On the other hand, Bipolar II is more difficult to separate from BPD since hypomanic episodes lack psychosis and can be mistaken for emotional intensity. That being said, people with bipolar disorder generally return to a stable mood in between episodes, whereas those with BPD experience ongoing emotional instability with frequent mood swings.
BPD doesn’t have a single cause but is believed to develop due to a combination of biological, environmental, and social factors. Genetics play a part, but life experiences, especially childhood trauma, also contribute. Some researchers even suggest that people with BPD may be wired to process emotions and social rejection differently.
Studies estimate that BPD is about 40% heritable, with twin studies showing that BPD is more common among identical twins than fraternal twins or siblings. However, differences in brain function may also explain the onset of borderline personality disorder.
In most people, the rostro-medial prefrontal cortex becomes active when experiencing rejection, which allows them to regulate emotional distress. However, in individuals with BPD, this region is inactive, potentially explaining why rejection feels especially painful and debilitating for them. This difference in brain function may make social interactions feel more unpredictable, threatening, or emotionally intense.
Adverse life experiences can have a significant impact and influence on those prone to personality disorders like BPD. Research shows that people who experience trauma, neglect, or unstable family relationships are at a much higher risk of developing BPD.
Some environmental risk factors include:
Another theory suggests that when children struggle to see both the good and bad in a person at the same time, they develop a defense mechanism called splitting (viewing people as either “all good” or “all bad”). This black-and-white thinking can carry into adulthood and make building and maintaining relationships more difficult.
Like most personality disorders, borderline personality disorder doesn’t look the same for everyone, but its symptoms follow similar patterns. People with BPD feel things more deeply than others, and those emotions can shift quickly. At times, their thoughts and behaviors may seem extreme, even to themselves, but the intensity of their feelings is very real.
Common signs and symptoms include:
Symptom Category | Symptoms |
Emotional Dysregulation | Intense mood swings that change within hours or minutes, feelings of emptiness, increased sensitivity to perceived rejection or criticism |
Impulsivity and Risky Behaviors | Acting on urges without thinking of consequences, reckless spending, unsafe sex, binge eating, substance use, self-harm |
Unstable Relationships | Fear of abandonment, extreme reactions to rejection (real or imagined), idealizing someone one minute and devaluing them the next |
Identity Disturbance | Feeling unsure of who they are, constantly changing goals, values, or interests, feeling disconnected from their own sense of self |
Self-Harm and Suicidal Behavior | Engaging in self-harm, suicidal thoughts or attempts, using pain as a way to deal with emotions |
Dissociation and Paranoia | Feeling detached from reality, struggling with trust issues, experiencing stress-related paranoia or distorted perceptions of events |
BPD has been officially recognized as a mental health condition since it was introduced in the DSM-III in 1980. Over time, our understanding of the disorder has evolved, but diagnosing BPD remains challenging due to overlapping symptoms with other mental health conditions.
Although BPD is traditionally diagnosed in adults, diagnosing adolescents is becoming less controversial. In some cases, symptoms may emerge during a person’s teenage years, and early intervention can improve long-term outcomes. However, many clinicians diagnose adolescents sparingly as personality traits are still developing.
Because BPD shares symptoms with other conditions, mental health professionals rely on comprehensive assessments, clinical interviews, and patient history to make sure they make a correct diagnosis. The process can take time, but receiving an accurate diagnosis is necessary for creating a treatment plan that works.
There is no single treatment that works for everyone with BPD, but therapy, medication, and self-care activities can help manage symptoms and improve quality of life. Treatment typically focuses on helping individuals regulate emotions, change harmful behavioral patterns, and develop healthier coping skills.
Psychotherapy is the most effective treatment for BPD, with studies showing that therapy significantly reduces BPD symptom severity, improves relationships, and decreases impulsive behaviors over time.
Common types of therapy are used for treating patients with BPD, including:
Long-term studies show that DBT and MBT are especially effective, showing improvements in self-harm reduction, suicidal behaviors, and depression lasting beyond 12 months of treatment.
There is no FDA-approved medication specifically for BPD, but certain medications are prescribed off-label to help manage symptoms like depression, anxiety, and impulsivity. Commonly used medications include:
Medications can help with symptoms, but they work better when combined with therapy.
Lifestyle choices and integrating self-care into your routine can help in managing BPD symptoms. These include:
People who adopt healthier habits are more likely to experience long-term recovery from BPD. For example, one study shows that regular exercise is linked to lower levels of psychiatric symptoms and better mental health.
Many individuals who recover also become more engaged in work, school, and social activities. This is compared to those who don’t recover and engage in unhealthy behaviors like smoking, substance abuse, and relying on sleep and pain medications.
Living with borderline personality disorder can be challenging, but Cura Behavioral Health is here for you. Our compassionate team of providers offer evidence-based therapies and personalized treatment plans to help you regain stability and improve your quality of life. If you or a loved one is struggling with BPD, reach out to us today to explore your treatment options.
Borderline Personality Disorder – StatPearls
Key Brain Activity Absent in Borderline Personality Disorder – Neuroscience News
Psychological therapies for people with borderline personality disorder – Cochrane Library
Pharmacological Management of Borderline Personality Disorder and Common Comorbidities – CNS Drugs
Determining if TMS therapy suits your mental health journey should involve consultation with a qualified professional. At Cura Behavioral Health, we provide comprehensive assessments to help you make informed treatment decisions.
Don’t let a mental health condition hold you back any longer. Schedule a consultation with Cura Behavioral Health today. Our experienced team is ready to answer your questions and create a personalized treatment plan tailored to your unique needs.
Join our newsletter to stay up to date on features and releases.
By subscribing you agree to with our Privacy Policy and provide consent to receive updates from our company.
Dr. Kevin Simonson, an esteemed Medical Director at Cura Behavioral Health, brings over 15 years of experience in psychiatry. A graduate from a top medical school, he specializes in the treatment of mood disorders and anxiety, employing a patient-centered approach. His dedication to evidence-based care and his commitment to advancing mental health practices have made him a respected figure in the field. Dr. Simonson’s leadership ensures the highest standard of care for the community at Cura Behavioral Health.
