Borderline personality disorder (BPD) is a mental illness that affects about 6 percent of adults at some point in their lives. (1) At its core, the disorder is about emotion dysregulation, says Ryan Hooper, PhD, a clinical psychologist in private practice in Chicago and an assistant clinical professor of psychology at the University of Illinois. “All the symptoms that come out of BPD are really an effort for the person to regulate themselves,” Dr. Hooper says.
Some of the signs and symptoms overlap with other mental health conditions, such as bipolar disorder, depression, and anxiety, according to the National Institute of Mental Health. (2) In fact, 85 percent of people with BPD have at least one other mental illness. That overlap can make BPD difficult to recognize and diagnose.
BPD and other mood disorders tend to come to light in times of transition, says Marra Ackerman, MD, a clinical assistant professor of psychiatry at NYU Langone Health in New York City. “These can be triggers because there may be a lot of upheaval and chaos,” she says.
So how does BPD manifest itself during these times of change? Here are six signs to be on the lookout for if you have an inkling you or someone you love is struggling with BPD.
Keep in mind, not everyone with BPD will experience every symptom listed here. (3) Some might identify with only a couple of these, while others might experience them all.
1. You Tend to Experience Intense Mood Swings
Dr. Ackerman says people with BPD feel extremes in their moods, and they tend to experience their emotions more intensely than people without BPD do. “That can range from cheerfulness to anger and irritability and even happiness at times,” she says.
Outsiders tend to focus on the negative moods that people with BPD sometimes feel, but Ackerman says it’s more about amplitude of emotions than types of emotions. “The range is bigger for these patients,” she says.
The moods are not only intense, but they can change quickly, sometimes lasting only a matter of hours. (3) That’s one key difference between BPD and bipolar disorder. Bipolar disorder involves intense mood swings, too, but the moods change much less frequently for these patients. They might stick with one mood for a few weeks or even months. (1)
Another key difference between BPD and bipolar disorder is people with BPD don’t experience the emotional highs, such as mania or hypomania, that people with bipolar disorder do, Ackerman says.
2. You Struggle With Low Self-Esteem and Fear Rejection
According to the National Institute of Mental Health, many people with BPD experience low self-esteem and have an unstable self-image. (3) This unstable sense of self can lead a person to seek praise or attention from friends or romantic partners, and cause drastic mood fluctuations depending on the outcome. Also tied to this symptom is ambitions, goals, and overall behavior. (4,5)
“Oftentimes people who struggle with BPD have this fear of abandonment,” Hooper says. “And that can be a very real abandonment, like someone trying to leave them behind, or it can be just a fear-based abandonment, like an imagined one.”
As a result of that fear of being left behind, people with BPD might have a hard time trusting other people. They might even stop communicating with a loved one if they have suspect they’ll be rejected in the near future. (3)
3. You Had a Traumatic Experience as a Child
In some cases, this fear of rejection or abandonment can be linked back to an earlier trauma, Ackerman says. For instance, maybe the person with BPD didn’t have consistent caregiving while growing up or was put in another disturbing situation. “It’s very common for a patient with BPD to have a history of trauma of some sort — childhood trauma, sexual abuse, physical abuse, or emotional abuse at some point in their life,” Ackerman says.
Marsha Linehan, PhD, is one of the leading researchers on BPD and suspects BPD is primarily caused by an invalidating environment, according to a study published in the journal Psychological Bulletin. (6)
An “invalidating environment,” Hooper says, essentially means “being told that your thoughts and feelings aren’t right or they don’t matter or they don’t count.” It’s easy to see how hearing this repeatedly could lead to low self-esteem and relationship troubles (two hallmarks of BPD), especially because Hooper says parents are often the ones responsible for creating this negative atmosphere.
Although researchers suspect there’s a genetic component to BPD, being exposed to these traumatic childhood experiences can increase the risk of developing the disorder. (1,3)
4. You Have Trouble Maintaining Stable Relationships
The signs mentioned above mix together to create relationship difficulties. The person with BPD might have trouble with interpersonal relationships across the board — from work relationships to romantic ones. Sometimes it’s the fear of abandonment that’s at the root of the problem. It can make someone with BPD need people to be available to them at all times. Having someone who’s unavailable or not available on a consistent basis can be very difficult for the person with BPD, Ackerman says.
The other thing that can keep people with BPD from having healthy relationships is stress-induced paranoia, which Ackerman says means patients with BPD may believe others don’t have their best interests in mind. People with BPD experience emotions intensely and can give more meaning and value to the things that go on around them as a result, she says.
Many people with BPD also take a love-hate approach to their relationships. “The fancy words we would use for that are idealization and devaluation,” Hooper says. Relationships can get really intimate, really fast. A person with BPD might meet someone and immediately put that person on a pedestal, thinking of them as the best person ever. That’s the idealization part. Devaluation comes in when the person with BPD starts to think that the other person might leave them or reject them in some way. At that point, the new friend goes from being the best person ever to the worst, Hooper says.
5. You’ve Had Suicidal Thoughts
To cope with the emotional instability and relationship issues, some people with BPD consider suicide. In fact, people with BPD have a much higher risk of suicide than the population as a whole, Ackerman says. Sixty to 70 percent of BPD patients make suicide attempts, according to a study published in the American Journal of Psychiatry. (7) Though unsuccessful attempts are way more common than completed ones, about 10 percent of people suffering from BPD die by suicide, which is similar to what you’d find among people with schizophrenia, according to an organization called Treatment and Research Advancements for Borderline Personality Disorder. (8)
Usually, suicide attempts are the impulsive result of dealing with difficult emotions. They can also be a person with BPD’s way of showing family members and friends that they’re in distress. (8)
Some people with BPD turn to other self-injurious behaviors, such as cutting or burning. (7) But this isn’t something all BPD patients experience. “It’s a subset of patients who might have those symptoms,” Ackerman says.
6. You Engage in Reckless Behavior
Some people with BPD engage in reckless behavior, such as going on shopping sprees, engaging in unsafe sex, using drugs or alcohol, driving dangerously, or developing eating disorders.
But there’s an important distinction to make regarding how often someone participates in these activities. Engaging in these types of activities while experiencing an elevated mood could be a sign that there’s a different mood disorder (not BPD) at play, according to the National Institute of Mental Health. (3)
For instance, when someone with bipolar disorder is experiencing a manic episode, they may have very high energy levels and engage in reckless behavior over a period of days or weeks, Ackerman says. “In BPD, this is more like a persistent pattern of reckless behavior that may come and go but not have these clear departures from baseline,” Ackerman says.
How Borderline Personality Disorder Is Diagnosed
Usually, the interpersonal challenges are the earliest signs that there’s something going on, but many people won’t decide to get help until they start having suicidal thoughts or make plans to hurt themselves, Ackerman says.
In order to diagnose BPD, a psychologist, psychiatrist, or clinical social worker with experience in mental disorders likely will: (3)
Interview the patient. “The gold standard for assessment is a structured interview where a trained clinician would ask very pointed questions around the illness,” Hooper says.
Examine the patient thoroughly to rule out other illnesses and conditions.
Determine if a person’s symptoms qualify as BPD. They need to meet five of the diagnostic criteria to be officially diagnosed. (7)
Review the patient’s family medical history. Having an immediate family member with the disorder increases the risk of developing it.
Hooper says there are a couple of good assessment tools out there but cautions against self-diagnosing. Instead, he says to seek out a licensed professional who has experience with depression and BPD.
By Moira Lawler Medically Reviewed by Allison Young, MD
Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa Nepean. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can’t pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.