Borderline Personality Disorder

People with borderline personality disorder may experience intense mood swings and feel uncertainty about how they see themselves. Their feelings for others can change quickly, and swing from extreme closeness to extreme dislike. These changing feelings can lead to unstable relationships and emotional pain.

People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their interests and values can change quickly, and they may act impulsively or recklessly.

Other signs or symptoms may include:

• Efforts to avoid real or perceived abandonment, such as plunging headfirst into relationships—or ending them just as quickly.
• A pattern of intense and unstable relationships with family, friends, and loved ones.
• A 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. Please note: If these behaviors happen mostly during times of elevated mood or energy, they may be symptoms of a mood disorder and not borderline personality disorder.
• Self-harming behavior, such as cutting.
• Recurring thoughts of suicidal behaviors or threats.
• Intense and highly variable moods, with episodes lasting from a few hours to a few days.
• Chronic feelings of emptiness.
• Inappropriate, intense anger or problems controlling anger.
• Feelings of dissociation, such as feeling cut off from oneself, observing oneself from outside one’s body, or feelings of unreality.

Not everyone with borderline personality disorder may experience all of these symptoms. The severity, frequency, and duration of symptoms depend on the person and their illness.

Researchers aren’t sure what causes borderline personality disorder, but studies suggest that genetic, environmental, and social factors may increase the risk of developing it. These factors may include:

• Family history: People who have a close family member (such as a parent or sibling) with the illness may be at a higher risk of developing borderline personality disorder.
• Brain structure and function: Research shows that people with borderline personality disorder may have structural and functional changes in the brain, especially in the areas that control impulses and emotion regulation. However, the studies do not demonstrate whether these changes were risk factors for the illness or if such changes were caused by the disorder.
• Environmental, cultural, and social factors: Many people with borderline personality disorder report experiencing traumatic life events, such as abuse, abandonment, or hardship during childhood. Others may have been exposed to unstable, invalidating relationships or conflicts.

Although these factors may increase a person’s risk, it doesn’t mean it is certain that they’ll develop borderline personality disorder. Likewise, people without these risk factors may develop the disorder in their lifetime.

Borderline personality disorder historically has been viewed as challenging to treat. But with newer, evidence-based treatment, many people with this disorder experience fewer and less severe symptoms, improved functioning, and better quality of life. It is important for patients with borderline personality disorder to receive treatment from a licensed mental health professional. Other types of treatment, or treatment from a provider who is not appropriately trained, may be ineffective or dangerous.

Many factors affect the length of time it takes for symptoms to improve once treatment begins. It is important for people with borderline personality disorder and their loved ones to be patient and receive support during treatment.

Seek—and stick with—treatment.

Studies funded by the National Institute of Mental Health (NIMH) indicate that individuals with borderline personality disorder who don’t receive adequate treatment are more likely to develop other chronic medical or mental illnesses and are less likely to make healthy lifestyle choices.

Psychotherapy

Psychotherapy, sometimes called “talk therapy,” is the first-line treatment for people with borderline personality disorder. Most psychotherapy occurs with a licensed, trained mental health professional in one-on-one sessions or with other individuals in group settings. Group sessions may help teach people with borderline personality disorder to interact with others and express themselves effectively.

Two examples of psychotherapies used to treat borderline personality disorder are:

• Dialectical Behavior Therapy (DBT): This treatment was developed specifically for individuals with borderline personality disorder. DBT uses concepts of mindfulness or awareness of one’s present situation and emotional state. DBT also teaches skills to help people control intense emotions, reduce self-destructive behaviors, and improve relationships.
• Cognitive Behavioral Therapy (CBT): This treatment can help people identify and change core beliefs and behaviors that come from inaccurate perceptions of themselves and others and problems interacting with others. It may help people reduce mood swings and anxiety symptoms and may reduce the number of self-harming or suicidal behaviors.

Read more on NIMH’s Psychotherapies health topic page.

Medications

Because the benefits of prescription medication for borderline personality disorder are unclear, medications aren’t typically used as the primary way to treat the illness. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental disorders such as mood swings or depression. Treatment with medications may require coordinated care from more than one medical professional.

Medications also can sometimes cause side effects in some people. Talk to your provider about what to expect from a particular medication. Read more in NIMH’s Mental Health Medications health topic.

Other Elements of Care

Some people with borderline personality disorder experience severe symptoms and need intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care.

Therapy for Caregivers and Family Members

Having a relative or loved one with the disorder can be stressful, and family members or caregivers may unintentionally act in ways that can worsen their loved one’s symptoms.

Although more research is needed to determine how well family therapy helps with borderline personality disorder, studies on other mental disorders show that including family members can help support a person’s treatment. Families and caregivers also can benefit from therapy.

Family therapy helps by:

• Allowing the relative or loved one to develop skills to understand and support a person with borderline personality disorder.
• Focusing on the needs of family members to help them understand the obstacles and strategies for caring for someone with the disorder.

Finding Help

If you’re not sure where to get help, a health care provider can refer you to a licensed mental health professional, such as a psychiatrist or psychologist with experience treating borderline personality disorder. If you need help starting the conversation, check out the Tips for Talking With Your Health Care Provider fact sheet.

Other resources include:

• Substance Abuse and Mental Health Services Administration’s Behavioral Health Treatment Services Locator, a tool for finding mental health services in your area
• NIMH’s Help for Mental Illnesses webpage
• Agency for Healthcare Research and Quality’s website

Tips for Family and Caregivers

Here are some ways to help a friend or relative with the disorder:

• Take time to learn about the illness to understand what your friend or relative is experiencing.
• Offer emotional support, understanding, patience, and encouragement. Change can be difficult and frightening to people with borderline personality disorder, but things can improve over time.
• Encourage your loved one in treatment for borderline personality disorder to ask about family therapy.
• Seek counseling for yourself. Choose a different therapist than the one your relative is seeing.

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

• NIMH’s Clinical Trials webpage: Information about participating in clinical trials
• Clinicaltrials.gov: Current Studies on Borderline Personality Disorders: List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country

Free Brochures and Shareable Resources

• Borderline Personality Disorder: A brochure that offers basic information about borderline personality disorder, including signs and symptoms, treatment, and finding help. Also available en español.
• 5 Action Steps for Helping Someone in Emotional Pain: Infographic presenting five steps for helping someone in emotional pain to prevent suicide. Also available en español.
• Suicide in America: Frequently Asked Questions: Fact sheet can help you, or a friend or family member, learn about the signs and symptoms, risk factors and warning signs, and ongoing research about suicide and suicide prevention. Also available en español.
• Warning Signs of Suicide: An infographic presenting behaviors and feelings that may be warnings signs that someone is thinking about suicide. Also available en español.
• Shareable Resources on Borderline Personality Disorder: Help support borderline personality disorder awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about borderline personality disorder.

Multimedia

• Experts Discuss Borderline Personality Disorder: Learn the signs, symptoms, diagnosis, treatments, and the latest research on borderline personality disorder.

Federal Resources

• Borderline Personality Disorder (MedlinePlus Medical Encyclopedia)
• Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders (Substance Abuse and Mental Health Services Administration)
• Personality Disorders (MedlinePlus - also en español)

Research and Statistics

• Journal Articles: References and abstracts from MEDLINE/PubMed (National Library of Medicine).
• Statistics: Personality Disorders: Webpage listing information on the prevalence of personality disorder among adults.

Last Reviewed: April 2022

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