What Is Borderline Personality Disorder (BPD)? Signs, Diagnosis, and Causes
Borderline personality disorder (BPD) is characterized by instability in self-image, mood, and relationships. Although people living with this condition typically face many challenges, there is support available, and we know more about BPD than we did in the past.1
BPD is thought to be caused by a combination of genetic factors and childhood experiences, as many people with the condition have suffered trauma at an early age.1
As a result, many people with BPD also have complex post-traumatic stress disorder (C-PTSD), which is caused by multiple traumatic experiences over a long period of time. In fact, there is some debate over whether BPD can be differentiated from C-PTSD, since many of their symptoms overlap.6
In addition, 90% of people with BPD have an insecure attachment style.4 Insecure attachment is when there’s a disruption to the bond between caregivers and their children, often affecting how people think, feel, and act as adults. Therefore, when trying to make sense of the causes of BPD, it can be useful to consider how early bonds factor in.
A mental health professional can help you determine whether attachment insecurity and C-PTSD play a role in BPD, affecting your view of yourself and others. This article can also help by exploring:
- What borderline personality is and its causes
- Defense mechanisms people with BPD often use to cope
- Signs of BPD in adults
- The four types of BPD
- How borderline personality disorder can affect relationships
- The differences between BPD and bipolar disorder
- How BPD can be treated
What Is Borderline Personality Disorder (BPD)?
People with borderline personality disorder typically experience mood instability, rocky relationships, and difficulties with their sense of identity. The causes of borderline personality disorder aren’t entirely clear, but they’re thought to involve both childhood experiences and genetic factors that impact brain development.1
Setting genetic factors aside, the childhood factors that may put people at risk of developing BPD include:
- Child abuse and neglect
- Family adversity
- Lack of warmth from caregivers
- Harsh and critical parenting
Across the different types of child neglect and abuse, emotional abuse is the most frequently associated with personality disorders like BPD. Emotional abuse can include:
- Name calling
- Controlling behavior
- Demeaning intelligence or abilities
- Gaslighting
- Being overly critical
- Threats of harm
- Withholding warmth and affection as a form of punishment
- Humiliation
- Failing to support social development
- Lack of positive and supportive reinforcement
Defense Mechanisms of BPD
To understand what’s happening for someone with BPD, it can be useful to think about some concepts that underlie the field of psychoanalysis (the therapy created by Sigmund Freud).
In psychoanalysis, each of us has defense mechanisms that protect us from negative feelings and inner conflicts.1 The defense mechanisms seen in people with BPD can include:
- Projection: When someone puts their negative feelings onto others, so they don’t have to face them. For example, accusing a partner of being emotionally cold when they themselves are internally fearing emotional intimacy.
- Splitting: When someone “splits” people, things, situations, and beliefs into one of two extreme categories, like good or bad. For instance, describing a new friend as “perfect” and then “terrible” after a disagreement.
- Acting out: When someone’s actions are outwardly destructive and distract from an internal problem or stressor. For example, blaming people instead of creating solutions, among other such behaviors.
Signs of BPD in Adults
Symptoms of BPD often begin to emerge during adolescence, while more impulsive and dangerous behaviors can increase in early adulthood.1 In order to receive a borderline personality disorder diagnosis, you’ll be asked if the following signs of BPD in adults have been present and recurring since adolescence.
- Persistent mood instability
- Difficulty regulating emotions
- Intense anger that’s difficult to control
- Patterns of unstable relationships
- Persistent instability in feelings about the self and identity
- Fear of abandonment and behaviors that try to avoid it
- Feelings of emptiness, loneliness, and isolation
- Impulsivity
- Temporary paranoia or dissociative symptoms
People with BPD may also self-harm or experience suicidal thoughts and behaviors. They may also have passing symptoms of psychosis. Coping mechanisms like high-risk sexual behavior, impulsive spending, and other risky behaviors are also not uncommon.1
Further, as mentioned, 90% of people with BPD have an insecure attachment style (anxious, avoidant, or disorganized). This finding may go some way towards explaining why people with BPD especially struggle with emotional regulation and relationships.4
For instance, people with insecure attachment often describe social interactions as less satisfying. They’re also more likely to perceive others as cold and respond coldly back. These are traits also commonly seen in those with BPD, as they’re often particularly sensitive to rejection. However, a sign that someone has BPD, not simply an insecure attachment style, is that they’re more likely to respond to perceived rejection with destructive behavior.4
The Four Types of BPD
Although not all healthcare providers agree, some believe there to be four types of BPD. Considering these categories may be useful if you feel like you only have some signs of BPD in adults and not others. For instance, some people may have traits of high-functioning BPD, which is also known as “quiet BPD” or the “discouraged type” – meaning other symptoms may not be as evident.
The following are brief descriptions of the four types of BPD:
- Discouraged: Directing painful emotions inward instead of toward others. People with this subtype may seem outwardly “high-functioning” and emotionally stable.
- Impulsive: Engaging in risky, aggressive, and self-destructive behaviors like binge eating, overspending, physical fights, and substance misuse.
- Self-destructive: Struggling with feelings of worthlessness and engaging in behaviors that harm themselves or their relationships. For example, self-harm, substance misuse, and threats of suicide.
- Petulant: Mood instability and negative self-image may lead to a desire for control in relationships. This could result in manipulation, stubbornness, and passive-aggressiveness.
Some people with BPD might feel a great deal of shame about their symptoms and behavior, but they should know that these issues are not a reflection of their true character. BPD is a mental health condition arising from some highly difficult life experiences. People with the condition are worthy and deserving of support, regardless of how their condition causes them to behave.
How BPD Affects Relationships
Borderline personality disorder can significantly disrupt relationships, especially romantic ones, as it typically involves patterns of instability and conflict. Since traits of BPD can be so similar to insecure attachment styles, looking at attachment may be helpful for understanding how BPD affects relationships.5
People with BPD can have any of the insecure attachment styles, but anxious and disorganized attachment are most commonly linked to the disorder. The traits associated with these styles may show up in relationships when someone with BPD wants to feel either extremely close to their partner or distance themselves from intimacy completely.5
In general, those with anxious attachment tend to experience frequent jealousy, while those with avoidant attachment tend to be quite pessimistic about love and therefore avoid close relationships. In disorganized attachment, anxious and avoidant tendencies co-exist, typically causing people to flip between the two states and experience “chaotic” and unstable connections.5
Additionally, emotional dysregulation in BPD can make it harder for couples to resolve conflicts, potentially escalating or lengthening them unnecessarily. Also, if someone with BPD struggles with empathy and intimacy, this can have a big impact on closeness, security, and communication in romantic relationships. Further, lacking a strong sense of self can mean a lack of understanding of what they want, their boundaries, and their emotions.5
Another feature of BPD that can cause challenges within relationships is splitting. Someone with the condition might switch between idealizing and devaluing their partner in extreme ways, causing big highs and lows in the relationship.
And finally, some research finds that people with BPD tend to be drawn to partners who also have BPD symptoms, which may cause more instances of upheaval and attachment difficulties.5
BPD vs Bipolar Disorder
BPD and bipolar disorder are often confused, with overlapping symptoms sometimes making diagnosis difficult.1 However, they are two distinct mental health conditions with key differences that require varying kinds of treatment.
In short, while people with bipolar disorder may experience intense emotional experiences and impulsivity, they also have episodes of mania and depression. Manic episodes may involve increased energy, elevated mood, inflated self-esteem, less need for sleep, fast speech, racing thoughts, restlessness, and risky behavior. Depressive episodes involve symptoms like low mood, loss of motivation and interest, fatigue, feelings of worthlessness, and potentially suicidal thoughts.7 These episodes of mania and depression are not present in BPD.
However, up to half of people with bipolar disorder also have borderline personality disorder. Diagnosis might be difficult if different symptoms merge together, but a mental health provider will ensure that the right support and treatment are given.
Treatment for Borderline Personality Disorder
The first-line BPD treatment is psychotherapy, which is most effective when it’s tailored to the unique characteristics of BPD.1
People with BPD may also benefit from mentalization-based treatment (MBT). This is an attachment-based method that helps clients regulate emotions and practice self-reflection.1
Dialectical behavior therapy, or DBT therapy for BP, is another effective approach. It combines ideas from mindfulness with cultivating both emotional regulation and interpersonal skills. It aims to increase the ability to tolerate negative emotions and change behaviors as a result.1
There’s also schema therapy, which looks at the different emotional states someone with BPD experiences. It helps people recognize when they’re in one of these states and helps them to cultivate a more balanced emotional mindframe.1
There are currently no medications approved by the FDA for treating BPD. This is because there’s no evidence that the core symptoms of BPD can be treated effectively with medication, unless someone has co-occurring severe depression, anxiety, agitation, or psychosis.1
Above all, the best therapy for you will be a space in which you feel seen and safe.
Get Mental Health Help for BPD Today
The symptoms of BPD can make life very difficult to navigate. However, many people with the condition benefit from therapy that gives them the space to process their upbringing and express their feelings.
At Mission Connection, our range of therapies gives you this space. Our team of professionals can also help you cultivate the skills for healthier emotional processing and relationships. You don’t have to figure out how to cope with BPD by yourself – healing is possible and entirely achievable.
Get in touch to learn about our treatments and begin designing your customized care plan.
References
- Chapman, J., Jamil, R. T., & Fleisher, C. (2024). Borderline personality disorder. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430883/
- Bailey, R., & Pico, J. (2023). Defense mechanisms. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559106/
- Neumann, E. (2017). Emotional abuse in childhood and attachment anxiety in adult romantic relationships as predictors of personality disorders. Journal of Aggression, Maltreatment & Trauma, 26(4), 430–443. https://doi.org/10.1080/10926771.2017.1299826
- Kaurin, A., Beeney, J. E., Stepp, S. D., Scott, L. N., Woods, W. C., Pilkonis, P. A., & Wright, A. G. C. (2020). Attachment and borderline personality disorder: Differential effects on situational socio-affective processes. Affective Science, 1(3), 117–127. https://doi.org/10.1007/s42761-020-00017-7
- Smith, M., & South, S. (2020). Romantic attachment style and borderline personality pathology: A meta-analysis. Clinical Psychology Review, 75, 101781. https://doi.org/10.1016/j.cpr.2019.101781
- Powers, A., Petri, J. M., Sleep, C., Mekawi, Y., Lathan, E. C., Shebuski, K., Bradley, B., & Fani, N. (2022). Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. Journal of Anxiety Disorders, 88, 102558. https://doi.org/10.1016/j.janxdis.2022.102558
- Jain, A., & Mitra, P. (2023). Bipolar disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558998/
