Borderline Personality Disorder (BPD)

Learn the symptoms, risk factors, treatment, and recovery supports for borderline personality disorder (BPD).

Learn more about borderline personality disorder:

Definition

Borderline personality disorder (BPD) is a mental disorder that involves struggle with intense and painful emotions, often related to relationships. People with BPD tend to struggle with self-image, impulses, emotional responses, and conflicts with loved ones and others.

People with BPD often have depression, anxiety, post-traumatic stress, substance use, and eating disorders. People with BPD have a high rate of self-harm, suicide attempts, and suicide.

Signs and Symptoms

A person with BPD shows many of the following symptoms:

  • Engaging in recurrent suicidal behaviors or intentionally hurting him or herself (self-injury)
  • Acting impulsively, in ways that can be dangerous—spending a lot of money, having sex with strangers, using illegal substances, driving recklessly, binge eating or drinking
  • Fearing abandonment by others, and feeling insecure about whether friends and loved ones will remain supportive
  • Tending to have unstable relationships with extreme emotions—difficulty understanding the feelings and needs of others, misinterpreting what others intend
  • Having a distorted, negative view of him or herself, even despite conflicting evidence, and being very self-critical
  • Having unstable moods that change rapidly and last at least a few hours, often because he or she sees situations in a rigid way and can’t see other perspectives
  • Having chronic, lasting feelings of emptiness
  • Feeling inappropriate, intense anger, or inability to control anger
  • Having temporary stress-related paranoia and feeling cut off from others and him or herself—feeling as if he or she is losing touch with reality.

These tend to cause problems in life, such as trouble keeping employment, housing, family ties, and friendships. People with BPD may undermine their ability to achieve goals. This can lead to job losses, relationship failures, and other problems.

The general traits of BPD remain relatively stable over time and across situations.

Risk Factors

About 1.6% of U.S. adults have BPD. The rate is similar in men and women, but women are more likely to get treatment. Up to 9% of people with BPD die from suicide. Up to 80% attempt suicide at some point. If you or someone you know is having suicidal thoughts, contact the Suicide Prevention Lifeline,1-800-273-TALK (8255). There are effective treatments that can help address your symptoms.

The cause of BPD is unknown. BPD often runs in families, so people are at greater risk if a family member has BPD. As with other mental disorders, traumatic experiences make BPD more likely.

Evidence-based Treatments

BPD can be treated with long-term (often a year or more) intensive psychotherapy designed for BPD and provided by a trained therapist. Combination of treatment approaches is common. For example, a person with BPD may receive psychotherapy and use medications for specific symptoms.

As always, a person’s healthcare professionals should collaborate on the treatment plan and follow up. The treatment plan should consider each person’s needs and choices. A person should consult a healthcare professional when choosing the right treatment and consider their own gender, race, ethnicity, language, and culture.

Psychotherapy

There are many forms of psychotherapy, sometimes called “talk therapy,” that are effective for BPD. Psychotherapy often is the main treatment for people with BPD. Therapy can be provided one-on-one or in a group. In therapist-led group sessions, people with BPD can learn better ways to express themselves and interact with others. Other forms of psychotherapy that focus on thoughts and actions may help reduce symptoms of depression, anxiety, and suicidal or self-harming behaviors.

Dialectical behavior therapy is the most widely used psychotherapy for BPD. It focuses on mindfulness, or paying attention to the current situation. The therapy teaches skills to control strong emotions, reduces self-destructive behaviors, and improves relationships. It emphasizes a balance between changing and accepting beliefs and actions.

Systems training for emotional predictability and problem solving (STEPPS) is a group therapy approach to help a person with BPD learn skills to monitor their symptoms, and ways to change their thinking and actions. It also provides information about BPD for family members and friends.

Mentalization-based treatment focuses on helping a person understand their own emotions and those of others. The core idea is that people learn in childhood how to understand emotions and relationships with others, and people with BPD did not fully learn these skills. The therapy helps people with BPD identify emotions and learn appropriate responses in their relationships.

Cognitive analytic therapy is a team-based approach. The person with BPD and a team of providers develop a shared understanding of his or her problems. The focus is to replace problematic thoughts, actions, and patterns with effective ways to cope.

Schema-focused therapy helps people with BPD change how they view themselves. The core idea is that BPD involves a harmful self-image that likely stems from negative childhood experiences. The self-image leads to problems in interacting with people and in coping with problems and stress.

Gunderson Good Psychiatric Management helps people with BPD learn to monitor and understand their symptoms. The therapy helps the person set goals for reducing symptoms and responding better to stress in relating to others.

Transference-focused psychotherapy helps people with BPD reframe their emotional understanding of experiences. The therapist helps him or her identify and change their inaccurate perceptions.

Medications

Generally, medications are not used specifically to treat BPD. Some people with BPD take medications to help reduce symptoms such as anxiety, depression, or aggression. People with BPD most commonly receive antidepressants, mood stabilizers, and antipsychotics.

For basic information about medications, visit Mental Health Medications from the National Institute of Mental Health (NIMH). For up-to-date information on medications, side effects, and warnings, access the Food and Drug Administration.

Complementary Therapies and Activities

In general, complementary therapies and activities can help people improve their well-being, and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, see the National Center for Complementary and Integrative Health.

Family programs and family psychoeducation are thought to help families affected by BPD. Some therapies, such as dialectical behavior therapy family skills training, include family members in treatment sessions. Such programs help families develop skills to better understand and support a relative with BPD. Some programs focus only on the needs of family members.

Apps for health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, access the Federal Government Mobile App Directory.

Recovery and Social Support Services and Activities

Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This includes:

  • Overcoming or managing one’s condition(s) or symptoms
  • Having a stable and safe place to live
  • Conducting meaningful daily activities, such as a job, school, volunteerism, and family caretaking
  • Having relationships and social networks that provide support, friendship, love, and hope

Recovery helps a person develop resilience, increasing the ability to cope with adversity and adapt to challenges or change. To learn more, visit the SAMHSA Recovery and Recovery Support topic.

Self-help and support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local support groups. Peer and family support services can help foster hope and promote outreach and engagement for those with behavioral health conditions. This includes both peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills.

Here are resources for people with BPD and their families:

Future Directions in Research and Treatment

Studies of BPD are looking at genetics, brain function, trauma, environmental factors, and psychosocial factors. Early diagnosis and treatment is one research focus. Other studies are looking at links between BPD, substance use disorders, and other behavioral health conditions.

More studies are needed of the value of treatments for BPD. Brain imaging studies of people with BPD have not yet yielded findings that can guide treatment or predict outcomes. Further studies of the causes of BPD—including family, environmental, and biological factors—may clarify treatment approaches and outcomes.

Finding Treatment

Consult a healthcare professional who has training and experience working with BPD. For general information on mental disorders and to locate treatment services in your area, contact the SAMHSA’s National Helpline , 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the National Institute of Mental Health (NIMH) Help for Mental Illnesses webpage have more information and resources.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Last Updated: 05/12/2017