Everything You Need To Know About Borderline Personality Disorder

BPD, misunderstood by many, is a common disorder with a variety of treatments available

September 9, 2023

Borderline personality disorder (BPD) is a complex condition. It affects how a person feels about themselves and others. BPD is characterized by intense, unstable emotions and relationships as well as insecurity and self-doubt.

BPD makes everything about a person feel unstable, ranging from moods, thinking, behavior, relationships, and sometimes identity. People with this condition have described BPD as the feeling of having an exposed nerve ending, essentially leaving someone to be easily triggered by small things.

But there are effective treatments for it.

Keep Reading To Learn

  • The truth about borderline personality disorder
  • How to recognize BPD in yourself and other people
  • How borderline personality disorder is diagnosed and treated
  • Common myths and misconceptions about BPD

Understanding the Rollercoaster of BPD

People with borderline personality disorder often feel a huge amount of emotional instability. It impacts a person’s self-image, likes and dislikes, and goals. This often makes them confused about their sense of self. The condition makes it difficult for a person to be comfortable in their skin.

Many people with BPD act impulsively, have intense emotions, and experience dissociation and paranoia when most distressed. This emotional volatility can cause relationship turmoil. Also, the inability to self-soothe can lead to impulsive, reckless behavior.

1.4% of American adults experience BPD

People with BPD are often on edge. They have high distress and anger levels, so they may be easily offended. They struggle with beliefs and thoughts about themselves and others, which can cause distress in many areas of their lives.

People living with BPD often have an intense fear of instability and abandonment. As a result, they have problems being alone.

The condition is also known for anger, mood swings, and impulsiveness. These qualities can dissuade people from being around someone with BPD. On top of this, many people with the condition struggle with self-awareness and how others perceive them. This makes them extremely sensitive.

BPD is a mind and body condition. Its symptoms begin to manifest during the early teenage years and gradually improve during adult life.

What Causes Borderline Personality Disorder?

BPD may be caused by genetics, brain abnormalities, and/or environmental factors. Due to the wide variety of suspected risk factors, it’s hard to determine who will develop it.

Environmental Factors

Early childhood adversity, such as child abuse or neglect, may be a cause.


Research suggests that it may be an inherited genetic condition or linked with other mental disorders among other family members.

Brain Abnormalities

Certain brain differences are thought to be contributing causes of the disorder. When certain brain chemicals responsible for mood regulation don’t function properly, there are changes in some areas of the brain. This has been linked to aggression, difficulty regulating destructive urges, and depression.

Watch Now!

Dr. Lois Choi-Kain helps us understand borderline personality disorder

BPD Doesn’t Often Occur Alone

Effective treatment involves addressing related disorders.

Many people diagnosed with borderline personality disorder experience other conditions, including:

  • Depression
  • Anxiety disorders
  • Eating disorders
  • Post-traumatic stress disorder (PTSD)
  • Bipolar disorder
  • Substance use disorder

There Are Many Misconceptions

This disorder is misunderstood by many, including some mental health practitioners. This confusion can impact and influence the way that people are treated.

Even worse, long-standing myths can discourage people from seeking help for the condition, especially if they feel their experience is being misunderstood.

Myth: It’s Not Treatable

Borderline personality disorder is very treatable. In the past, since BPD affects someone’s personality, many were quick to conclude that it was untreatable because someone’s personality cannot be changed.

More recently, many therapies have been proven effective as treatments, including dialectical behavior therapy (DBT), mentalization-based treatment (MBT), and transference-focused psychotherapy (TFP).

Now, a growing number of less intensive, generalist approaches, like general psychiatric management (GPM), are also being practiced around the world.

A BPD diagnosis doesn’t mean that someone will live with symptoms forever. With treatment, the symptoms ebb and flow. Many people with the condition can have high-functioning lives.

Myth: People With BPD Are Victims of Child Abuse

This is not always the case.

While some cases of borderline personality disorder stem from childhood trauma, a diagnosis is more likely to be the result of a combination of environmental factors. These can include attachment, childhood trauma, biological factors, and social factors.

The Myth of BPD and Gender

It’s estimated that over 14 million Americans have BPD. Once more commonly diagnosed in women, the largest study done on psychiatric disorders shows that it occurs equally often in women and men.

One explanation behind it appearing to affect more women is that women are more likely to seek mental health care than men. Since research on BPD is often conducted in psychiatric settings, it was previously less likely for men with borderline personality disorder to be included in these research efforts.

Another explanation is that BPD is often misdiagnosed in men. Many men with the condition are often diagnosed with depression or PTSD.

Or perhaps the issue is that for years, the general public and many in the psychiatric community have viewed mental illness in boys and mental illness in girls in very different ways.

The Bias of Behavior

To illustrate this gender bias, psychologist Alan E. Fruzzetti, PhD, offers a simple test.

“If I told you that a student in a classroom was pounding on a desk and being disruptive, would the image of a boy or a girl enter your mind?” he asks. “Or, if I told you that a student in a classroom was upset and incessantly tapping on a desk, would you think it was a boy or a girl?”

Most of us would imagine the “pounding” student was a boy and the “tapping” student was a girl. And, when observing essentially the same behaviors, many people would describe them and react to them very differently, according to the gender of the person displaying the behavior.

There are various factors as to why we view boys and girls through different lenses.

Different behaviors are deemed acceptable or troubling depending on one’s gender, leading to different social responses for boys and girls.

In general, a girl who is angry, depressed, or displaying other signs of distress has a better chance of being treated with compassion and understanding—and being referred to counseling and treatment—than a boy.

In contrast, boys who show similar behaviors are often punished or ignored completely.

“The problem is that both boys and girls display ‘non-normative’ behaviors, and our misunderstanding of these behaviors has produced serious consequences for their mental health,” Fruzzetti explains.

Gender Gap in BPD Diagnosis

This gap between boys and girls is particularly present in the diagnosis and treatment of BPD.

BPD affects approximately the same number of men and women, but the condition is likely slightly over-diagnosed in women and significantly under-diagnosed in men.

Many studies have explored the differences between men and women who meet the criteria for BPD, finding that more men with substance use disorders are diagnosed with BPD than women, while more females with eating disorders or PTSD are diagnosed with BPD.

“When boys don’t fit social and emotional norms, their behavior can be misinterpreted,” Fruzzetti says. “Bias around gender may have a lot to do with these different diagnoses.”

For example, when men display anger, it is more often seen as a sign of antisocial behavior than it is in women, even though women with BPD show more aggression than non-BPD women, and men with BPD show less aggression than non-BPD men.

Also, established stereotypes about the nature of masculinity can lead to BPD being misdiagnosed or missed altogether.

Fruzzetti states that boys generally possess fewer social and emotional skills compared to girls, which is often misunderstood and incorrectly attributed to a lack of motivation or flaws in character.

Challenges of BPD in Boys and Men

Because of misdiagnosis and underdiagnosis, many boys with BPD do not receive any treatment, receive the wrong treatment, or worse, end up in prison.

About 20% of males in the criminal justice system actually have BPD.

According to Fruzzetti, overall, our health care system is not set up to help men with BPD. In particular, the prison system does not provide proper treatment.

In prison, biases and stigma about mental illness are intensified. Boys and men who struggle with BPD are more likely to be punished rather than treated.

“The solution isn’t to be less compassionate towards women; it’s to be more compassionate towards men,” Fruzzetti says.

Meg’s Journey With BPD

Deconstructing Stigma participant Meghan

Meg is a participant in McLean’s Deconstructing Stigma campaign, and she struggles with BPD.

Read more about Meg’s mental health story and her message of hope for those who are also struggling.

Deconstructing Stigma participant Meghan

Recognizing Borderline Personality Disorder in Yourself—or Others

People with borderline personality disorder struggle with self-regulation. Self-regulation is the ability to manage emotions, thoughts, and behaviors in ways that have positive outcomes, like self-esteem and good relationships.

To be officially diagnosed, a person has to exhibit five or more related symptoms. These symptoms have to be ongoing and impact various aspects of life.

There are a handful of medically recognized symptoms of borderline personality disorder.

Instability in Relationships

Intense and short-lived relationships are common for people with BPD. It’s very common for someone with this disorder to have intense, unstable relationships filled with drastic and quick-changing feelings.

A person with BPD may fall in love quickly and assume that the other person will make them happy. Typically, this results in the person feeling hurt and disappointed and can further intensify emotional swings. People with this condition may have either perfect or horrible relationships, with rapid changes in perception resulting from anger, hate, and devaluation.

Extreme Emotional Swings

Someone with this condition often experiences unstable moods and emotions. The little things that don’t mean much to others—like someone not holding the door open for you or meeting a new friend—can be either very exciting or frustrating.

Many with this condition can be happy one moment and extremely sad or disappointed the next. Their moods are also very intense and unpredictable in timing. They can last anywhere from a few minutes to a few hours or longer.

Explosive Feelings of Anger

Many people with BPD struggle with intense anger and a short temper. This makes it difficult for them to feel in control of their emotions once they have been provoked. They can quickly fill with rage, though this anger may not always be outwardly directed and can result in self-harm. Sometimes the person might be angry at themselves and not at anyone or anything else.


Self-harm is risky behavior that may make the person feel good at the moment of distress. Many people with BPD often engage in self-harming activities, think about suicide, and make suicidal gestures and threats.

Many people with borderline personality disorder engage in sensation-seeking behavior that could be harmful, especially when they are angry.

Risky or deliberate self-harm activities may include:

  • Engaging in dangerous and unhealthy binge drinking
  • Cutting or other self-injury
  • Going on shopping and spending sprees
  • Regularly engaging in unsafe sex
  • Using drugs

Not all self-harm is intended to end in death. It’s important to remember that it’s often used as a way to feel better in a grim moment. However, if it goes untreated, these risky behaviors can end in suicide.

McLean’s Michael Hollander, PhD, an expert in self-harm in adolescents, helps us understand more about teen cutting and self-injury.

Lingering Feelings of Emptiness or Worthlessness

A lot of people with the condition struggle with emptiness or worthlessness. Many with BPD report feeling like there is a void inside of them or like they don’t matter. As a result, they often turn to sex, drugs, or food to try to feel satisfied.

Feeling Out of Touch With Reality

Many diagnosed with BPD feel suspicious about events in their lives. They struggle with feelings of suspicion and paranoia about the intentions of people around them. When they are stressed, they may lose touch with reality and become disassociated. Disassociation feels like being spaced out, foggy, or as if you exist outside of your own body.

BPD can be confused with other forms of mental illness, so a diagnosis is important. If you or someone close to you often has feelings of emptiness, loneliness, or insecurity that cause irrationality or impulsivity, it’s important to talk to your health care provider.

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When Is It Time To See a Professional?

If you are experiencing any of the previously mentioned signs and symptoms associated with borderline personality disorder, please consult a mental health professional. This condition is common and treatable.

You should see a doctor any time your symptoms are triggered. If you are unsure of your triggers, try to think of a time in the past when you experienced raging and intense emotions, acted impulsively, or had a desire to harm yourself. The events before this emotion are likely your triggers.

Many who have BPD experience suicidal thoughts. These can include but aren’t limited to mental images and fantasies about self-harm and plotting suicide. If you are experiencing suicidal thoughts and may harm yourself or someone else, call 911 immediately or visit your nearest emergency room.

Understanding and Recognizing Symptoms

People with BPD are sensitive to stress, so stressful situations activate symptoms related to the condition. The stressors that promote BPD’s most volatile symptoms can be external or internal, and they often vary from one person to another. There are both interpersonal and mental triggers of borderline personality disorder, many of which are unique to the individual.

Managing these symptoms, either for yourself or your partner, starts by understanding emotions, thoughts, and memories that set off symptoms. Then you can better manage addressing the symptoms if a stressor is unavoidable. You should work with a mental health professional to learn physical and mental exercises to understand triggers and develop skills to successfully manage them.

Interpersonal Relationship Events

Separations, disagreements, and rejections—real or perceived—are the most common triggers for symptoms. A person with BPD is highly sensitive to abandonment and being alone, which brings about intense feelings of anger, fear, suicidal thoughts and self-harm, and very impulsive decisions.

When something happens in a relationship that makes them feel abandoned, criticized, or rejected, their symptoms are expressed. People with borderline personality disorder experience rejection sensitivity, which makes relationships very intense and dependent. Events that can worsen this can be losing a job, ending a relationship, or experiencing rejection of any type.

Identifying Episodes

To better manage triggers, it is crucial to understand episodes. These episodes are highly dependent on the situation at hand and the specific individual, but there are common red flags for recognizing an episode.

Things that can indicate an episode is occurring:

  • Intense angry outbursts
  • Suicidal thoughts and self-harm behavior
  • Going to great lengths to feel something, then becoming increasingly avoidant and withdrawn
  • Paranoia, feeling as if there is someone out to get you

These episodes can also involve extreme feelings of positivity and euphoria. People with this condition can be very impulsive. It’s important to note these emotional highs as signs of an episode because they may be involved in risky behavior as well.

Treating Borderline Personality Disorder

Treatment involves breaking down the dysfunctional patterns of the brain’s thinking, feeling, and behavior that cause distress to maintain a better emotional balance. Sometimes health care providers may suggest medication as part of a care plan.

The treatment options often used are general psychiatric management (GPM), dialectical behavior therapy (DBT), mentalization-based treatment (MBT), and transference-focused psychotherapy (TFP).

General Psychiatric Management

Sometimes referred to as good psychiatric management, GPM is designed to provide “good enough” treatment to most patients. This treatment is not inferior to others. Studies have shown that GPM can be as effective as DBT in treating patients.

GPM combines the essential ingredients of other treatments to provide care to the patient, even when specialized or more resource-intensive treatments are not available.

Dialectical Behavior Therapy

DBT is known as the gold standard BPD treatment. It emphasizes the development of four skill sets: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. DBT teaches patients to control their intense emotions and minimize their destructive patterns.

Through DBT, patients can also learn how to build interpersonal skills and develop self-awareness.

DBT has been clinically tested, proven to be effective in borderline personality disorder and depression treatment in adolescents and adults, and is used extensively at McLean Hospital.

Watch Now!

Dr. Lois Choi-Kain talks about treating BPD

Mentalization-Based Treatment

MBT aims to help patients by improving interpersonal and relationship skills while reducing self-destructive behaviors. Mentalizing focuses on the ability to differentiate and concentrate on your emotional state of mind and separate your own thoughts and feelings from those around you.

Since individuals with BPD can find it difficult to recognize the impacts of their behaviors, MBT encourages focusing and reflecting on mental states to better understand how mental state affects behavior in ourselves and others.

Transference-Focused Psychotherapy

TFP focuses on the patient’s sense of identity and aims to create more stable and realistic experiences of both self and others. With BPD, one’s sense of identity may feel contradicted. TFP focuses on addressing identity-based problems with interpersonal relationships, self-esteem, and mood.

By helping patients learn to verbalize what they are feeling—versus acting impulsively on emotions—TFP helps with increased functioning and satisfaction in interpersonal relationships.

In addition to these therapies, group and individual therapy may be useful as well. Group and individual therapies cover a broad range of topics and are not necessarily sessions dedicated to BPD. Group and individual therapy can be beneficial for addressing mindfulness, interpersonal relationships, stress management, emotion regulation, and family relationships.

How Is Borderline Personality Disorder Diagnosed?

Borderline personality disorder is a complex condition that doesn’t present itself the same way in every person.

Some mental and psychological disorders have similar symptoms, so it’s vital to see a licensed mental health professional for an assessment and the right diagnosis.

To diagnose, your provider may go through the following:

  • A detailed interview with your doctor, a mental health provider, or both
  • A psychological evaluation
  • Medical history and/or a medical exam
  • Discussing signs and symptoms, including criteria in the hallmark signs of BPD

Most diagnoses are in patients 18 and older. BPD can, however, be diagnosed in younger patients.

If you are experiencing the mentioned signs and symptoms associated with borderline personality disorder, please consult a mental health professional.

People with this condition often experience suicidal thoughts, such as mental images and fantasies about self-harm and plotting suicide. You should contact a suicide hotline number, a close loved one, or a mental health provider to get help.

Suicide prevention resources can be found below.

Good News: There’s Hope for Folks With BPD!

Because borderline personality disorder is as unique as each person who lives with it, treatment requires a specialized approach.

Many people have BPD and, at times, experience emotional anguish from the condition. However, you don’t have to resort to living a life that’s full of pain and heartbreak. It’s important to take care of yourself, recognize your triggers, and work with your health care team to determine what treatments will help keep it in check.

By committing to care and learning as much as possible about it, you can make a difference in your quality of life—and the lives of those around you.

McLean Is Here to Help

Patient and clinician walk and talk outside

McLean offers world-class care for teens and adults who struggle with borderline personality disorder. Contact us today to find the care that’s right for yourself or your loved one.

Patient and clinician walk and talk outside

Want More Info?

Looking for even more information about borderline personality disorder? You may find these resources helpful.

Interesting Articles, Videos, and More

Learn more about borderline personality disorder and what you can do if you or a loved one is displaying signs of BPD.

Helpful Links

These organizations may also have useful information:

Behavioral Tech: Training for Mental Health Professionals
Behavioral Tech provides robust training for clinicians, especially in dialectical behavior therapy and other treatments for borderline personality disorder. Behavioral Tech also offers resources for providers and consumers in an effort to bring ever-better treatments to those in need. The organization supports advocacy efforts and BPD research.

Borderline Personality Disorder Resource Center
The mission of the Borderline Personality Disorder Resource Center (BPDRC) is to promote BPD education and connect those affected by BPD to established resources for treatment and support. The BPDRC is affiliated with the Personality Disorders Institute at New York-Presbyterian Hospital/Westchester Division, and their efforts are overseen by innovators in the research and treatment of personality disorders. Among many resources, the BPDRC maintains a nationwide database of clinicians, agencies, and facilities that focus on treating BPD and co-occurring disorders.

National Education Alliance for Borderline Personality Disorder
This group provides education, while raising public awareness and understanding, in an attempt to reduce stigma and promote research and enhance the quality of life of those affected by borderline personality disorder. They work with Congress to enhance the quality of life for those individuals affected by this serious but treatable mental illness. NEABPD’s many resources include BPD Family Guidelines, The Family Connections Program, and Family Education Workshop videos.

New England Personality Disorder Association
NEPDA’s mission is to promote education, support, and advocacy in the field of personality disorders, with a concentration on borderline personality disorder. NEPDA sponsors workshops, conferences, and small group meetings for family members, friends and other loved ones, consumers of mental health services, professionals, and the community at large to improve awareness of personality disorders and reduce the stigma that is often associated with them.

Personality Disorder Awareness Network (PDAN)
A not-for-profit organization dedicated to increasing public awareness of personality disorders, alleviating the impact of personality disorders on families, and preventing the development of personality disorders in children.

Treatment and Research Advances Association for Borderline Personality Disorder
The TARA for Borderline Personality Disorder’s mission is to foster education and research in the field of personality disorders, like borderline personality disorder. They support and encourage educational programs and endeavors targeting mental health professionals, consumers of mental health services, families, and communities to reduce stigma and increase awareness, to disseminate available information on etiology and treatment, and to advocate for accomplishments of these goals.

Suicide Prevention Resources

Although it is not possible to predict suicide with any certainty, our best tool is recognition of the signs that many people exhibit when contemplating suicide. The following three behaviors should prompt you to seek immediate help for yourself or a loved one:

  • Talking about wanting to die or to kill oneself
  • Looking for a way to kill oneself, such as searching online or obtaining a gun
  • Talking about feeling hopeless or having no reason to live

If You or Someone You Know Needs Help

Find more suicide prevention resources.

If you are suicidal or are a danger to yourself or others, please call 9-1-1 or visit your nearest emergency room immediately.

These organizations also offer suicide prevention resources:

988 Suicide & Crisis Lifeline
If you are suicidal, please call 988 or 800.273.TALK (8255). You’ll be connected to a skilled, trained counselor at a crisis center in your area. Counselors are available 24 hours a day, seven days a week. The 988 Suicide & Crisis Lifeline website also offers many resources for those looking for support.

American Foundation for Suicide Prevention
The American Foundation for Suicide Prevention (AFSP) is dedicated to saving lives and bringing hope to those affected by suicide. AFSP creates a culture that’s smart about mental health through education and community programs, develops suicide prevention through research and advocacy, and provides support for those affected by suicide. AFSP has local chapters in all 50 states, with programs and events nationwide.

Samaritans: Massachusetts 24-Hour Crisis HelpLine
A non-denominational, not-for-profit volunteer organization dedicated to reducing the incidence of suicide by befriending individuals in crisis and educating the community about effective prevention strategies. The Samaritans provide a free and confidential 24-hour phone befriending line. Call or text the 24/7 statewide Helpline at 877.870.4673.

Stop A Suicide Today!
Stop A Suicide Today is a nationwide campaign by Screening for Mental Health, Inc., to empower individuals to help themselves, colleagues, friends, and loved ones who are concerned about or feel suicidal.

Suicide Prevention Resource Center
The Suicide Prevention Resource Center is the only federally supported resource center devoted to advancing the implementation of the National Strategy for Suicide Prevention.

Books About BPD

Book cover - DBT for Dummies

DBT For Dummies
by Gillian Galen, PsyD, Blaise Aguirre, MD
(Wiley, 2021)

Book cover Handbook of Good Psychiatric Management for Adolescents With Borderline Personality Disorder

Handbook of Good Psychiatric Management for Adolescents With Borderline Personality Disorder
edited by Lois W. Choi-Kain, MEd, MD, and Carla Sharp, PhD
(American Psychiatric Association Publishing, 2021)

Book cover - GPM and DBT

Good Psychiatric Management and Dialectical Behavior Therapy: A Clinician’s Guide to Integration and Stepped Care
edited by Anne K.I. Sonley, JD, MD, FRCPC, and Lois W. Choi-Kain, MEd, MD
(American Psychiatric Association Publishing, 2020)

Book cover - GPM for BPD

Applications of Good Psychiatric Management for Borderline Personality Disorder: A Practical Guide
edited by Lois W. Choi-Kain, MEd, MD, and John G. Gunderson, MD
(American Psychiatric Association Publishing, 2019)

Book cover - Borderline Personality Disorder

Borderline Personality Disorder: A Case-Based Approach
edited by Brian Palmer, MD, and Brandon Unruh, MD
(Springer, 2018)

Book cover - Beyond Borderline

Beyond Borderline: True Stories of Recovery From Borderline Personality Disorder
by John G. Gunderson, MD, Perry D. Hoffman, PhD
(New Harbinger Publications, 2016)

Book cover - BPD and Mood Disorders

Borderline Personality and Mood Disorders: Comorbidity and Controversy
edited by Lois W. Choi-Kain, MEd, MD, and John G. Gunderson, MD
(Springer, 2015)

Book cover - Coping with BPD

Coping With BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder
by Blaise Aguirre, MD, and Gillian Galen, PsyD
(New Harbinger, 2015)

Book cover - Handbook of GPM for BPD

Handbook of Good Psychiatric Management (GPM) for Borderline Patients
by John G. Gunderson, MD, with Paul S. Links, MD, FRCPC
(American Psychiatric Association Publishing, 2014)

Book cover - Mindfulness for BPD

Mindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy
by Blaise Aguirre, MD, and Gillian Galen, PsyD
(New Harbinger, 2013)

Book cover - BPD in Adolescent

Borderline Personality Disorder in Adolescents: A Complete Guide to Understanding and Coping When Your Adolescent Has BPD
by Blaise Aguirre, MD
(Fair Winds Press, 2007)

Book cover - Understanding and Treating Borderline Personality Disorder

Understanding and Treating Borderline Personality Disorder: A Guide for Professionals and Families
by John G. Gunderson, MD, and Perry D. Hoffman, PhD
(American Psychiatric Association Publishing, 2005)

Book cover - Narcissistic Personality Disorder

Identifying and Understanding the Narcissistic Personality
by Elsa F. Ronningstam
(Oxford University Press, 2005)

Borderline Personality Disorder

Borderline Personality Disorder
by Mary C. Zanarini, ed.
(Taylor & Francis, 2005)