The primary characteristic of borderline personality disorder is instability. There is a tendency for unpredictable behavior and erratic changes of mood, which results in a pattern of rocky relationships, inconsistent self-image, and rollercoaster emotions.
Criteria for Diagnosing Borderline Personality Disorder:
As described above, there must be an ongoing pattern of instability in interpersonal relationships, self-image, and mood, as well as impulsive behaviors. These must be present by early adulthood, as well as at least five of the following additional criteria:
- Fear of abandonment, with frantic efforts to avoid it
- A pattern of rocky relationships
- Self-image that may change suddenly and dramatically
- Impulsivity in at least two self-damaging ways
- Recurrent self-mutilating behaviors, suicidal threats, or suicide attempts
- Intense mood shifts; extreme emotional reactions
- A feeling of emptiness that won’t go away
- Anger issues
- Paranoia or dissociative symptoms when extremely stressed
Individuals with borderline personality disorder struggle with relationships in all areas of life. They often have a history littered with multiple broken friendships, strained or estranged relationships with family members, and a string of dramatic break-ups with ex-romantic partners. They often struggle to get along with co-workers, employers, teachers, doctors, counselors, and neighbors. Individuals with BPD tend to pursue very intense relationships –they may shower the other person with compliments, attention, gifts, and promises, which at first may seem very exciting and charming to the other person.
But they may quickly become overly demanding, with expectations that the other person expends all their time and energy on them. It begins to feel clingy and the other person may feel smothered. The individual with BPD will idealize the other person and say things like “You’re the best friend (or boyfriend, counselor, etc….) that I’ve ever had! You’re the only person who has ever been this good to me!”
But it usually doesn’t take long for the other person to fall from their pedestal — at the slightest wrong move, the other person is suddenly and completely devalued. It can be due to something as simple as canceling plans (even for a valid reason), spending time with other people, or innocently forgetting a minor detail. Suddenly, an extreme emotional reaction occurs, often a fit of intense anger, and the other person is now accused of being intentionally hurtful, abusive, demeaning, neglectful, or deceptive. They will be accused of not caring enough, not being there enough, or not giving enough.
Following this major blow-up, the fear of abandonment kicks in, and the individual with borderline personality disorder may relentlessly pursue the other person, trying frantically to save the relationship, flipping back to idealizing and desperately proclaiming the other person to be their “everything.”
Individuals with BPD worry constantly about being rejected or left out. When faced with a situation where the other person may be away or unavailable for a while, there is often fear, panic, and inappropriate anger. If the other person is a few minutes late, this is perceived as abandonment and means the other person is “bad.” If the other person attempts to establish healthy boundaries, an individual with BPD may resort to self-harm in order to force the other person’s attention back upon them.
For the person attempting to have a relationship with someone with BPD, it may feel like: “I love you! I hate you! Come here, I need you. Get away from me!” This is confusing and frustrating for the other person who is constantly either deemed as “the best” or “the worst,” and, as a result, these intense relationships often come to a dramatic and ugly end. Sometimes individuals with BPD eventually choose to bond with a pet instead of attempting any more new relationships with other people.
Folks with borderline personality disorder tend to change their minds frequently and dramatically about who they are and what they want to do with their lives. They may suddenly change career goals, sexual orientation, or even their basic values. Opinions, plans, and hobbies may be suddenly traded for other things that are vastly different. Things they were once very passionate about may become things they hate. Many individuals with BPD struggle with low self-esteem.
Individuals with BPD behave in impulsive ways that cause damage to their own lives. For some, this could be going on impulsive spending sprees or gambling away money that is needed for bills. For others, it might mean impulsively getting involved in dangerous sexual situations. It could also be reckless driving, taking unnecessary risks in traffic, binge drinking, or using illegal drugs. This could also include self-sabotaging behaviors such as dropping out of school right before graduation or intentionally blowing an interview for a good job opportunity.
Self-mutilation is common among folks with borderline personality disorder. This includes cutting, burning, picking, or anything else that an individual does to harm their own body intentionally. Suicidal thoughts and threats are also common, and many individuals with BPD actually attempt to end their lives by suicide. Some of them succeed. Sadly, approximately 10% of individuals with BPD die by suicide.
Intense emotions are experienced by people with this personality disorder. Their reactions to everyday stressors often seem extreme and excessive to others. Their moods can change swiftly and dramatically in response to challenges or changes, whether large or small. They are often angry, irritable, anxious, or depressed.
They live in fear of abandonment, and constantly worry about hypothetical things that could cause their worst fears to come true. Even when all is going well, they are often unable to enjoy anything due to that horrible, nagging fear that is always lingering right under the surface. Some individuals with BPD report a feeling of emptiness that never seems to completely go away. They become bored easily and are often searching for something to do, in hopes that it will help them feel more fulfilled. Their communication often comes across to others as sarcastic or bitter.
Anger is a very real issue for people with borderline personality disorder. They feel angry often, and it is usually a very intense form of anger that they have difficulty controlling. Often their anger is inappropriate — in other words, it occurs without a valid reason. They tend to have a short fuse and lose their temper easily and often, which can lead to verbal outbursts or physical assaults on others. Individuals with BPD may seem like they are always angry about something — and often, this is true. Sometimes they are angry and don’t even know why. This anger is sometimes directed at others, and sometimes it is directed inwardly at themselves.
When they lash out at others, these angry altercations are often followed by intense feelings of guilt and shame, which further increase their fear of abandonment and can seem to validate their low self-esteem. This creates a vicious emotional cycle.
Paranoia and Dissociative Symptoms:
Stress creates difficulties for everyone, but individuals with borderline personality disorder have an extra tough time dealing with it. For them, extreme stress (especially if related to a real or imagined abandonment) can actually lead to symptoms of paranoia and dissociation, which fortunately, do not usually last very long, but nevertheless, can be distressful and frightening. Dissociative symptoms may include the experience of feeling detached from one’s own body, temporary loss of memory or perception of time, or feeling like the world is distorted or not real. In some cases, brief psychotic symptoms such as hallucinations could also occur.
Borderline personality disorder is diagnosed predominantly (about 75%) in females, according to the American Psychiatric Association. This personality disorder has a strong genetic link, but childhood physical abuse, sexual abuse, neglect, or loss of a parent as a child can also increase the likelihood of its development.
It is common for individuals with BPD to also have diagnoses of Major Depressive Disorder, Bipolar Disorder, various substance use disorders, eating disorders (especially bulimia), PTSD, ADHD, or other personality disorders.
Treatment options are available for borderline personality disorder. Mental health therapists skilled in providing Dialectical Behavior Therapy (DBT) or Transference-Focused Psychotherapy (TFP) can provide treatment that can be helpful in reducing suicidal ideation, regulating moods, and altering harmful behavioral patterns.
Diagnostic criteria for Borderline Personality Disorder is taken from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, published by the American Psychiatric Association. For more information on personality disorders, please visit What is a Personality Disorder? – Navigating Life (juliebailey.net) and Get Help With Personality Disorders (psychiatry.org).