BPD is a common mental illness. People affected have difficulty managing their emotions and impulses, relating to people and maintaining a stable self-image. BPD can be highly distressing for the person affected, and often for their family and friends too. It can be confusing and easily misunderstoo. Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions. Borderline personality disorder (BPD), mental illness characterized by chronic instability in the affected individual’s mood, relationships, and sense of identity. The term borderline was first brought into psychiatric terminology in 1938 by American psychoanalyst Adolph Stern. Stern used it to. Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships with other people.

1. Mental Illness Borderline Personality
2. Mental Illness Borderline Personality
3. Life With Borderline Personality Disorder

Overview

Borderline personality disorder is an illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.

Signs and Symptoms

People with borderline personality disorder may experience mood swings and display uncertainty about how they see themselves and their role in the world. As a result, their interests and values can change quickly.

People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships.

Other signs or symptoms may include:

• Efforts to avoid real or imagined abandonment, such as rapidly initiating intimate (physical or emotional) relationships or cutting off communication with someone in anticipation of being abandoned
• A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
• 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 occur primarily during a period of elevated mood or energy, they may be signs of a mood disorder—not borderline personality disorder
• Self-harming behavior, such as cutting
• Recurring thoughts of suicidal behaviors or threats
• Intense and highly changeable moods, with each episode lasting from a few hours to a few days
• Chronic feelings of emptiness
• Inappropriate, intense anger or problems controlling anger
• Difficulty trusting, which is sometimes accompanied by irrational fear of other people’s intentions
• Feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality

Not everyone with borderline personality disorder experiences every symptom. Some individuals experience only a few symptoms, while others have many. Symptoms can be triggered by seemingly ordinary events. For example, people with borderline personality disorder may become angry and distressed over minor separations from people to whom they feel close, such as traveling on business trips. The severity and frequency of symptoms and how long they last will vary depending on the individual and their illness.

Risk Factors

The cause of borderline personality disorder is not yet clear, but research suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing borderline personality disorder.

• Family History. People who have a close family member, such as a parent or sibling with the disorder may be at higher risk of developing borderline personality disorder.
• Brain Factors. Studies show that people with borderline personality disorder can have structural and functional changes in the brain especially in the areas that control impulses and emotional regulation. But is it not clear whether these changes are risk factors for the disorder, or 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 adversity during childhood. Others may have been exposed to unstable, invalidating relationships, and hostile conflicts.

Although these factors may increase a person’s risk, it does not mean that the person will develop borderline personality disorder. Likewise, there may be people without these risk factors who will develop borderline personality disorder in their lifetime.

Treatments and Therapies

Borderline personality disorder has historically been viewed as difficult to treat. But, with newer, evidence-based treatment, many people with the disorder experience fewer or less severe symptoms, and an improved quality of life. It is important that people with borderline personality disorder receive evidence-based, specialized treatment from an appropriately trained provider. Other types of treatment, or treatment provided by a doctor or therapist who is not appropriately trained, may not benefit the person.

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

Tests and Diagnosis

A licensed mental health professional—such as a psychiatrist, psychologist, or clinical social worker—experienced in diagnosing and treating mental disorders can diagnose borderline personality disorder by:

• Completing a thorough interview, including a discussion about symptoms
• Performing a careful and thorough medical exam, which can help rule out other possible causes of symptoms
• Asking about family medical histories, including any history of mental illness

Borderline personality disorder often occurs with other mental illnesses. Co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with the symptoms of borderline personality disorder. For example, a person with borderline personality disorder may be more likely to also experience symptoms of depression, bipolar disorder, anxiety disorders, substance use disorders, or eating disorders.

Seek and Stick with Treatment

NIMH-funded studies show that people with borderline personality disorder who don’t receive adequate treatment are:

• More likely to develop other chronic medical or mental illnesses
• Less likely to make healthy lifestyle choices

Borderline personality disorder is also associated with a significantly higher rate of self-harm and suicidal behavior than the general public.

People with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away.

If you or someone you know is in crisis, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are free and confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Read more on NIMH’s Suicide Prevention health topic page.

The treatments described on this page are just some of the options that may be available to a person with borderline personality disorder.

Psychotherapy

Psychotherapy is the first-line treatment for people with borderline personality disorder. A therapist can provide one-on-one treatment between the therapist and patient, or treatment in a group setting. Therapist-led group sessions may help teach people with borderline personality disorder how to interact with others and how to effectively express themselves.

It is important that people in therapy get along with, and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with the disorder to maintain a comfortable and trusting bond with their therapist.

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

• Dialectical Behavior Therapy (DBT): This type of therapy was developed for individuals with borderline personality disorder. DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help:
• Control intense emotions
• Reduce self-destructive behaviors
• Improve relationships
• Cognitive Behavioral Therapy (CBT): This type of therapy can help people with borderline personality disorder identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others, and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

Read more on NIMH’s Psychotherapies health topic page.

Medications

Because the benefits are unclear, medications are not typically used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms such as:

• mood swings
• depression
• other co-occurring mental disorders

Treatment with medications may require care from more than one medical professional.

Certain medications can cause different side effects in different people. Talk to your doctor 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

Families and caregivers of people with borderline personality disorder may also benefit from therapy. 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.

Some borderline personality disorder therapies include family members, caregivers, or loved ones in treatment sessions. This type of therapy helps by:

• Allowing the relative or loved one develop skills to better 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 borderline personality disorder. Although more research is needed to determine the effectiveness of family therapy in borderline personality disorder, studies on other mental disorders suggest that including family members can help in a person's treatment.

Finding Help

More information about finding a health care provider or treatment for mental disorders in general is available on our Help for Mental Illness webpage.

Tips for Family and Caregivers

To help a friend or relative with the disorder:

• Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with borderline personality disorder, but it is possible for them to get better over time
• Learn about mental disorders, including borderline personality disorder, so you can understand what the person with the disorder is experiencing
• Encourage your loved one who is in treatment for borderline personality disorder to ask about family therapy
• Seek counseling for yourself from a therapist. It should not be the same therapist that your loved one with borderline personality disorder is seeing

Join a Study

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

Health Hotlines

• National Suicide Prevention Lifeline: The Lifeline provides 24-hour, toll-free, and confidential support to anyone in suicidal crisis or emotional distress. Call 1-800-273-TALK (8255) to connect with a skilled, trained counselor at a crisis center in your area. Support is available in English and Spanish and via live chat.
• Disaster Distress Hotline: People affected by any disaster or tragedy can call this helpline, sponsored by the Substance Abuse and Mental Health Services Administration, to receive immediate counseling. Call 1-800-985-5990, or text “TalkwithUs” to 66746, to connect with a trained professional from the closest crisis counseling center within the network.
• Veterans Crisis Line: This helpline is a free, confidential resource for Veterans of all ages and circumstances. Call 1-800-273-8255, press '1'; text 838255; or chat onlineto connect with 24/7 support.
• Crisis Text Line: Text HELLO to 741741 for free and confidential support 24 hours a day throughout the U.S.

Learn More

Free Brochures and Fact Sheets

• 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.

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 Revised: December 2017

Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of the NIMH is appreciated. Please see ourCiting NIMH Information and Publications pagefor more information.

What is borderline personality disorder?

Borderline personality disorder (BPD) is a kind of mental health problem. It may also be called emotionally unstable personality disorder. People with BPD have unstable moods and can act recklessly. They also have a hard time managing their emotions. If you have BPD, you may have problems with daily tasks, obligations, and life events. You may have trouble keeping jobs and relationships. And you may use food, alcohol, or other substances to cope.

It's important to get treatment, because you are at higher risk of suicide. You are also at higher risk for depression, anxiety, substance abuse, and self-harm. Experts are still learning about the condition. Certain kinds of treatment can help and are often quite successful.

What causes borderline personality disorder?

Mental health experts don't know exactly what causes BPD. Some studies have shown it may be passed down in families. Your social and cultural surroundings may also play a part. For example, you may be at higher risk for BPD if you are part of a community with unstable relationships. People are at a higher risk for getting borderline personality disorder if they have suffered from abuse or neglect. Living with parents or guardians who have a history of substance abuse or criminal activity may increase the risk as well.

What are the symptoms of borderline personality disorder?

The symptoms of BPD often start during the teen years. The symptoms can vary from person to person. But people with BPD will have at least 5 of these symptoms over time:

• A pattern of severe mood changes over hours or days
• Extreme anger and problems controlling anger
• Strong, up-and-down relationships with family and friends that can go quickly from very close to anger and hatred
• Extreme fear of and reactions to abandonment, and extreme behaviors to avoid abandonment
• A rapidly changing sense of self that can cause sudden changes in goals, values, or behaviors
• Feeling disconnected from themselves, their body, or reality, or having paranoid thoughts
• Ongoing feelings of emptiness
• Self-destructive behaviors, such as substance abuse, binge eating, unsafe sex with multiple partners, unsafe driving, or reckless spending
• Suicide attempts or self-harming behavior, such as cutting, hair pulling, or burning

The symptoms of BPD may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is borderline personality disorder diagnosed?

If you have BPD symptoms, you can be diagnosed by a mental health provider. This type of specialist can include a psychiatrist or a psychologist. Or you may be seen by a clinical social worker or psychiatric nurse practitioner.

The mental health provider will ask about your medical history and your symptoms. You may be asked about your family's history of mental health conditions. You may also have a physical exam. This can rule out other illness. Make sure to tell the mental health provider about any health problems you have and any medicines you take.

How is borderline personality disorder treated?

Your healthcare provider will figure out your specific treatment for BFP based on the following:

• The extent of the problem
• Your age, overall health, and medical history
• Your tolerance for specific medicines, procedures, or therapies
• Expectations for the course of the disorder
• The opinion of the healthcare providers involved in your care
• Your opinion and preference

Many people with BPD respond well to treatment and get better. The most common treatment for BPD is psychotherapy. It can be done one-on-one or in a group setting. It may also be helpful if your family is part of the treatment. A trained psychotherapist may use one or more of these methods:

• Cognitive behavioral therapy. This gives you tools to help change your thoughts and actions.
• Dialectical behavior therapy. This helps you to be more aware of the current moment. It teaches you how to reduce extreme emotions and actions.
• Schema-focused therapy. This helps you change how you see yourself. It helps you turn negative views into more positive ones.
• Systems Training for Emotional Predictability and Problem Solving, or STEPPS. This trains you to use tools to manage your reactions to certain situations. Family and friends are also trained.

Medicines can also help some people with BPD. Neuroleptic and atypical antipsychotic medicine can help with some symptoms. Antidepressant and antianxiety medicine can be used to treat symptoms of depression or anxiety that may happen at the same time as BPD.

If you have severe symptoms, you may need hospital care for a time.

What are the complications of borderline personality disorder?

BPD may seriously affect a person's ability to cope and function in a job or in school. Other common problems that affect people with BPD include getting other mood disorders such as anxiety, depression, bipolar, substance abuse, eating disorders, and other psychiatric conditions. The person may have repeated hospitalizations due to repeated suicide attempts, self-mutilation, and disruptive behaviors. It can even lead to multiple prison sentences.

Living with borderline personality disorder

If you have BPD:

• See your healthcare provider or therapist on schedule. Don't skip appointments.
• Make sure to get enough sleep. Tell your healthcare provider if you're having trouble sleeping.
• Keep a healthy diet, and eat at regular meal times.
• Be physically active to help reduce stress and boost mood.
• Keep track of people, places, or situations that trigger your symptoms.
• Talk with your healthcare provider right away if your symptoms get worse, or if you feel suicidal.

When should I call my healthcare provider?

Mental Illness Borderline Personality

If your symptoms get worse or you have new symptoms, tell your healthcare provider.

Key points about borderline personality disorder

• Borderline personality disorder is a mental health problem. It can cause you to feel impulsive, reckless, moody, and emotionally unstable.
• BPD can be caused by living in a disruptive environment with unstable family support.
• People often seek medical help after attempting self-harm including cutting, self-mutilation, and suicide.
• People with BPD generally do very well with medical and cognitive therapy treatment.
• Early diagnosis can improve the person's long-term quality of life. It can also help the person form stable relationships. And help prevent violent disruptions in the life of the individual and his or her peers.
• Symptoms tend to be chronic and lifelong.

Next steps

Mental Illness Borderline Personality

Tips to help you get the most from a visit to your healthcare provider:

Life With Borderline Personality Disorder

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.