29/03/2020 NIMH » Borderline Personality Disorder

The National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml

The National Institute of Mental Health: www.nimh.nih.gov

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
https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml 1/5
29/03/2020 NIMH » Borderline Personality Disorder

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

https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml 2/5
29/03/2020 NIMH » Borderline Personality Disorder

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.

https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml 3/5
29/03/2020 NIMH » Borderline Personality Disorder

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. You may also find additional information through the
NIMH Outreach Partners or the NIMH National Partners.

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
What are Clinical Trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and
conditions, including borderline personality disorder. During clinical trials, treatments might be new
drugs, new types of psychotherapy, new combinations of drugs, or new ways to use existing treatments.
The goal of clinical trials is to determine if a new test or treatment works and is safe.

Although individual participants 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

https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml 4/5
29/03/2020 NIMH » Borderline Personality Disorder

better helped in the future. Decisions about participating in a clinical trial are best made in
collaboration with a licensed health professional.

To learn more about clinical trials, please visit the NIH Clinical Research Trials and You website. To find
a clinical trial, visit ClinicalTrials.gov.

Learn More
Free Brochures and Fact Sheets

Borderline Personality Disorder

NIMH Answers Questions About Suicide
Suicide in America: Frequently Asked Questions
Eating Disorders: About More Than Food
Depression Basics

Federal Resources

Borderline Personality Disorder - Medline Plus: Medical Encyclopedia

Personality Disorders - Medline Plus: Medical Encyclopedia
Veterans Crisis Line

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 our Citing NIMH Information and
Publications page for more information.

https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml 5/5