Borderline Personality Disorder Explained: Signs, Causes, and BPD Treatment Options

What Is Borderline Personality Disorder?

Borderline personality disorder is defined as a pervasive pattern of instability in mood, self-image, relationships, and behaviors.[1] It is diagnosed in approximately 1.6% of the general population and tends to be more frequently diagnosed in women than in men.[2]

BPD is often defined as an emotional dysregulation disorder. In other words, the brain’s ability to regulate emotional responses is significantly impaired, which results in intense emotional reactions and rapid shifts in mood.[3] It is this emotional intensity that causes many of the interpersonal and behavioral patterns associated with the disorder. It is important to understand that they are not character flaws, but responses to overwhelming experiences.

BPD is sometimes misdiagnosed as bipolar disorder, depression, or anxiety since they share many features.[4] However, there are very important differences when comparing these conditions, so it is imperative to have an accurate diagnosis for effective treatment to take place.

What Causes BPD?

BPD develops through a combination of factors, including:

• Genetic factors — BPD has a moderate genetic component, with research estimating that anywhere from 40% to 60% of the variance in BPD traits can be attributed to genetics.[5]
• Neurobiological factors — There are significant functional differences in brain activity patterns in people with BPD, especially in the amygdala and prefrontal regions, which involve emotional processing and regulation.[6]
• Trauma and adverse childhood experiences — Many people with BPD report histories of trauma, abuse, neglect, or an invalidating environment as a child. Although not all people with BPD have experienced trauma, it is associated with an increased risk for developing BPD.[7]
• Invalidating environments —  Environments where a child’s emotional responses are dismissed, minimized, or otherwise inappropriately responded to. Marsha Linehan’s biosocial theory explains that an invalidating environment plays a central role in BPD development.[8]

Symptoms of BPD

There are many different symptoms associated with BPD, and they can impact virtually every area of a person’s life. The most common include:

• Fear of abandonment — Intense, often frantic, attempts to avoid real or imagined abandonment, regardless of whether the person can objectively substantiate their fear.
• Unstable relationships — Relationships characterized by their intensity and instability, typically with idealization and devaluation that shifts rapidly.
• Unstable identity — An unstable sense of self, identity, and values that can differ from one moment to the next.
• Impulsivity — Impulsive and self-damaging behavior, such as excessive spending, binge drinking, binge eating, reckless driving, and uninhibited sexual behavior.
• Self-harm and suicidality — Recurrent and pervasive self-harm, suicidal gestures, threats, and attempts; these symptoms require immediate clinical attention.
• Emotional dysregulation — Intense mood swings that typically last hours rather than days; emotional reactivity that is difficult to regulate.
• Chronic emptiness— A chronic sense of emptiness or numbness that can be one of the most distressing internal symptoms of the disorder.
• Inappropriate anger — Intense and difficult-to-control anger often followed by guilt or shame once it subsides.
• Dissociation — Stress-related paranoid or dissociative episodes, particularly during periods of intense emotions.

When to Seek Professional Help

Anyone experiencing symptoms consistent with BPD should get evaluated by a qualified clinical provider. Because of how frequently BPD is misdiagnosed and the serious impairment to daily functioning and interpersonal relationships it can cause, early and accurate assessment is critically important.

Entry into a BPD treatment program is particularly appropriate when:

• There is evidence of self-harm or suicidal behavior, or these behaviors have escalated over time.
• Outpatient treatment has not provided sufficient relief, or the patient has had difficulties maintaining their outpatient therapy.
• Symptoms of BPD have become so severe that they have greatly disrupted the patient’s daily functioning and ability to relate to others.
• The clinical picture is further complicated by co-occurring disorders, such as substance use, depression, or anxiety.
• A structured and immersive therapeutic environment is necessary for stabilizing the patient and establishing an appropriate basis for effective therapeutic intervention.

Borderline Personality Disorder Treatment at Helios West Palm

Due to the complexity and severity of BPD, the correct clinical approaches and treatment modalities are critical. Helios West Palm’s BPD treatment program is based on scientific evidence and is individualized to each patient by trained clinicians. Each patient receives a comprehensive psychiatric evaluation as part of the admission process. After the evaluation, an individualized treatment plan will be developed to address both the presenting issues of BPD and any co-occurring disorders. 

While we will employ multiple therapies as part of a comprehensive treatment program for BPD, all BPD presenting clients will receive Dialectic Behavior Therapy (DBT). This evidence-based modality was developed by Marsha Linehan specifically for the treatment of BPD and remains an effective and widely used treatment.[9] DBT provides patients with four main skill areas to assist with emotions: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

Benefits of BPD Treatment

One of the most frequently asked questions from our clients is, “Will I ever get better?”

And the answer is “yes.” With proper intervention, a meaningful improvement is certainly possible. Long-term studies have found that approximately 70%–85% of people with BPD no longer meet full criteria for diagnosis after sustained treatment.[10] Some of the benefits of an evidence-based treatment program for BPD include:

• Decreased frequency and severity of self-harm and suicidal behaviors
• Improved emotional regulation, where intense emotional reactions are still experienced but can be managed instead of being acted upon impulsively
• More stable, satisfying relationships with patterns of idealization, devaluation, and fear of abandonment are better understood and less automatic
• An improved and stable sense of self
• Improved daily functioning at work, in relationships, and in everyday life
• Reduced impulsivity and better decision-making
• A clearer and more compassionate relationship with oneself