Borderline personality disorder anger

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Helping Someone with Borderline Personality Disorder

Have a loved one who’s been diagnosed with BPD? While you can’t force them to seek treatment, you can take steps to improve communication, set healthy boundaries, and stabilize your relationship.

People with borderline personality disorder (BPD) tend to have major difficulties with relationships, especially with those closest to them. Their wild mood swings, angry outbursts, chronic abandonment fears, and impulsive and irrational behaviors can leave loved ones feeling helpless, abused, and off balance. Partners and family members of people with BPD often describe the relationship as an emotional roller coaster with no end in sight. You may feel like you’re at the mercy of your loved one’s BPD symptoms—trapped unless you leave the relationship or the person takes steps get treatment. But you have more power than you think.

You can change the relationship by managing your own reactions, establishing firm limits, and improving communication between you and your loved one. There’s no magic cure but with the right treatment and support, many people with BPD can and do get better and their relationships can become more stable and rewarding. In fact, patients with the most support and stability at home tend to show improvements sooner than those whose relationships are more chaotic and insecure. Whether it’s your partner, parent, child, sibling, friend, or other loved one with BPD, you can improve both the relationship and your own quality of life, even if the person with BPD isn’t ready to acknowledge the problem or seek treatment.

Learning all you can

If your loved one has borderline personality disorder, it’s important to recognize that he or she is suffering. The destructive and hurtful behaviors are a reaction to deep emotional pain. In other words, they’re not about you. When your loved one does or says something hurtful towards you, understand that the behavior is motivated by the desire to stop the pain they are experiencing; it’s rarely deliberate.

Learning about BPD won’t automatically solve your relationship problems, but it will help you understand what you’re dealing with and handle difficulties in more constructive ways.

Recognizing the signs and symptoms of BPD

Recognizing the signs and symptoms of borderline personality disorder is not always easy. BPD is rarely diagnosed on its own, but often in conjunction with co-occurring disorders such as depression, bipolar disorder, anxiety, an eating disorder, or substance abuse. Your family member or loved one with BPD may be extremely sensitive, so small things can often trigger intense reactions. Once upset, borderline people are often unable to think straight or calm themselves in a healthy way. They may say hurtful things or act out in dangerous or inappropriate ways. This emotional volatility can cause turmoil in their relationships and stress for family members, partners, and friends.

Many people in a close relationship with someone who suffers from BPD often know that there’s something wrong with their loved one, but have no idea what it is or if there is even a name for it. Learning a diagnosis of borderline personality disorder can come as a source of both relief and hope.

Does your loved one have borderline personality disorder?

In your relationship:

  1. Do you feel like you have to tiptoe around your loved one, watching every little thing you say or do for fear of setting them off? Do you often hide what you think or feel in order to avoid fights and hurt feelings?
  2. Does your loved one shift almost instantaneously between emotional extremes (e.g. calm one moment, raging the next, then suddenly despondent?) Are these rapid mood swings unpredictable and seemingly irrational?
  3. Does your loved one tend to view you as all good or bad, with no middle ground? For example, either you’re “perfect,” and the only one they can count on, or you’re “selfish” and “unfeeling” and never truly loved them.
  4. Do you feel like you can’t win: that anything you say or do will be twisted and used against you? Does it feel as if your loved one’s expectations are constantly changing, so you’re never sure how to keep the peace?
  5. Is everything always your fault? Do you feel constantly criticized and blamed for things that don’t even make sense? Does the person accuse you of doing and saying things you never did? Do you feel misunderstood whenever you try to explain or reassure your partner?
  6. Do you feel manipulated by fear, guilt, or outrageous behavior? Does your loved one make threats, fly into violent rages, make dramatic declarations, or do dangerous things when they think you’re unhappy or may leave?

If you answer “yes” to most of these questions, your partner or family member might have borderline personality disorder.

To help someone with BPD, first take care of yourself

When a family member or partner has borderline personality disorder, it’s all too easy to get caught up in heroic efforts to please and appease him or her. You may find yourself putting most of your energy into the person with BPD at the expense of your own emotional needs. But this is a recipe for resentment, depression, burnout, and even physical illness. You can’t help someone else or enjoy sustainable, satisfying relationships when you’re run down and overwhelmed by stress. As in the event of an in-flight emergency, you must “put on your own oxygen mask first.”

Avoid the temptation to isolate. Make it a priority to stay in touch with family and friends who make you feel good. You need the support of people who will listen to you, make you feel cared for, and offer reality checks when needed.

You’re allowed (and encouraged) to have a life! Give yourself permission to have a life outside of your relationship with the person with BPD. It’s not selfish to carve out time for yourself to relax and have fun. In fact, when you return to your BPD relationship, you’ll both benefit from your improved perspective.

Join a support group for BPD family members. Meeting with others who understand what you’re going through can go a long way. If you can’t find an in-person support group in your area, you may want to consider joining an online BPD community.

Don’t neglect your physical health. Eating healthfully, exercising, and getting quality sleep can easily fall by the wayside when you’re caught up in relationship drama. Try to avoid this pitfall. When you’re healthy and well rested, you’re better able to handle stress and control your own emotions and behaviors.

Learn to manage stress. Getting anxious or upset in response to problem behavior will only increase your loved one’s anger or agitation. By practicing with sensory input, you can learn to relieve stress as it’s happening and stay calm and relaxed when the pressure builds.

Remember the 3 C’s rule

Many friends or family members often feel guilty and blame themselves for the destructive behavior of the borderline person. You may question what you did to make the person so angry, think you somehow deserve the abuse, or feel responsible for any failure or relapse in treatment. But it’s important to remember that you’re not responsible for another person. The person with BPD is responsible for their own actions and behaviors.

The 3 C’s are:

  1. I didn’t cause it.
  2. I can’t cure it.
  3. I can’t control it.

Source: Out of the Fog

Communicating with someone who has BPD

Communication is a key part of any relationship but communicating with a borderline person can be especially challenging. People in a close relationship with a borderline adult often liken talking with their loved one to arguing with a small child. People with BPD have trouble reading body language or understanding the nonverbal content of a conversation. They may say things that are cruel, unfair, or irrational. Their fear of abandonment can cause them to overreact to any perceived slight, no matter how small, and their aggression can result in impulsive fits of rage, verbal abuse, or even violence.

The problem for people with BPD is that the disorder distorts both the messages they hear and those they try to express. BPD expert and author, Randi Kreger, likens it to “having ‘aural dyslexia,’ in which they hear words and sentences backwards, inside out, sideways, and devoid of context.”

Listening to your loved one and acknowledging his or her feelings is one of the best ways to help someone with BPD calm down. When you appreciate how a borderline person hears you and adjust how you communicate with them, you can help diffuse the attacks and rages and build a stronger, closer relationship.

Communication tips

It’s important to recognize when it’s safe to start a conversation. If your loved one is raging, verbally abusive, or making physical threats, now is not the time to talk. Better to calmly postpone the conversation by saying something like, “Let’s talk later when we’re both calm. I want to give you my full attention but that’s too hard for me to do right now.”

When things are calmer:

Listen actively and be sympathetic. Avoid distractions such as the TV, computer, or cell phone. Try not to interrupt or redirect the conversation to your concerns. Set aside your judgment, withhold blame and criticism, and show your interest in what’s being said by nodding occasionally or making small verbal comments like “yes” or “uh huh.” You don’t have to agree with what the person is saying to make it clear that you’re listening and sympathetic.

Focus on the emotions, not the words. The feelings of the person with BPD communicate much more than what the words he or she is using. People with BPD need validation and acknowledgement of the pain they’re struggling with. Listen to the emotion your loved one is trying to communicate without getting bogged down in attempting to reconcile the words being used.

Try to make the person with BPD feel heard. Don’t point out how you feel that they’re wrong, try to win the argument, or invalidate their feelings, even when what they’re saying is totally irrational.

Do your best to stay calm, even when the person with BPD is acting out. Avoid getting defensive in the face of accusations and criticisms, no matter how unfair you feel they are. Defending yourself will only make your loved one angrier. Walk away if you need to give yourself time and space to cool down.

Seek to distract your loved one when emotions rise. Anything that draws your loved one’s attention can work, but distraction is most effective when the activity is also soothing. Try exercising, sipping hot tea, listening to music, grooming a pet, painting, gardening, or completing household chores.

Talk about things other than the disorder. You and your loved one’s lives aren’t solely defined by the disorder, so make the time to explore and discuss other interests. Discussions about light subjects can help to diffuse the conflict between you and may encourage your loved one to discover new interests or resume old hobbies.

Don’t ignore self-destructive behaviors and suicidal threats

If you believe your loved one is at an immediate risk for suicide Do NOT leave the person alone. Call your loved one’s therapist or:

  • In the U.S., dial 911 or call the National Suicide Prevention Lifeline at 1-800-273-TALK.
  • In other countries, call your country’s emergency services number or visit IASP to find a suicide prevention helpline.

Setting healthy boundaries with a borderline loved one

One of the most effective ways to help a loved one with BPD gain control over his or her behavior is to set and enforce healthy limits or boundaries. Setting limits can help your loved one better handle the demands of the outside world, where schools, work, and the legal system, for example, all set and enforce strict limits on what constitutes acceptable behavior. Establishing boundaries in your relationship can replace the chaos and instability of your current situation with an important sense of structure and provide you with more choices about how to react when confronted by negative behavior. When both parties honor the boundaries, you’ll be able to build a sense of trust and respect between you, which are key ingredients for any meaningful relationship.

Setting boundaries is not a magic fix for a relationship, though. In fact, things may initially get worse before they get better. The person with BPD fears rejection and is sensitive to any perceived slight. This means that if you’ve never set boundaries in your relationship before, your loved one is likely to react badly when you start. If you back down in the face of your loved one’s rage or abuse, you’ll only be reinforcing their negative behavior and the cycle will continue. But, remaining firm and standing by your decisions can be empowering to you, benefit your loved one, and ultimately transform your relationship.

How to set and reinforce healthy boundaries

Talk to your loved one about boundaries at a time when you’re both calm, not in the heat of an argument. Decide what behavior you will and will not tolerate from the person and make those expectations clear. For example, you may tell your loved one, “If you can’t talk to me without screaming abuse at me, I will walk out.”

Do…

  • Calmly reassure the person with BPD when setting limits. Say something like, “I love you and I want our relationship to work, but I can’t handle the stress caused by your behavior. I need you to make this change for me.”
  • Make sure everyone in the family agrees on the boundaries—and how to enforce the consequences if they’re ignored.
  • Think of setting boundaries as a process rather than a single event. Instead of hitting your loved one with a long list of boundaries all at once, introduce them gradually, one or two at a time.

Don’t…

  • Make threats and ultimatums that you can’t carry out. As is human nature, your loved one will inevitably test the limits you set. If you relent and don’t enforce the consequences, your loved one will know the boundary is meaningless and the negative behavior will continue. Ultimatums are a last resort (and again, you must be prepared to follow through).
  • Tolerate abusive behavior. No one should have to put up with verbal abuse or physical violence. Just because your loved one’s behavior is the result of a personality disorder, it doesn’t make the behavior any less real or any less damaging to you or other family members.
  • Enable the person with BPD by protecting them from the consequences of their actions. If your loved one won’t respect your boundaries and continues to make you feel unsafe, then you may need to leave. It doesn’t mean you don’t love them, but your self-care should always take priority.

Supporting your loved one’s BPD treatment

Borderline personality disorder is highly treatable, yet it’s common for people with BPD to avoid treatment or deny that they have a problem. Even if this is the case with your loved one, you can still offer support, improve communication, and set boundaries while continuing to encourage your friend or family member to seek professional help.

While medication options are limited, the guidance of a qualified therapist can make a huge difference to your loved one’s recovery. BPD therapies, such as Dialectical Behavior Therapy (DBT) and schema-focused therapy, can help your loved one work through their relationship and trust issues and explore new coping techniques, learning how to calm the emotional storm and self-soothe in healthy ways.

How to support treatment

If your loved one won’t acknowledge that they have a problem with BPD, you may want to consider couple’s therapy, where the focus is on the relationship and promoting better communication, rather than on your loved one’s disorder. Your partner may more readily agree to this and eventually consider pursuing BPD therapy in the future.

Encourage your loved one to explore healthy ways of handling stress and emotions by practicing mindfulness, employing relaxation techniques such as yoga, deep breathing, meditation, or sensory-based stimulation to relieve stress in the moment. Again, you can participate in any of these therapies with your loved one, which can strengthen your bond and may encourage them to pursue other avenues of treatment as well.

By developing an ability to tolerate distress, your loved one can learn how to press pause when the urge to act out or behave impulsively strikes. HelpGuide’s free Emotional Intelligence Toolkit offers a step-by-step, self-guided program to teach your loved one how to ride the “wild horse” of overwhelming feelings while staying calm and focused.

Setting goals for BPD recovery: Go slowly

When supporting your loved one’s recovery, it’s important to be patient and set realistic goals. Change can and does happen but, as with reversing any kind of behavior pattern, it takes time.

  • Take baby steps rather than aiming for huge, unattainable goals that set you and your loved one up for failure and discouragement. By lowering expectations and setting small goals to be achieved step by step, you and your loved one have a greater chance of success.
  • Supporting your loved one’s recovery can be both extremely challenging and rewarding. You need to take care of yourself, but the process can help you grow as an individual and strengthen the relationship between you.

People who have BPD often have tremendous issues with anger — both expressing it and being the recipient of it. They will often go to extreme lengths to make people happy in order to avoid having people get angry at them. The flip side of that is that they themselves can go into a drop dead rage at the drop of a hat. I will examine why this happens.

Some psychiatrists believe that people have intense issues around anger because when they were children, they were not “allowed” to express it and, in some cases, told that even feeling it was somehow bad. As they grow up, they learn that anger is a “bad” thing and so learn to go to great lengths to avoid having it in their life.

If they have grown up in a setting where anger is not okay, it becomes just one more “bad feeling” they feel and they will either try to run away from it or will be so overwhelmed by it that it boils over because they do not know how to contain it. In many cases, though the person feels anger on a regular basis and engages in expressing it negatively they are unaware that they are even feeling this emotion and can not even identify it as a feeling. For them, it “just happens”. They feel victimized by it because they don’t know where it comes from or how to stop it from happening.

Sometimes anger can be felt more remotely in terms of low-lying irritation or annoyance which is then displaced onto other people. This is a partial explanation for why people with BPD are always “pissed off” at the world. Most people who have this kind of unaddressed anger channel it into extreme feelings of anxiety because they have to express it somehow. In some cases, it can be expressed somatically — that is as irritable bowel syndrome or extreme headaches caused by tension.

The crux of the matter here is that almost everyone is afraid of anger because we are not taught how to express it properly. Anger is simply one of many emotions. It is neither good nor bad. The way you choose to deal with it is what attributes a value to it. When you are able to understand and accept that anger is an emotion like so many others and that it has no power to hurt you, you will be on your way to setting yourself free. The only thing negative about anger are the consequences involved if you deal with your anger inappropriately by lashing out and yelling at people or breaking things or turn it in on yourself.

People like to say that depression is anger turned inwardly. I think depression in people with BPD is caused by years of neglect and not feeling heard, being scapegoated by the family of origin and feeling bullied. Yes, all those things can lead a person to feel angry but that anger is reactive in nature. The resulting “depression” is just the way the person with BPD chooses to express those angry feelings.

One of the ways to deal with anger issues is to learn and practice assertiveness. When you become an assertive person you learn how to stand up for yourself so you don’t get walked all over by people. Learning how to stand up for yourself assertively allows you to have a voice so you can express yourself in a rational manner and, hopefully, be heard by the people with whom you are interacting with. It can alleviate some of the feelings of helplessness a person can feel in an intimate relationship.

The other way to learn to deal with anger is to learn conflict negotiation skills. This is not for the faint of heart because it requires you to look closely at both sides of an argument and figure out what you really want rather than hiding behind what you think you want.

Another reason that a person may be afraid of anger is because they fear retaliation from the other person. They worry that the other person will abandon them if they are “not nice enough”. We are taught from childhood that “nice girls don’t “do conflict” and told to suppress our angry feelings. But the bottom line is that conflict is found in every single relationship be it an interpersonal one or a work relationship. So, it is imperative that we learn how to approach conflict so that it can be productive and not confrontational.

A third way is to learn anxiety reduction techniques such a mindfulness meditation and box breathing. In my experience, my anger was always anxiety-fueled feelings that had completely run amok. Once I learned how to get better control over my anxiety, my anger levels began to diminish.

Being able to express anger in an assertive, productive manner will help your relationships a great deal. As with all things related to BPD, one of the first steps in recovery is learning to take responsibility for your feelings, words and actions. Without that component you will stay stuck.

About the Author: Dee Chan

Dee Chan was diagnosed with BPD more than 35 years ago back when the diagnosis was still fairly new and not very well understood. She has been living with it and coping with it ever since and finding ways to thrive despite it. She has been able to put it into complete remission and turned her life around completely through the practices of gratitude, forgiveness and accountability. Find out more about Dee’s work on her website bpdnomore.com.

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What Is “Quiet” Borderline Personality Disorder?

Katie Reed, a blogger and mom of four from Salt Lake City, spent many years living with “quiet” borderline personality disorder before getting a proper diagnosis. Before that, she was misdiagnosed repeatedly — with bipolar disorder, Asperger’s syndrome, and anxiety disorder — none of which ever felt “right.”

It was after her third suicide attempt in 2009 that she was diagnosed with borderline personality disorder (BPD), a diagnosis that thankfully changed her life for the better.

“When I was finally diagnosed with BPD, it was like a light went on, and I suddenly understood what was going on in my brain and why I acted the way I did,” Reed tells Talkspace.

What is “Quiet” Borderline Personality Disorder, and How Does It Differ From Classic Borderline Personality Disorder?

The National Institute of Mental Health (NIH) describes borderline personality disorder (referred to most often as BPD) as marked by erratic mood swings, poor self-image, impulsive behavior, extreme “black-and-white” thinking, self-harm, and an inability to maintain stable relationships. Episodes of heightened anger, depression, or anxiety are another hallmarks of the disorder. These episodes can last for a few hours to a few days.

While there is no known, clear cause for BPD, experts believe a combination of genetics, brain structure and function, as well as environmental and social issues come into play. Many therapists point to a history of childhood trauma or abuse as a root cause of the disorder.

“Quiet” BPD isn’t readily distinguished from “regular” BPD—at least not in an official sense (it does not have a special designation in the Diagnostic and Statistical Manual of Mental Disorders , for example). And yet, therapists and their patients often see a clear distinction between the “quieter” cases of BPD and its more traditional manifestations.

While “classic” BPD is characterized by episodes of violent outbursts, individuals with “quiet” BPD tend to direct this violence inward.

“hose with ‘quiet’ borderline personality disorder act in,” says Dr. Gerard Lawson, President of the American Counseling Association. “There is less hostility and fewer aggressive outbursts, but there may still be isolation, and self-injurious behaviors or suicide attempts.”

People with “quiet” BPD will still experience the intense emotional roller-coaster than distinguishes the disorder, but will often be working harder to shut these emotions down, or push them aside. Very often, their sense of self is marked by shame or self-hatred.

“People with BPD often feel that their emotions are ‘wrong’ and spend a great deal of energy either pushing their feelings down or trying to justify ,” explains Jessica Tappana, LCSW, therapist and owner of Aspire Counseling. “Whether you react by withdrawing (“quiet”) or acting out, the emotional desperation of BPD…can feel unbearable.”

How is “Quiet” Personality Disorder Diagnosed?

Reed has always experienced BPD as an “inward experience.” There was very little “acting out,” and much of her intense emotions resulted in intense periods of self-harm.

“My rage and sadness are usually internalized, and my frustrations are directed inward. My arms are criss-crossed with scars in various degrees of healing from years of self-harm (cutting),” Reed explains. “I also tend to deal with upset by cutting myself off from those I love, becoming robotic in my interactions, refusing to allow empathy or sympathy in. It has affected every relationship I’ve ever had.”

Because people with the with “quiet” form of BPD don’t exhibit the classic explosive symptoms of the disorder, it can take much longer to get a proper diagnosis, which is particularly troubling when the symptoms of the “quiet” disorder involve self-harm.

“I think people who have more internalized symptoms aren’t diagnosed at all,” says Dr. Colleen Cira, Licensed Clinical Psychologist and the Founder and Executive Director of Cira Center for Behavioral Health. “Borderline Personality Disorder has such a reputation in the psychological community as presenting as angry, manipulative, explosive.”

Dr. Cira explains that while there are symptoms of the “quiet” form of BPD listed in the DSM, they are often overlooked when evaluating a patient, making it more difficult for patients to get a proper diagnosis. “This is a real problem because not only do these people need treatment to address their BPD symptoms, they also likely has trauma histories and need treatment to address their trauma histories as well,” she says.

Patients who have not been properly diagnosed with “quiet” borderline personality disorder often end up feeling “invisible” and “misunderstood,” says Dr. Cira, which only makes the disorder harder to live with, and leads to more episodes of self-harm and lower self-esteem.

Treatment (and Hope) For People With “Quiet” Borderline Personality Disorder

Getting a proper diagnosis for a “quiet” version of BPD tends to be half the battle. When patients find out the name for what they’ve been living with, it can be like a huge weight is lifted from their shoulders.

“I have felt far less crazy since getting my diagnosis because now I know what I am dealing with,” says Reed.

The good news is that treatment options for “quiet” BPD have increased over the years, as the disorder becomes better understood. Once patients get a diagnosis, there are several evidence-based treatments out there.

“Not so long ago (15-20 years) some very skilled clinicians believed there was no help for individuals who have a disorder like BPD,” says Dr. Lawson. “Now, there are actually very good treatment options, and they are improving.”

According to the National Alliance of Mental Health (NAMI), psychotherapy is the recommended treatment, with Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), and Mentalization-Based Therapy (MBT) topping the list of treatment methodologies.

DBT is the therapy of choice for therapist Jessica Tappana, who has used it frequently to treat “quiet” borderline personality patients in her practice. It’s an intensive treatment with four components: individual therapy, group DBT skills training, coaching throughout the week, and weekly meetings with your consultation team. But its comprehensive nature is what makes it so successful, according to Tappana.

“DBT does more than treat the symptoms of quiet BPD, it teaches you a new way to interact with the world around you,” she says.

Whatever method you use to treat “quiet” BPD, it is important you find a therapist that you feel comfortable with. “Quiet” BPD is something many will struggle with on and off for the rest of their lives. But treatment can lessen the symptoms significantly, and decrease the number of “episodes” patients experience.

Since getting diagnosed and entering treatment, Reed says she has far fewer episodes “Thankfully, as I’ve gotten older, I’ve been able to manage my illness better,” Reed shares. “It used to be several times a week that I would have ‘episodes’ but nowadays it is far rarer — once a year or so at most.”

Most importantly, Reed is now able to recognize what is happening to her, and work through it with a little more compassion and self-love. Reed openly writes about her experiences with mental illness on her blog, and considers herself an advocate for people with the disorder.

Reed’s hope for the future is that more people suffering with “quiet” BPD can get the treatment they need to live life to the fullest. “It’s a really important subject to share with people and help them understand,” she says.

Could It Be Borderline Personality Disorder?

When someone has anxiety, depression, or another form of a mental health condition, symptoms are usually present day in and day out for weeks, months, or years. With symptoms of borderline personality disorder (BPD), people may have strong emotional episodes that last only hours at a time, flaring up time and again. And this serious psychiatric disorder is one that requires serious treatment. Why? It can destroy relationships, careers, and even someone’s life if it’s not identified and brought under control.

You may wonder, do I have borderline personality disorder? According to the Mayo Clinic, borderline personality disorder symptoms include a pattern of unstable intense relationships, distorted self-image, extreme emotions and impulsiveness. Borderline personality disorder symptoms occur across a variety of settings and typically begin in the teenage years or early adulthood and may include:

  • An intense fear of abandonment or instability
  • Difficulty tolerating being alone
  • Feelings of emptiness
  • Frequent mood swings (happiness, anxiety, irritability)
  • Impulsiveness
  • Inappropriate anger or having physical fights
  • Periods of stress-related paranoia and loss of contact with reality
  • Suicidal threats or self-injury
  • Temper outbursts
  • Pattern of unstable or tempestuous interpersonal relationships
  • Impaired or unstable sense of self and identity

People with symptoms of borderline personality disorder may have unpredictable relationships and sudden emotional shifts to sadness or anger. They may take risks that can hurt themselves or others, even physically. Some people with borderline personality disorder symptoms engage in unsafe sex, eating binges, risky driving, or gambling sprees. These behaviors are thought to be related to a poor self-image of the person with BPD. Also, when they are highly emotional, they might have trouble thinking clearly about themselves or others.

While there are many new studies on borderline personality disorder symptoms, the cause is unknown. There may be a genetic link, or it could be that chemicals in the brain such as serotonin are not working properly.

Studies show that early childhood trauma may be common among people with borderline personality traits. That trauma may include:

  • Early parental loss or separation
  • Neglect
  • Physical abuse
  • Sexual abuse
  • Verbal abuse

But many people who have experienced early childhood trauma do not have borderline personality traits.

Doctors used to believe that borderline personality disorder symptoms last an entire lifetime. Today, with in-depth psychotherapy and certain medications, people with BPD can get better — but they must seek treatment to do so.

Do any of these symptoms sound familiar?

Borderline Personality Disorder Symptoms

The symptoms of borderline personality disorder include: a recurring pattern of instability in relationships, efforts to avoid abandonment, identity disturbance, impulsivity, emotional instability, and chronic feelings of emptiness, among other symptoms.

The main feature of borderline personality disorder (BPD) is a significant pattern of instability in interpersonal relationships, self-image, and emotions. People with borderline personality disorder can be very impulsive and may demonstrate self-injurious behaviors (e.g., risky sexual behaviors, cutting, or suicide attempts).

Borderline personality disorder occurs in most people by early adulthood (early 20s). A person with this condition will have experienced an unstable pattern of interacting with others for years. This pattern of behavior is usually closely related to the person’s self-image and early social interactions with friends and family. The behavior pattern is present in a variety of settings (e.g., not just at work or home) and often is accompanied by a similar lability (fluctuating back and forth, sometimes in a quick manner) of a person’s emotions and feelings.

People with borderline personality disorder are usually more sensitive than most people to environmental circumstances. The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior.

They experience intense abandonment fears and inappropriate anger, even when faced with a realistic time-limited separation or when there are unavoidable changes in plans. For instance, a person with this condition may experience sudden despair in reaction to a clinician’s announcing the end of the hour; or panic and fury when someone important to them is just a few minutes late or must cancel an appointment. They may believe that this “abandonment” implies that they are a “bad person.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Relationships and the person’s emotions may sometimes be seen by others or characterized as being shallow.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. In order for a personality disorder to be diagnosed, the behavior pattern must be seen in two or more of the following areas: cognition (thinking); affect (feeling); interpersonal functioning; or impulse control.

In personality disorders, this enduring pattern of behavior is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Borderline Personality Disorder

A person with this disorder will also often exhibit impulsive behaviors and have a majority of the following symptoms:

  • Frantic efforts to avoid abandonment, whether the abandonment is real or imagined
  • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  • Identity disturbance, such as a significant and persistent unstable self-image or sense of self
  • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  • Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  • Transient, stress-related paranoid thoughts or severe dissociative symptoms

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes, and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year.

Borderline personality disorder is more prevalent in females (75 percent of diagnoses made are in females). It is thought that this disorder affects between 1.6 and 5.9 percent of the general population.

Like most personality disorders, BPD typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

Details about Borderline Personality Disorder Symptoms

Frantic efforts to avoid real or imagined abandonment.

Do you have borderline personality disorder?

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Borderline Personality Test
Borderline Personality Quiz

The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, emotion, thinking and behavior. Someone with borderline personality disorder will be very sensitive to things happening around them in their environment. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic separation or when there are unavoidable changes in plans. For instance, becoming very angry with someone for being a few minutes late or having to cancel a lunch date. People with borderline personality disorder may believe that this abandonment implies that they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.

Unstable and intense relationships.

People with BPD may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough. These individuals can empathize with and nurture other people, but only with the expectation that the other person will “be there” in return to meet their own needs on demand. These individuals are prone to sudden and dramatic shifts in their view of others, who may alternately be seen as beneficent supports or as cruelly punitive. Such shifts reflect disillusionment with a caregiver whose nurturing qualities had been idealized or whose rejection or abandonment is expected.

Identity disturbance.

There are sudden and dramatic shifts in self-image, characterized by shifting goals, values and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to a righteous avenger of past mistreatment. Although they usually have a self-image that is based on being bad or evil, individuals with borderline personality disorder may at times have feelings that they do not exist at all. Such experiences usually occur in situations in which the individual feels a lack of a meaningful relationship, nurturing, and support. These individuals may show worse performance in unstructured work or school situations.

Learn more: Characteristics of borderline personality disorder

How is Borderline Personality Disorder Diagnosed?

Personality disorders such as BPD are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood, or genetic tests that are used to diagnose borderline personality disorder.

Many people with this disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for borderline personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Treatment of Borderline Personality Disorder

Treatment of borderline personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see borderline personality disorder treatment.

References

Borderline Personality Disorder In Children and Adolescents

It is difficult to diagnose borderline disorder accurately in children because similar symptoms may evolve into one of several disorders as the child develops.15,16 However, the disorder can be readily diagnosed in adolescence or early adulthood. 17,18,22 Nonetheless, there are indications of significant behavioral problems before the full form of the disorder becomes apparent.

Some children do appear to have symptoms that are very similar to borderline disorder in adolescents and adults. Parents of some borderline patients report they detected problems as early as the first year of life. The affected babies seem more “colicky,” cry more, have diminished ability to experience pleasure, sleep less restfully, are upset more readily by changes in routine, and are more difficult to soothe when upset.

In early childhood, children who later are diagnosed with borderline disorder are often described as being more demanding and requiring more attention than their brothers and sisters. Some seem to worry more, have more episodes of sadness, are more sensitive to criticism, continue to be more readily upset by changes in routine or plans, and are more easily angered. They are easily frustrated, and when frustrated they may have severe temper tantrums. Some have great difficulty separating from home to attend school, and under stress may demonstrate physical symptoms such as pulling out small strands of their hair, frequent stomach cramps, headaches, problems eating, and an abnormal sleep pattern.

In spite of these reports from parents, the fact is that we really do not know very much from scientific studies about what people with borderline disorder were like as children. There are relatively few articles in the medical literature about the characteristics of borderline disorder in children, and there is a lack of clear agreement about the presence and the diagnostic criteria of the disorder during childhood.16

A number of different descriptions of behaviors have been developed to diagnose children with borderline disorder. However, they appear to most accurately define those children who will later in life develop a number of different mental disorders, including borderline disorder and other personality disorders, attention deficit hyperactivity disorder and substance use disorders. 4

In general, these are the groups of symptoms in children that suggest a significant problem may be present that requires evaluation and possibly treatment:

  • hyper-reactive emotions with severe temper outbursts
  • poor impulse control, especially assaultive acts towards themselves or others
  • significantly impaired thinking and reasoning
  • marked disturbances in personal relationships

In the presence of these symptoms, it is advisable to seek a child psychiatrist experienced in treating borderline disorder.

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