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Borderline personality disorder

Borderline personality disorder (BPD) is a mental health disorder that generates significant emotional instability. This can lead to a variety of other stressful mental and behavioral problems.

With borderline personality disorder, you may have a severely distorted self-image and feel worthless and fundamentally flawed. Anger, impulsiveness and frequent mood swings may push others away, even though you may desire to have loving and lasting relationships.

If you have borderline personality disorder, don't get discouraged. Many people with this disorder get better with treatment and can live satisfying lives.

Symptoms Causes Risk factors Complications

Borderline personality disorder affects how you feel about yourself, how you relate to others and how you behave.

Signs and symptoms of borderline personality disorder may include:

  • Impulsive and risky behavior, such as risky driving, unsafe sex, gambling sprees or illegal drug use
  • Awareness of destructive behavior, including self-injury, but sometimes feeling unable to change it
  • Wide mood swings
  • Short but intense episodes of anxiety or depression
  • Inappropriate anger and antagonistic behavior, sometimes escalating into physical fights
  • Difficulty controlling emotions or impulses
  • Suicidal behavior
  • Feeling misunderstood, neglected, alone, empty or hopeless
  • Fear of being alone
  • Feelings of self-hate and self-loathing

When you have borderline personality disorder, you often have an insecure sense of who you are. Your self-image, self-identity or sense of self often rapidly changes. You may view yourself as evil or bad, and sometimes you may feel as if you don't exist at all. An unstable self-image often leads to frequent changes in jobs, friendships, goals and values.

Your relationships are usually in turmoil. You may idealize someone one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even minor misunderstandings. This is because people with borderline personality disorder often have difficulty accepting gray areas — things seem to be either black or white.

When to see a doctor

If you're aware that you have any of the signs or symptoms above, talk to your doctor or a mental health provider. Proper treatment can help you feel better about yourself and help you live a more stable, rewarding life.

If you notice signs or symptoms in a family member or friend, talk to that person about seeing a doctor or mental health provider. But you can't force someone to seek help. If the relationship causes you significant stress, you may find it helpful to see a therapist yourself.

As with other mental disorders, the causes of borderline personality disorder aren't fully understood. Experts agree, though, that the disorder results from a combination of factors. Factors that seem likely to play a role include:

  • Genetics. Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental disorders among family members.
  • Environmental factors. Many people with borderline personality disorder have a history of childhood abuse, neglect and separation from caregivers or loved ones.
  • Brain abnormalities. Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

Personality is shaped both by inherited tendencies and environmental factors, as well as experiences during childhood. Some factors related to personality development can increase the risk of developing borderline personality disorder. These include:

  • Hereditary predisposition. You may be at a higher risk if a close family member — your mother, father, brother or sister — has the same or a similar disorder, particularly a mood or anxiety disorder.
  • Childhood abuse. Many people with the disorder report being sexually or physically abused during childhood.
  • Neglect. Some people with the disorder describe severe deprivation, neglect and abandonment during childhood.

Also, borderline personality disorder is diagnosed more often in young adults and adult women than in men.

Borderline personality disorder can damage many areas of your life. It can negatively affect intimate relationships, jobs, school, social activities and self-image. Repeated job losses and broken marriages are common. Self-injury, such as cutting or burning, can result in scarring and frequent hospitalizations. Suicide rates among people with BPD are high.

In addition, you may have other mental health disorders, including:

  • Depression
  • Alcohol or substance abuse and dependency
  • Anxiety disorders
  • Eating disorders
  • Bipolar disorder

Because of risky, impulsive behavior, you are also more vulnerable to unplanned pregnancies, sexually transmitted infections, motor vehicle accidents and physical fights. You may also be involved in abusive relationships, either as the abuser or the abused.

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