Most people who have BPD suffer from problems regulating their emotions and thoughts and sometimes reckless behavior. Anger, impulsiveness and frequent mood swings may push others away, even though they may desire to have loving and lasting relationships.

Most of the time, signs of the disorder first appear in childhood. But problems often don’t start until early adulthood. Problems with emotions and behaviors are hard to improve. But with treatment, most people with severe symptoms do get better over time.

Causes

The causes of borderline personality disorder are not fully understood, but scientists agree that it is the result of genetic and environmental influences.

Genetics: while no specific gene has been shown to directly cause BPD, studies in twins suggest this illness has strong hereditary links. BPD is about five times more common among people who have a first-degree relative with the disorder.

Environmental factors: people who experience traumatic life events, such as physical or sexual abuse during childhood or neglect and separation from parents, are at increased risk of developing BPD.

Brain function: the way the brain works is often different in people with BPD, suggesting that there is a neurological basis for some of the symptoms. Specifically, the portions of the brain that control emotions and decision-making/judgment may not communicate well with one another.

Imaging studies (MRI) in people with BPD have shown abnormalities in brain structure and function, evidence that biology is a factor.  In people with BPD, more activity than usual has been seen in the parts of the brain that control feeling and expressing emotions.

Symptoms

Intense emotions and mood swings.

May see others as either “good” or “bad” and may shift from one view to the other suddenly, for minor reasons. This can make relationships very difficult.

Fear of being left alone (abandoned). This fear may lead to frantic attempts to hold on to those around. Or it may cause to reject others before they get reject.

Unstable personal relationships that alternate between idealization—“I’m so in love!”—and devaluation—“I hate her.” This is also sometimes known as “splitting.”

Unstable self-image, and low self-worth which affects moods, values, opinions, goals and relationships.

Periods of intense depressed mood, irritability or anxiety, lasting a few hours to a few days.

Uncontrollable anger often followed by shame and  guilt. Aggressive behavior. Feelings of emptiness.

Dissociative feelings, disconnecting from thoughts or sense of identity, or “out of body” type of feelings and stress-related paranoid thoughts.

Treatment

Psychotherapy, such as dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT) and psychodynamic psychotherapy, is the first line of choice for BPD.

There is no medication specifically made to treat the core symptoms of emptiness, abandonment and identity disturbance. Rather, several medications can be used to treat the remaining symptoms. For example, mood stabilizers and antidepressants help with mood swings and dysphoria. Antipsychotic medication may help control symptoms of rage and disorganized thinking.

Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive or suicidal behavior to ensure safety.

New Research on Borderline Personality Disorder

Recent neuroimaging studies show differences in brain structure and function between people with BPD and people who do not have this illness.

Some research suggests that brain areas involved in emotional responses become overactive in people with BPD when they perform tasks that they see as negative.

People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods seen in BPD.

Another study showed that, when looking at emotionally negative pictures, people with BPD used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues.

Reviewed By: Dr. Mehrang Khazaee

Kernberg OF, Michels R. Borderline personality disorder. Am J Psychiatry. 2009 May; 166(5): 505–۸٫

Zanarini MC, Barison LK, Frankenburg FR, Reich DB, Hudson JI. Family history study of the familial coaggregation of borderline personality disorder with Axis I and non-borderline dramatic cluster Axis II disorders. Journal of Personality Disorders.2009; 23:357–۳۶۹٫  [PubMed]