Borderline Personality Disorder (BPD): Symptoms and Causes

What Is Borderline Personality Disorder?

A borderline personality disorder (BDP) is a mental health condition affecting people’s mood, way of thinking, relationships and behaviour. Based on statistics, around 1 in 100 people live with borderline personality disorder. When people experience borderline personality disorder, they probably face several challenges, including unstable emotions, relationships and a wavering sense of identity. BPD can significantly affect your self-image, life goals, and things people like or dislike.

People with BPD experience extreme mood swings, emphasised instability in interpersonal relationships and impulsivity. Many people compare BPD with the feeling that you are on a rollercoaster, affecting almost every aspect of one’s life. There are cases when people have high-functioning or quiet BPD who may seem emotionally stable and high-functioning. On the inside, these people experience intense mood swings, depression, anxiety, low self-confidence, fear of abandonment and negative feelings.

People with a BPD often have a history of childhood trauma, neglect or abuse. They often live with negative emotions and pessimistic anticipation of the future and feel like their life doesn’t matter. In challenging periods, people with borderline personality disorder may be prone to alcohol, substance misuse or self-destructive behaviours.

BPD Symptoms

In most cases, the characteristics of borderline personality disorder appear in the late teenage years or early adulthood. Stressful events can trigger them; sometimes, they might decrease or disappear entirely with proactive support.

Symptoms of borderline personality disorder can vary from manageable to severe and can include a combination of the following:

Intense and Unstable Relationships: People with BPD often struggle with forming and maintaining stable relationships. They might experience intense emotional attachments quickly, followed by sudden shifts to anger or detachment.
Fear of Abandonment: People with BPD might have an extreme fear of being abandoned or rejected, even if there’s no objective reason. This fear can lead to desperate behaviours to avoid abandonment, such as clinginess or acting out.
Unstable Self-Image: A person with BPD might have a fluctuating and unclear sense of self. They may struggle with self-identity and self-worth and feel uncertain about their life goals, values, and interests.
Impulsivity: Impulsive behaviours are common among those with BPD. This can include impulsive spending, substance abuse, risky sexual behaviours, binge eating, and reckless driving.
Self-Harming Behaviours: People might engage in self-harming behaviours as a way to cope with emotional pain. This can include cutting, burning, or other forms of self-inflicted harm.
Intense Mood Swings: People often experience rapid and severe mood swings that can last hours or even days. These mood swings can range from extreme happiness to deep sadness or anger.
Chronic Feelings of Emptiness: People with BPD might feel a persistent sense of emptiness and inner void, even when engaged in activities or surrounded by others.
Anger and Hostility: People can struggle to regulate their emotions, particularly anger. They might experience episodes of intense anger, often triggered by perceived abandonment or rejection.
Paranoia and Dissociation: Some people with BPD might experience episodes of paranoia or dissociation, where they feel disconnected from reality or have distorted perceptions of themselves and the world around them.
Stress-Related Paranoia: During stress, people with BPD might experience temporary psychotic-like symptoms, such as paranoia or severe dissociation.

It’s important to note that not all people who develop borderline personality disorder experience all of these symptoms. For precise identification, it’s best to consult a mental health professional.

What Causes Borderline Personality Disorder

Healthcare professionals believe that borderline personality disorder is not caused by one single factor but by a combination of different factors. It can often appear after experiencing a severe shock or trauma.

Here are the most common causes of borderline personality disorder:

Childhood history of abuse and trauma: Almost 70% of people with BPD have reported a history of emotional or physical abuse or a traumatic experience as a child. Here, we can include sudden and unexpected separation from a parent, lack of emotional connections with parents, particularly the mother, or having parents with substance misuse disorder.
Family medical history: Surveys show that borderline personality disorder may run in families. For example, if someone from your family has a borderline personality disorder or related mental health challenges, you’re more likely to develop BPD as well.
Changes in the brain: In people with BPD, there is a kind of ‘miscommunication’ between the brain part that controls emotions and behaviour. This can be reflected in challenges with behaviour and impulse control.

Risk Factors for Borderline Personality Disorder (BPD)

While the clear cause has not been determined yet, researchers suggest several risk factors that might lead to developing borderline personality disorder. Below, we have discussed each one in detail.

Family History

Family history is considered a significant risk factor for developing borderline personality disorder. Research suggests that people with a family history of BPD or other related mental health conditions are at an increased risk of developing BPD. Here’s how family history contributes to the risk:

It’s important to remember that while family history is a risk factor, it does not guarantee that someone will develop BPD. Many people with a family history of BPD do not develop the disorder. On the other hand, some people without a family history can create it.

Brain Structure

The brain’s structure plays a significant role in developing borderline personality disorder. BPD symptoms have been linked to differences in key brain regions, such as the amygdala, prefrontal cortex, and hippocampus. These structural differences can contribute to difficulties in emotion regulation, impulse control, memory processing, and self-identity.

Differences in neurotransmitter systems, like serotonin, also affect mood stability and impulsivity. While brain structure is just one of several factors influencing BPD, understanding its role can guide therapeutic approaches to address the disorder’s neural underpinnings.

Social and Environmental Factors

Social and environmental factors play a significant role in developing borderline personality disorder. Early childhood adversity, such as trauma, neglect, or invalidation of emotions, can disrupt healthy emotional development and coping mechanisms. Unstable relationships and a lack of supportive social networks can exacerbate BPD symptoms.

Cultural influences and societal pressures also contribute to the expression of BPD traits. It’s important to recognise how these external factors interact with individual vulnerabilities to shape the course of the disorder and inform effective treatment strategies.

BPD Triggers

Borderline Personality Disorder (BPD) is a complex mental health condition characterised by difficulties in regulating emotions, maintaining stable relationships, and a stable self-image. BPD triggers can be caused by various factors, often involving emotional or environmental stressors. These triggers can lead to worsening BPD symptoms or the onset of a crisis.

Common BPD triggers include:

Fear of abandonment is a prevalent characteristic of BPD. Intense emotional reactions and episodes of BPD can be triggered by situations where a person feels abandoned or rejected.
Cognitive triggers, such as intrusive thoughts.
Loss of a loved one or separation
Criticism - As a common BPD trigger, people tend to be extremely sensitive to criticism and rejection, whether it is constructive or not. This heightened sensitivity can cause emotional distress and activate characteristics associated with BPD.
Stressful life events, such as changing jobs, moving, or ending a relationship, reflected an intense fear.

Changes in routine, especially daily routines, can lead to mixed feelings and result in instability and loss of control, which can become a major BPD trigger.
Unstable or abusive relationships
Negative self-perception
Trauma or abuse - A significant number of people with BPD have experienced trauma in the past, such as emotional, physical, or sexual abuse. These traumatic memories can serve as potent triggers.
Substance misuse

The next phase is managing BPD triggers, and this phase requires three steps:

Identifying Triggers – the most important part is recognising triggers and working with mental health professionals to develop effective coping strategies.
Creating an Action Plan – Creating an action plan to address triggers can enable people with BPD to control their reactions better. This could include stepping away from the trigger, participating in soothing activities, or concentrating on tasks that stimulate logical thinking.
Seeking Professional Help – Psychotherapy, particularly dialectical behaviour therapy (DBT), can provide skills to manage these triggers, regulate emotions, improve overall functioning and overall treat borderline personality disorder.

What is a BPD Episode?

People with BPD often experience intense episodes that can significantly impact their daily lives in a negative way. The key characteristics of a BPD episode include:

Emotional instability is one of the primary signs which can bring intense negative emotions and mood swings. They can range from extremely high places of emotion to severe lows within a short period of time.
Intense emotions of anger can result in challenges in controlling anger, sarcasm, bitterness, temper loss or even physical altercations.
Suicidal behavior and thoughts as a response to an intense fear of abandonment and emotional pain.
Impulsive behaviour and dissociation are reflected in binge eating, substance abuse, reckless driving, and feelings of detachment from one’s thoughts, emotions or physical body.
Paranoid thoughts and loss of reality can lead to the desperate need to fill an internal void from a sense of purposelessness. Paranoid thoughts take place when one’s mind is filled with irrational thoughts that everyone is hateful towards the person.

Behavioural Manifestations

Withdrawal and Avoidance: People with BPD may display heightened withdrawal and avoidance during an episode, often isolating themselves from others and steering clear of social interactions.

Risk-Taking Behaviour: Impulsive actions like gambling, reckless driving, or self-sabotaging success can emerge during a BPD episode, falling under risk-taking behaviour. These behaviours are often impulsive and can lead to severe consequences.

How Is Borderline Personality Disorder Identified?

BPD identification involves a comprehensive assessment by a mental health professional, considering the duration and impact of these symptoms on daily life. It is often confused with other mental disorders, such as bipolar disorder, and therefore, it requires careful and professional assessment before establishing the diagnosis.

Accurate identification is crucial for developing targeted treatment plans, which may include therapy and, in some cases, medication in order to improve overall well-being.

A typical pattern for identifying borderline personality disorder includes:

Detailed conversation with mental health professional
A psychological evaluation that often includes completing questionnaires
Medical history and exams
In-depth discussion of your signs and symptoms

Other Conditions That Can Co-occur With BPD

Borderline personality disorder often co-occurs with other mental health conditions. These challenges can intensify BPD symptoms and might require a combination of treatment strategies. Accurate identification and a holistic approach are essential to address all co-occurring conditions, promoting better symptom management and overall recovery.

Common mental health challenges that may co-occur with BPD include:

Depression
Anxiety disorder
Autism
Eating disorders
Post-traumatic stress disorder (PTSD)
Substance misuse
Other personality disorders, like narcissistic personality disorder

BPD vs Bipolar

Borderline Personality Disorder (BPD) and Bipolar Disorder are both mental health conditions that affect mood, behaviour, and relationships. While they may share some overlapping characteristics, they are distinct disorders with different triggers and treatment approaches. Knowing the differences is crucial for accurate identification and effective management. The table below provides a comparative overview of the key characteristics of BPD and Bipolar Disorder, highlighting their unique features and similarities.

BPD and Self-harm

People with borderline personality disorder often struggle with self-harming behaviours. These actions can include cutting, burning, or other forms of self-inflicted harm. Self-harm is frequently used as a coping mechanism to manage overwhelming emotions or distress. Understanding the link between BPD and self-harm is vital for support workers to provide effective treatment strategies, supporting people find healthier ways to cope and manage their emotions.

BPD Meltdown

Borderline personality disorder can lead to emotional meltdowns. These episodes involve intense emotional reactions that can be triggered by stress, rejection, or perceived abandonment. During a meltdown, people may experience extreme mood swings, impulsivity, and difficulty calming down. Understanding how BPD contributes to meltdowns is crucial for developing coping strategies and providing support to manage and navigate these overwhelming emotional experiences.

Treatment Options for BPD

“How is borderline personality disorder treated?” is the most frequently asked question regarding this mental health challenge. A borderline personality disorder is a complex mental health challenge that can significantly impact a person’s thoughts, emotions, relationships, and overall functioning.

It’s important to note that treatment for BPD typically involves a combination of different approaches tailored to the individual’s needs. Here are some common treatment options for BPD:

The most important aspect when supporting people with borderline personality disorder is nourishing acceptance and emotional comfort. Reducing social stigma and raising awareness of mental health is essential in creating an inclusive world and instilling hope in people with mental health challenges. Therefore, we need to think twice before reacting to specific situations, as many people are fighting silent battles that we may not know about.

Mental Health Support with Leaf Complex Care

Overcoming the stigma around borderline personality disorder and providing people with person-centred care is our priority. We deliver humanised and human-rights-based care to people with borderline personality disorder in their own homes, empowering them to overcome mental health challenges and supporting them to reach their full potential.

Our outcome-focused support workers strive to create a comfortable and nurturing environment for people with borderline personality disorder and other mental health challenges. We always prioritise the independence of the people we serve and make them active participants in every decision about the support they receive.

We offer high-quality, CQC-regulated care for people with borderline personality disorder across the UK, with offices in Bristol, Birmingham, South East and Somerset.

Contact us today, and we will develop a personalised care plan tailored to your needs.