Key Takeaways
- Borderline personality disorder (BPD) is a mental health condition characterised by difficulties regulating emotions, an unstable sense of self, impulsivity and difficulties in relationships.
- Common features include a strong fear of abandonment, intense and unstable relationships, rapid changes in emotions, feelings of emptiness, impulsive behaviour, self-harm and, in some people, brief episodes of dissociation or suspiciousness during periods of stress.
- Having some of these symptoms does not necessarily mean that you have BPD. Diagnosis depends on a persistent pattern of symptoms, how they occur across different situations and how much they affect your life.
- BPD can overlap with depression, anxiety, post-traumatic stress disorder and bipolar disorder, so a careful assessment is important.
A Typical Story
Jane and her boyfriend have been seeing a couples therapist. Her boyfriend has been thinking about ending the relationship, but feels worried because Jane has threatened to harm herself when separation is discussed. Jane describes this as her fifth relationship in three years. She becomes very attached to her partners and can feel devastated when she senses that they are pulling away.
Jane also describes periods of feeling sad, empty and worthless. She had a difficult childhood, including an emotionally abusive father, and often finds herself hoping that a partner will finally give her the sense of safety and unconditional love she felt was missing growing up. Their couples therapist suggests that Jane also sees a psychiatrist for a fuller assessment, including whether she may have BPD or another mental health condition.
What Does BPD Feel Like?
You might notice that your emotions can shift much more quickly and intensely than you expect. A small disagreement with someone you care about may leave you feeling deeply hurt or rejected. You may become convinced that the relationship is falling apart, even when the other person does not see it that way. Once the intensity has passed, you may wonder why the situation felt so overwhelming at the time.
Everyone experiences strong emotions, relationship difficulties and mood changes from time to time. These experiences alone do not mean that someone has BPD.
What makes BPD different is the persistent pattern. Difficulties with emotions, relationships, impulsivity and sense of self tend to recur over time and can cause significant distress or interfere with daily life.
What Is Borderline Personality Disorder?
Borderline personality disorder is a mental health condition that affects how a person regulates emotions, relates to other people, controls impulses and experiences their sense of self.
People with BPD may experience emotions very intensely and may be particularly sensitive to rejection or signs that someone important to them might leave. This can make close relationships feel both very important and very difficult.
Some people with BPD also struggle with an unstable sense of who they are. They may feel chronically empty or worthless, which can sometimes look similar to depression.
Not everyone with BPD looks the same. A person does not need to have multiple relationships, self-harm or show every possible symptom. The combination and severity of symptoms vary considerably from person to person.
What Are the Signs and Symptoms of Borderline Personality Disorder?
BPD can affect emotions, relationships, behaviour and a person’s sense of self. Common features include:
Fear of abandonment
A strong fear of being left, rejected or abandoned is common. A person may become extremely distressed when they sense someone pulling away and may make intense efforts to prevent a real or perceived separation.
Intense or unstable relationships
Relationships may become very intense. Someone may idealise another person at one point, then feel deeply disappointed, hurt or angry with them later. This does not mean the feelings are insincere; rather, perceptions of the relationship can shift dramatically when emotions are intense.
An unstable sense of self
A person may struggle to maintain a consistent sense of who they are, what they value or what they want from life. Their view of themselves can change substantially depending on circumstances, relationships and emotional state.
Impulsive behaviour
Some people act impulsively in ways that can be harmful, such as excessive spending, unsafe sex, substance use, binge eating or dangerous driving. Impulsivity on its own, however, does not mean that someone has BPD.
Self-harm or suicidal behaviour
Self-harm, suicidal thoughts, threats or attempts can occur in BPD, particularly during periods of intense emotional distress or perceived rejection or abandonment. These should always be taken seriously. If there is an immediate risk of harm, seek urgent professional or emergency help.
Rapid changes in mood
People with BPD may move rapidly between intense anxiety, sadness, anger, shame or irritability. These shifts are often triggered by interpersonal events and commonly last from a few hours to a few days.
Chronic feelings of emptiness
Some people describe a persistent sense of emptiness, numbness or feeling that something is missing, even when there is no obvious external reason.
Intense anger
Anger may feel unusually intense or difficult to control. This can appear as irritability, repeated arguments, shouting or losing one’s temper.
Stress-related paranoia or dissociation
During periods of severe stress, some people may briefly become unusually suspicious or experience dissociation, such as feeling detached from themselves or that their surroundings are unreal. These experiences are usually transient.
Does Having These Signs Mean You Have BPD?
Not necessarily. Many of these experiences can occur outside BPD, and several other mental health conditions can cause similar symptoms.
For example, BPD is sometimes confused with bipolar disorder because both can involve changes in mood and impulsivity. In BPD, emotional shifts are often rapid and closely related to interpersonal events. Bipolar disorder, in contrast, involves distinct episodes of depression and mania or hypomania, with sustained changes in mood, energy and activity.
Depression, anxiety disorders, post-traumatic stress disorder, ADHD, eating disorders and substance use can also overlap with some features of BPD. They can also coexist with BPD.
This is why BPD cannot be diagnosed from an online checklist. A psychiatrist or psychologist will consider the overall pattern of symptoms, how long they have been present, how they affect different areas of life, developmental and relationship history, and whether another condition better explains the symptoms.
What Causes Borderline Personality Disorder?
There is no single cause of BPD. It is best understood as a multifactorial condition arising from a combination of genetic, biological, psychological and environmental influences.
Family history appears to play a role. Childhood adversity, including abuse, neglect, unstable caregiving or other difficult early experiences, is also more common among people with BPD and may contribute to difficulties with attachment and emotional regulation.
However, a difficult childhood does not inevitably lead to BPD, and not everyone with BPD has experienced childhood trauma. It is therefore too simplistic to attribute BPD solely to parenting or attachment difficulties.
How Is Borderline Personality Disorder Diagnosed?
There is no blood test or brain scan that diagnoses BPD. Diagnosis is made through a comprehensive clinical assessment.
A psychiatrist or psychologist may ask about:
- Your current symptoms and how they affect everyday life
- How long these patterns have been present and whether they occur across different situations
- Your childhood, family and important relationships
- Current and previous romantic relationships
- Previous mental health treatment and diagnoses
- Any history of self-harm or suicidal thoughts or behaviour
- Alcohol, substance use and other relevant medical or psychiatric factors
The purpose is not to blame parents or partners. It is to understand how longstanding patterns developed and to distinguish BPD from other conditions that may look similar.
Can BPD Occur Alongside Other Mental Health Conditions?
Yes. It is common for people with BPD to have another mental health condition at the same time, including depression, anxiety disorders, post-traumatic stress disorder, eating disorders, substance use disorders, ADHD or another personality disorder.
When conditions coexist, symptoms can overlap and influence one another. A careful assessment helps clarify what is present and which problems should be prioritised in treatment.
Can Borderline Personality Disorder Be Treated?
Yes. BPD is treatable, and many people improve substantially over time. Symptoms often become less severe with age, particularly with appropriate treatment and support.
Psychotherapy is the main treatment for BPD. The most suitable approach depends on the person’s difficulties, goals, preferences, ability to engage in therapy and available resources.
Medication is not a primary treatment for the core features of BPD. However, medication may sometimes be used for particular symptoms or, importantly, for coexisting conditions such as depression or anxiety. This should be considered as part of an individualised treatment plan.
What Types of Therapy Are Used for BPD?
Dialectical behaviour therapy
Dialectical behaviour therapy (DBT), developed by psychologist Dr Marsha Linehan, was designed specifically for people with BPD and chronic suicidal or self-harming behaviour. It teaches skills in mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness, and may include individual therapy and group skills training.
Schema therapy
Schema therapy helps people understand why they may keep repeating the same patterns in their lives and relationships, even when they know these patterns are not helpful. These patterns, known as schemas, often develop when we are young and can include deeply held beliefs such as ‘people I love will eventually leave me’, ‘I cannot trust other people’, or ‘I am not good enough’. For someone with BPD, a relatively small event, such as a partner taking longer than usual to reply to a message, can activate an abandonment schema and trigger intense fear, sadness or anger. Schema therapy helps people recognise when these old patterns have been triggered, understand where they may have come from, and gradually develop healthier ways of managing their emotions, relationships and sense of self.
Other psychological therapies
Other structured psychotherapies, including transference-focused psychotherapy and approaches drawing on cognitive or psychodynamic principles, may also be helpful. The important point is that treatment should be structured, consistent and delivered by a clinician experienced in working with personality difficulties.
There is no single therapy that is best for everyone. A mental health professional can help decide which approach is most suitable.
What Can You Do If Someone With BPD Is Having an Emotional Crisis?
It can be difficult to know what to say when someone you care about is extremely distressed. A few principles can help:
- Stay calm and speak in an even, non-confrontational tone.
- Listen before immediately correcting their interpretation of what happened.
- Acknowledge that their distress is real, even if you do not agree with every conclusion they have reached.
- Avoid escalating an argument while emotions are very intense.
• Encourage them to use coping strategies or a safety plan developed with their mental health professional. - Maintain clear and healthy boundaries while remaining supportive.
- Take threats or acts of self-harm seriously and seek urgent help if you are concerned about safety.
If someone is at immediate risk of harming themselves or another person, do not try to manage the situation alone. Seek urgent professional or emergency assistance.
When Should You Speak to a Mental Health Professional?
If several of these experiences feel familiar and they repeatedly affect your relationships, work, studies or wellbeing, it may be useful to speak to a mental health professional. You do not need to be certain that you have BPD before asking for help.
Consult a Mental Health Professional
Borderline personality disorder is more than simply having mood swings or difficult relationships. It is a longstanding pattern involving difficulties with emotional regulation, relationships, impulsivity and sense of self.
Because its symptoms can overlap with several other mental health conditions, an online symptom list cannot establish a diagnosis. A proper assessment can help make sense of what is happening and, just as importantly, identify what treatment may help.
Private Space Medical provides psychiatric and psychological care for adults in Singapore. Our psychiatrists and psychologists can assess your concerns and discuss an individualised treatment plan with you.
