Borderline Personality Disorder

What Is It?

Borderline personality disorder is characterized by poor self-image, great difficulty coping with loneliness, and feeling empty. People with this disorder have unstable relationships, highly reactive and intense moods, and impulsive behavior. They are more likely to attempt or commit suicide. Sometimes they harm themselves (for example, cutting or burning) as a form of self-punishment or to combat a numb feeling. At those times, suicide is not the goal.

When stressed, people with borderline personality disorder may develop psychotic-like symptoms. They experience a distortion of perception or belief rather than a distinct break with reality. Especially in close relationships, they tend to misinterpret or amplify what other people feel about them. For example, they may assume persecutory or hateful feelings when a friend or family member may be only mildly annoyed or angry.

Personality disorders probably are caused by both environmental and biological factors. Some researchers have suggested that borderline personality disorder springs from an abusive or neglectful childhood. A significant number of people with this disorder report a history of abuse in childhood. Experts also have suggested that people with this disorder may have inherited difficulties regulating their anxiety or moods. They may be more vulnerable to loss or more sensitive to stress.

People with borderline personality disorder have a deep fear of abandonment. They compete for social acceptance, are terrified of rejection, and often feel lonely even in the context of an intimate relationship. Therefore, it is more difficult for them to manage the normal ups and downs of a romantic partnership. Impulsive, self-destructive behavior may be an attempt to ward off rising anxiety related to the fear of being left alone.

The flip side of the fear is the hope that a relationship will be completely soothing. These people may idealize a family member, romantic partner or friend, then become enraged when an inevitable disappointment occurs. They might hold that person responsible for the pain they feel and devalue the relationship.

It is quite common for people with borderline personality disorder to also have a mood disorder, eating disorder or substance abuse problem. The person may turn to alcohol or drugs to escape from painful, uncontrollable emotions.

There is no clear line between a personality style and a disorder. Personality patterns are considered to be a disorder when they impair a person's functioning and cause stress.

Three times as many women as men are diagnosed with borderline personality disorder. It occurs in about 2 percent of the population in the United States.

Symptoms

It is normal to feel vulnerable, so most people have experienced some of the symptoms on this list. The diagnosis of borderline personality disorder is reserved for people who have many of these symptoms to a severe degree, over a long period of time.