Core Symptoms of BPD: A Comprehensive Guide

Imagine being so afraid of abandonment that you do almost everything to get someone to like you, and then when you start getting close, you quickly and unceremoniously leave them before they can leave you. Because you’re sure that they will leave you at some point. This dilemma and the psychological pain that comes with a deep-seated fear of abandonment is at the heart of borderline personality disorder. 

In this article, we will unpack BPD. We will look at the symptoms, causes, comorbidities and common treatments for BPD. However, do keep in mind that this is not meant as a tool to self-diagnose. This is an informative piece which will give you an overview of this personality disorder.

What are the symptoms of borderline personality disorder?

Borderline Personality Disorder or BPD is a personality disorder that is characterised by three things: 

1. Intense and unstable relationships 
2. Intense emotions and difficulty regulating oneself 
3. Impulsive or high risk-taking behaviour 

Symptoms of BPD may show up as 

• Taking extreme measures to avoid separation or rejection 
• Idealizing someone one moment and disregarding or devaluing them the next 
• Impulsive or high risk-taking behaviours such as excessive spending, gambling, substance abuse, unprotected or unsafe sex
• Sabotaging one’s relationships or work 
• Short temper or intense emotional reactions 
• Mood swings
• Self-harm behaviour or thoughts  

Individuals with BPD are also at a high risk of suicide and self-harm. This is why it’s important to get timely and appropriate help. 

What causes Borderline Personality Disorder?

Although there is no absolute clarity on what causes BPD, it is generally seen that those presenting with this personality disorder come from households where there was instability. They may have witnessed or directly experienced abuse, or neglect while growing up. This makes sense, right? We learn about relationships from our childhood experiences. If we’ve experienced instability or emotional neglect from our primary caregivers or other important figures while growing up, we may learn to expect this from everyone we encounter. 

Although some evidence shows poor development of areas of the brain responsible for emotion regulation among individuals with BPD, it is not clear whether these changes cause or contribute to BPD, or occur as a result of it. 

Not just Borderline Personality Disorder: Common comorbid disorders that show up with BPD

Individuals with BPD sometimes struggle with other mental health issues like anxiety, depression and PTSD. If you consider the impact of environmental and psychosocial factors in the development of BPD, it will make sense. Someone who’s been exposed to an unstable environment is understandably at a higher risk of developing anxiety and depression. Quite often, individuals with BPD have faced a traumatic event or circumstance, making them more vulnerable to developing PTSD as well. 

Sometimes, to cope with the emotional pain that accompanies BPD, one may take to substances as a way to self-soothe. This can be a slippery slope to addiction, making substance abuse another common comorbidity among individuals living with BPD. They may share a similar relationship with food, making them more vulnerable to disordered eating. 

What’s the right treatment for Borderline Personality Disorder? 

While long-term therapy can help us build a better and deeper relationship with ourselves, some evidence-based treatment approaches are recommended for BPD. 

Evidence-based treatments for Borderline Personality Disorder: 

• Dialectical Behavioural Therapy or DBT is a form of treatment designed specifically for BPD. The goal of the treatment is to help the individual accept how one feels, and break out of the black-or-white thinking that individuals with BPD are prone to. An example of this black-or-white thinking is: If someone doesn’t answer my call, they must be ignoring me and not want to talk to me ever again.
• Mentalization Based Therapy or MBT helps us understand the thoughts and feelings that we and others have. BPD makes it difficult to pause and make sense of our thoughts, feelings and needs, and certainly, those of others around us. MBT equips individuals with techniques that can be used to be more attentive to one’s state of mind.
• Schema-Focused Therapy or SFT helps the individual unlearn unhelpful schemas. A schema, in simple words, is how we interpret the world around us. SFT is an integrative form of treatment which draws from different schools of thought of psychology to help the individual unlearn ways of interpreting the world that cause them distress. Of course, after unlearning comes learning. SFT also involves psychoeducation around this. 
• Systems Training for Emotional Predictability and Problem-Solving or STEPS goes beyond the individual. It is a form of group therapy which gives the individual an opportunity to engage with others in a healthier manner. This is important because individuals with BPD tend to struggle with their relationships. A group setting can help one challenge their relational beliefs and encourage them to examine how they show up in social settings. 

Psychiatric medication may be given to manage symptoms of comorbid conditions like anxiety or depression. However, medication has not been effective in managing symptoms of BPD. Again, considering that individuals with BPD have a history of unhealthy relationship and attachment patterns, it makes sense that treatment would require a healthy and safe relationship. Psychotherapy provides an individual with a corrective relationship experience. 

BPD can be distressing, but one doesn’t have to go through it alone. Remember that since relational damage is a big part of BPD, building healthy relationships is a big part of managing and working through it. Psychotherapy and the specific treatment modalities that we discussed above can help you learn the necessary skills to build better relationships. 

I know, it may sound ironic. On the one hand, I said that individuals with BPD struggle with maintaining healthy relationships. And the other hand, I say that healthy relationships can help one feel better. But is it really that ironic? 

Consider this: 

If you have a Vitamin C deficiency, what do you do? 

By that logic, if a mental health issue stems from a lack of something fundamental, what does one need to feel better? 

References: 

Bateman, A., & Fonagy, P. (2010). Mentalization-based treatment for borderline personality disorder. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 9(1), 11–15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816926/ 

Borderline Personality Disorder. (2023, February 1). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/borderline-personality-disorder#:~:text=BPD%20can%20be%20caused%20by 

‌Blum, N., St. John, D., Pfohl, B., Stuart, S., McCormick, B., Allen, J., Arndt, S., & Black, D. W. (2008). Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up. American Journal of Psychiatry, 165(4), 468–478. https://doi.org/10.1176/appi.ajp.2007.07071079 

Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. (2017). What works in the treatment of borderline personality disorder. Current Behavioral Neuroscience Reports, 4(1), 21–30. https://doi.org/10.1007/s40473-017-0103-z 

Mayo Clinic. (2019, July 17). Borderline personality disorder - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237 

National Health Service. (2019, February 12). Overview - Borderline personality disorder. Nhs.uk. https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview/

Pascual, J. C., Arias, L., & Soler, J. (2023). Pharmacological Management of Borderline Personality Disorder and Common Comorbidities. CNS Drugs, 37(6), 489–497. https://doi.org/10.1007/s40263-023-01015-6 

Shah, R., & Zanarini, M. C. (2018). Comorbidity of Borderline Personality Disorder. Psychiatric Clinics of North America, 41(4), 583–593. https://doi.org/10.1016/j.psc.2018.07.009 

Tan, Y. M., Lee, C. W., Averbeck, L. E., Brand-de Wilde, O., Farrell, J., Fassbinder, E., Jacob, G. A., Martius, D., Wastiaux, S., Zarbock, G., & Arntz, A. (2018). Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions. PLOS ONE, 13(11), e0206039. https://doi.org/10.1371/journal.pone.0206039 

‌Treatment - Borderline personality disorder. (2021, February 12). Nhs.uk. https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/treatment/