Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental health condition that makes a person emotionally unstable, causing difficulties in how someone feels about themselves and others. This difficulty leads to severe, unstable mood swings, impulsivity, and instability, affecting a person's relationships, sense of identity, and self-image.

It puts people in a relentless cycle of intense emotions and impulsive actions, making navigating daily life and relationships challenging.

This condition, affecting 1.6% of the population, demands a nuanced understanding and a compassionate approach to treatment.

At Elevate Psychiatry, our deep understanding of borderline personality disorder allows us to tailor our treatments to meet your unique needs.

Borderline Personality Disorder Basics

BPD impacts the way a person thinks and feels about themselves and others, which can cause problems in everyday life, including at work, in friendships, and in romantic relationships. 

It's associated with a high degree of emotional suffering and can lead to a variety of emotional and behavioral issues.

The underlying issues of BPD involve intense emotional experiences and heightened sensitivity to environmental and interpersonal stress. Those with BPD may struggle with a deep fear of abandonment and often go to great lengths to avoid real or imagined separation or rejection. 

This condition also affects a person's ability to maintain stable relationships and can lead to a pattern of intense and unstable connections with others.

Advances in treatment have significantly improved the outlook for people with BPD, offering them the possibility of leading fulfilling lives.

Symptoms of Borderline Personality Disorder

Symptoms of BPD include strong emotions, troubled relationships, and changing views of oneself, which can greatly impact a person's life and interactions with others.

Key features and symptoms of BPD include:

  1. Fear of abandonment: People with BPD are often terrified of being abandoned or left alone. Even something harmless as a loved one arriving home late from work, can trigger intense fear. This fear can lead to frantic efforts to keep the other person close.
  2. Unstable relationships: People with BPD tend to have intense, short-lived relationships. They may believe that each new person they meet is "the one" and quickly become disappointed.
  3. Unclear or shifting self-image: A person with BPD may have a significantly unstable sense of self. They can change from hating themselves to thinking they are okay. They may also lack a clear direction in life, frequently changing jobs, friends, lovers, religion, values, goals, or sexual identity.
  4. Impulsive, self-destructive behaviors: Impulsivity is a common symptom, manifesting in areas that are potentially self-damaging, such as binge eating, drug or alcohol abuse, reckless driving, and risky sex.
  5. Self-harm and suicidal behavior: Self-harm, suicidal thoughts, and suicidal behaviors are common among people with BPD. This can include cutting, burning, or other forms of self-injury.
  6. Extreme emotional swings: Emotional instability in BPD can cause intense mood swings over a few hours or days. While everyone experiences mood changes, for people with BPD, these swings are more severe and can happen more frequently.
  7. Chronic feelings of emptiness: People with BPD often talk about feeling empty, as if there's a hole or a void inside them. This feeling is uncomfortable, so they may try to fill the void with things like drugs, food, or sex. 
  8. Explosive anger: They may struggle with intense anger and a short temper. Even minor issues can provoke anger. They might also struggle with controlling themselves once they've become upset.
  9. Feeling suspicious or out of touch with reality: Paranoia and dissociation may occur in people with BPD, especially under stress. They may feel suspicious of others' motives or feel as if they are losing touch with reality.

Causes of Borderline Personality Disorder

The exact cause of BPD is not known, but it is believed to be the result of a combination of genetic, environmental, and social factors. Here's a breakdown of these contributing elements:

  1. Genetic factors: Research suggests that BPD may have a genetic component. However, no specific genes have been clearly linked to BPD.
  2. Brain structure and function: Differences in brain structure and function may also contribute to BPD. Some studies have shown changes in brain areas involved in emotion regulation, impulse control, and aggression. However, it's not clear whether these differences are a cause or result of the disorder.
  3. Environmental factors: Many people with BPD have a history of exposure to stressful or traumatic life events, especially during childhood. These can include physical or sexual abuse, neglect, early parental loss, and emotional abuse. 
  4. Social factors: Factors such as family environment, cultural and social influences, and early relationships can play a role in the development of BPD. For example, growing up in an environment where emotions were ignored or punished can contribute to difficulty in understanding and regulating emotions.
  5. Neurobiological factors: Research shows that those with BPD may have an underlying neurobiological vulnerability, making them more susceptible to emotional dysregulation and impulsive behaviors. This vulnerability, combined with environmental stresses, may trigger the development of BPD.

It's important to note that not everyone with these risk factors will develop BPD, and not all with BPD have these specific backgrounds. The development of BPD is likely a complex interaction of these factors rather than the result of any single cause.

Diagnosing Borderline Personality Disorder

Diagnosing BPD involves a thorough assessment by a mental health professional, using clinical interviews and evaluating symptoms against the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. The process includes:

  • Clinical interviews: Discussing mental health history, current symptoms, and behavior patterns
  • Diagnostic criteria: Checking for at least five out of nine specific symptoms outlined in the DSM-5, such as relationship instability, identity disturbance, impulsivity, and emotional instability
  • Differential diagnosis: Ruling out other mental health conditions that could explain the symptoms
  • Psychological testing: Conducting personality interviews to gather more information
  • Medical evaluation: Excluding physical health issues that might mimic psychiatric symptoms

The goal is to accurately identify BPD while differentiating it from other disorders, ensuring an appropriate treatment plan.

How We Treat Borderline Personality Disorder

At Elevate Psychiatry, we specialize in offering BPD treatment plans specifically customized to your needs. BPD is primarily focused on talk therapy, with medication sometimes used to treat specific symptoms or co-occurring disorders. 

The goals of treatment are to help patients understand and manage their emotions, reduce impulsive behaviors, and improve relationships. Here's a closer look at how we approach BPD treatment.

Talk Therapy

Talk therapy is the cornerstone of BPD treatment, with several types shown to be effective:

  • Dialectical behavior therapy (DBT): DBT is specifically designed for dealing with BPD. It combines cognitive-behavioral techniques with mindfulness practices. DBT focuses on teaching coping skills to manage intense emotions, reduce self-destructive behaviors, and improve relationships. 
  • Cognitive behavioral therapy (CBT): CBT helps patients identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others. It helps in reducing symptoms like mood swings and self-harming behaviors.
  • Schema-focused therapy: This approach combines elements of CBT with other forms of talk therapy, focusing on identifying and changing abnormal thought patterns.
  • Mentalization-based therapy (MBT): MBT helps people better understand their own and others' mental states, which can influence emotions and actions. It's particularly useful for improving relationships and emotional regulation.
  • Transference-focused psychotherapy (TFP): TFP focuses on the relationship between the patient and therapist, using the dynamic in this relationship to understand and address problematic patterns in the patient's relationships outside of therapy.


While there are no medications specifically approved to treat BPD, medications may be prescribed to address specific symptoms or co-occurring disorders, such as mood swings, depression, or anxiety. These can include:

  • Antidepressants
  • Mood stabilizers
  • Antipsychotics

Supportive Care

Support groups, education about the disorder, and family therapy can also help people and their loved ones understand BPD and develop strategies to cope with its challenges. At Elevate Psychiatry, we help people get in contact with support groups that offer a safe and nurturing environment for sharing experiences and strategies.

These groups are designed to foster a sense of community and belonging among individuals affected by BPD, allowing for the exchange of personal insights and coping mechanisms under the guidance of our experienced mental health professionals.

Lifestyle and Self-Care

In addition to following formal treatment regimens, engaging in regular physical activity, sleeping well, eating healthily, and practicing mindfulness or other stress-reduction techniques can support overall well-being.

Treatment for BPD can be challenging and requires a long-term commitment. However, with appropriate therapy and support, those with BPD can achieve substantial improvement and lead fulfilling lives.

Managing Borderline Personality Disorder with Elevate Psychiatry

At Elevate Psychiatry, your health and well-being are our top priority. Don’t let BPD challenges dictate your life. 

Your experience is unique to you, and we will help you find a treatment path that best suits your needs.

Book an appointment online or get in touch with us at one of our three locations:

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