Borderline Personality Disorder
Borderline Personality Disorder
Authored by: Christiana Louisa Ticoalu, M.A., Psychology & Management
Language Editor: Alda Belinda
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog
IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions.
Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a condition that describes individuals who endure personality disturbances that manifest as instability of personal relationships, affect, and impulsivity. Those with the condition often struggle with their identity and self-image (for instance, they may define and present themselves differently depending upon whom they are with). During periods of heightened negative affect, the tendency for impulsivity may lead to engagement in rash behaviours. In some instances, individuals engage in self-destructive behaviours including self-harm. Furthermore, periods of heightened arousal are sometimes accompanied by the experience of transient dissociative or psychotic-like features.
The condition is also characterized by feelings of chronic emptiness. Generally, those with borderline personality disorder experience an intense fear of abandonment and have difficulty tolerating instability or uncertainty. Despite craving closeness and interpersonal intimacy, many may think and behave in ways that undermine, and challenge the formation of, healthy relationships.
With symptoms lasting at least one year, borderline personality disorder is often detrimental to one’s day-to-day life and is accompanied by considerable distress and impairment across important life domains, interfering with functioning (social, occupational or otherwise).
Importantly, disruptions are not attributable to other mental health conditions, substances, or medication on the central nervous system. Further, symptoms are not better attributable to withdrawal.
Domains of Borderline Personality Disorder
Individuals with borderline personality disorder demonstrate heightened emotional sensitivity and instability, mood reactivity, and negative affect. Consequently, many experiences a deficit in the ability to regulate emotions rely upon of maladaptive techniques to do so.
Many individuals with borderline personality disorder struggle to control their actions. This may cause them to engage in self-destructive behaviours including but not limited to:
- Excessive spending
- Substance use
- Promiscuous behaviours
- Suicide attempts
A hallmark of borderline personality disorder is a pattern of unstable relationships. Individuals with the condition often experience an intense, at times irrational, fear of being alone or being abandoned. Those with this condition frequently shift from idealization to devaluation. Generally speaking, many view the world as, ultimately, black-and-white: believing that all people are “all good” or “all bad”. Unfortunately, their very impulsive and volatile emotions and behaviours sometimes lead to the very abandonment and alienation that they fear.
Furthermore, interpersonal difficulties may be further exacerbated by identity disturbance, volatility or incoherence. For instance, those with the condition may demonstrate the frequent change of goals, beliefs, perspectives, and vocational aspirations. Moreover, their sense of self may shift depending upon whom they are with.
Cognitive difficulties often appear alongside borderline personality disorder and are closely associated with its psychopathology. Cognitive difficulties may spread across multiple domains, but commonly involve disruptions to executive functions. In addition to brief, psychotic symptoms, commonly endured cognitive symptoms include:
- Derealization (perceiving the external world to be strange, bizarre, or not quite real)
- Depersonalization (the sensation that one’s body is not one’s own, unreal, or has been altered in some strange way).
- In some instances, individuals may also experience illusions, the misinterpretation or misperception of existing stimuli.
For a comprehensive list of the condition’s symptomatology, we recommend you visit the ICD-11 webpage. Please note that on this page, it is referred to as the “Borderline Pattern” under the umbrella of “Personality Disorders”. Those with the condition fulfill at least 5 of the symptoms listed.
Comorbidities are co-occurring conditions that lead to a greater symptom burden, and may in some cases predict poorer course and outcome. Common conditions that appear alongside borderline personality disorder include but are not limited to:
- Mood disorders (particularly major depressive disorder)
- Eating disorders
- Anxiety disorders
- Conduct disorders
- Substance use disorders
- Attention Deficit Hyperactivity Disorder
- Operational defiant disorder
Development and Course
Below, we present existing findings. Nevertheless, we would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.
- Borderline personality disorder has been defined as a chronic and heterogeneous condition
- The condition can appear at any time in one’s life, but adolescence has been deemed a “sensitive period” for the condition’s onset.
- Borderline personality disorder typically peaks in adulthood, and declines during a later phase of an individual’s life
- Some individuals are diagnosed with borderline personality disorder during mid-to-late adulthood. This being said, it is theorized the condition does not have a sudden onset during adulthood; instead, the prodromal indications of the condition are usually traceable to an individual’s youth.
- In the absence of treatment, most patients do not fully recover and continue to endure both the social and vocational consequences of the condition.
- A recent study reports age-related differences in the expressions of Borderline Personality Disorder symptoms.
- It is reported that during in adolescence, symptoms include affective dysregulation, emotional lability, impulsivity and suicidality
- During adulthood, this may shift to maladaptive interpersonal functioning and heightened functional impairments
Gender and Sex-Related Differences
- Whilst earlier research finds the condition is more prevalent in women, more recent research suggests that there is no significant difference in the prevalence of the condition.
- Women have been reported to demonstrate more significant overall symptomatology (this includes depressive, anxious and somatic symptoms)
- Men demonstrate more explosive tendencies, including heightened aggression
Etiological Risk Factors
Several factors influence the stability and maintenance of borderline personality disorder over time. According to Linehan’s biopsychosocial model (1993), Borderline personality disorder manifests as the product of an interaction between genes, biology and the environment. This compromises an individual’s ability to regulate both emotions and impulses.
Please note the following factors are not mandatory preconditions for the presence of borderline personality disorder. Further, whilst a correlation exists between these variables and the onset of the disorders, the presence of any one, or a combination of several, of the variables included below is not necessarily indicative an individual will experience the condition.
Temperamental or Personality Factors
- High neuroticism and negative affect
- Generalized impulsivity
- Affect instability
- Intolerance of aloneness
Heritability and Genetic Predispositions
- Maternal history of the condition’s pathology
- Whilst some studies find that the condition may be explained by shared genetics, other studies do not echo these findings.
- Overall, it is supposed that borderline personality disorder results from a predisposition to emotional dysregulation and an invalidating environment
- Compromised amygdalic processing (this neural area has been implicated in the regulation of emotions, including those commonly observed amongst individuals with BPD, fear, anger and aggression)
- Compromised hippocampal processing (an area implicated in behavioural regulation and control)
- Compromised functioning of the orbitofrontal cortex (an area involved in behavioural planning and decision making)
- The presence of comorbid psychiatric disorders
- Neurotransmitter imbalance: specifically, altered levels of serotonin (lead to changes in emotional regulation and impulsivity)
- Low socioeconomic status (including low educational level and low-status occupation)
- Parental aggression
- Growing up with parents or guardians who endure severe mental health conditions
- A history of abuse (physical, sexual abuse, psychological abuse)
- Maltreatment and neglect during childhood
- Growing up in an invalidating environment in which a child is told “you should not feel this way”, or is punished for expressing emotion. The child is taught to believe their emotional responses are neither appropriate nor valid
The symptoms of borderline personality disorder have widespread consequences across social, economic, academic, occupational domains and otherwise. These consequences may have detrimental effects on one’s quality of life. Whilst not everyone experiencing this condition will experience these disruptions, studies have highlighted various associated consequences. Individuals with borderline personality disorder have been observed to be at heightened risk for:
- Suicidal behaviour
- Suicide attempts
- Self-image disturbances
- Fractured relationships (familial, romantic or otherwise)
- Impulsive tendencies have been correlated with reckless behaviours including: substance abuse, impulsive spending, self-harm, binge eating and reckless driving.
A Gentle Reminder
We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help.
Sources and Readings
We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading.
Bozzatello, P., Bellino, S., Bosia, M., & Rocca, P. (2019). Early Detection and Outcome in Borderline Personality Disorder. Frontiers in Psychiatry, 10, 710. https://doi.org/10.3389/fpsyt.2019.00710
Kulacaoglu, F., & Kose, S. (2018). Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe. Brain Sciences, 8(11), 201. https://doi.org/10.3390/brainsci8110201
Linehan, M. M., Schmidt, H., 3rd, Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. The American Journal on Addictions, 8(4), 279–292. https://doi.org/10.1080/105504999305686
Shearin, E. N., & Linehan, M. M. (1994). Dialectical behavior therapy for borderline personality disorder: theoretical and empirical foundations. Acta psychiatrica Scandinavica. Supplementum, 379, 61–68. https://doi.org/10.1111/j.1600-0447.1994.tb05820.x
Silberschmidt, A., Lee, S., Zanarini, M., & Schulz, S. C. (2015). Gender Differences in Borderline Personality Disorder: Results From a Multinational, Clinical Trial Sample. Journal of Personality Disorders, 29(6), 828–838. https://doi.org/10.1521/pedi_2014_28_175