Borderline Personality Disorder (BPD): What You Need to Know

Illustration of a sad person sitting with arms wrapped around knees, surrounded by chaotic scribbles and arrows. Text reads 'What is BPD?' representing Borderline Personality Disorder.

Introduction

Borderline Personality Disorder (BPD) is a mental health condition that affects how people feel about themselves and how they relate to others. People with BPD often have intense emotions, unstable relationships, and a strong fear of being abandoned. It is more common than many think around 1 to 2 people in every 100 are affected (1).

What Does BPD Feel Like?

Living with BPD can feel like being on an “emotional rollercoaster.” Common experiences include:

• Strong, fast-changing emotions – anger, sadness, or anxiety that can shift within hours.

• Relationship struggles – feeling very close to someone one moment, then suddenly feeling rejected or hurt.

• Fear of abandonment – worrying a lot about friends, family, or partners leaving.

• Unstable sense of self – not always knowing who you are, or what you want.

• Risky behaviors – such as reckless spending, unsafe sex, or substance use.

• Self-harm or suicidal thoughts – unfortunately, these are common in BPD, with around 75% of people attempting self-harm and about 10% dying by suicide (2).

• Chronic emptiness – feeling numb or like “something is missing inside.”

Why Does BPD Happen?

There is no single cause. Instead, BPD develops from a mix of:

• Biology – studies show BPD runs in families, with genes explaining 40–60% of the risk (3).

• Brain function – brain scans show that areas controlling emotions (like the amygdala and prefrontal cortex) work differently in people with BPD (4).

• Environment – childhood trauma, neglect, or invalidating family situations are common in those later diagnosed (5).

This means BPD is not your fault. It develops through an interaction of vulnerabilities and life experiences.

Can BPD Be Treated?

Yes. Although BPD can be very challenging, it is treatable. Many people recover with the right therapy and support.

• Therapy is the most effective treatment.

  • Dialectical Behavior Therapy (DBT) teaches skills for managing strong emotions and reducing self-harm.

  • Mentalization-Based Therapy (MBT) helps people understand their own and others’ emotions.

  • Schema Therapy works on changing deep patterns of thinking and behavior.

• Medication does not cure BPD but can help with depression, anxiety, or impulsivity when needed (6,7).

• Support networks – friends, family, and peer groups can play a vital role in recovery.

Outlook

In the past, BPD was thought to be “untreatable.” This is no longer true. Research shows that most people with BPD improve over time. A large study following patients for 16 years found that the majority reached remission, especially with treatment (8).

Conclusion

Borderline Personality Disorder is a serious but treatable condition. While symptoms such as emotional instability, impulsivity, and self-harm can be very distressing, modern therapies have proven effective, and most people improve significantly over time. Recovery is not always quick, but with persistence, professional support, and the involvement of family or peers, people with BPD can build stable relationships, regulate emotions, and lead meaningful lives. Understanding BPD as a condition rooted in both biology and environment helps reduce stigma and encourages hope for recovery.

References

1. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–45.

2. Black DW, Blum N, Pfohl B, Hale N. Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. J Pers Disord. 2004;18(3):226–39.

3. Distel MA, Trull TJ, Derom CA, Thiery EW, Grimmer MA, Martin NG, et al. Heritability of borderline personality disorder features is similar across three countries. Psychol Med. 2008;38(9):1219–29.

4. Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF. Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Biol Psychiatry. 2013;73(2):153–60.

5. Ball JS, Links PS. Borderline personality disorder and childhood trauma: evidence for a causal relationship. Curr Psychiatry Rep. 2009;11(1):63–8.

6. Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48(12):1060–4.

7. Ingenhoven T, Lafay P, Rinne T, Passchier J, Duivenvoorden H. Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. J Clin Psychiatry. 2010;71(1):14–25.

8. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and Axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2012;169(5):476–83.

   
   

   Image citation: Skyland Trail. What is BPD? [Internet]. Atlanta (GA): Skyland Trail; [cited 2025 Aug 22]. Available from: https://www.skylandtrail.org/understanding-borderline-personality-disorder/

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