Walking the Line

Borderline personality disorder symptoms and treatments

/ Author:  / Reviewed by: Robert Carlson, M.D

Impulsive? Unstable? No emotional control?

While at first glance these might seem like symptoms of a number of mental health problems, they could be signs of borderline personality disorder (BPD).

What was once thought of as irregular (“borderline”) forms of existing mental disorders, the illness was recognized for the first time as a separate disorder in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-III) in 1980.

Though this title is now considered a bit outdated and vague, it has clearly defined symptoms and treatments to provide borderline patients with hope and options.

Symptoms and Patterns

The National Institute of Mental Health (NIMH) reports that a diagnosis of borderline personality disorder requires that patients exhibit a long-standing pattern of at least five symptoms from a list present in the DSM. According to NIMH, in a given year 1.6% of American adults meet this diagnosis.

One potential symptom is reckless behaviors that might include binge eating, spending sprees, impulsive sexual encounters and drug abuse. Self-induced harm or threat thereof (like cutting or suicidal behaviors) may also be present.

People with BPD often have quickly-changing and extreme moods, especially anger, and display patterns of unstable relationships that also jump from intense lows and intense highs. This can manifest itself in relationships with friends, family members and romantic partners.

When borderline patients sense a threat of abandonment (whether or not that threat is real), they often again react in extremities. They may display depression, panic or rage in response. They might also battle with an enduring sense of emptiness.

Internally, patients might have a distorted view of themselves and/or paranoia and dissociative symptoms. According to NIMH, this can include “feeling cut off from oneself, observing oneself from outside the body or losing touch with reality.”

Length of episode can vary from hours to several days, but a lasting pattern must be present to diagnose the disorder.

Treatment Options

Treatments for BPD are still being explored and tested. However, psychotherapy is the commonly accepted mode of treatment.


Three main types of therapy are the most prevalent.

Cognitive behavioral therapy (CBT) is aimed at helping patients understand and change the way they think. Patients are taught to distinguish core beliefs causing their inaccurate perceptions. Exploring this can improve mood and anxiousness and reduce the tendency to self-harm.

Another common treatment is dialectical behavioral therapy (DBT) which centers around mindfulness. By cultivating a more aware sense of the present moment, patients are taught to control emotions and behaviors. It focuses less on change and more on acceptance than CBT.

Schema-focused therapy attempts to reframe the way patients view themselves (their “schemas”). According to NIMH, “This approach is based on the idea that borderline personality disorder stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.”


While medication might be helpful for treating specific symptoms, there is currently no Food and Drug Administration approved drug to treat the disorder.

In a 2006 review out of the University of Bristol, studies on pharmacological interventions for BPD were analyzed and the data found to be lacking.

Ten randomized studies (with a combined total of 554 subjects) that each compared psychoactive drugs with another treatment for borderline personality disorder were examined.

According to the authors, “pharmacological treatment of people with BPD is not based on good evidence from trials." However, they did feel that the use of antidepressants to treat BPD showed potential and should be explored more, stating,  "well designed, conducted and reported clinically meaningful trials are possible and needed with, perhaps, the question of antidepressant versus placebo being addressed first."

As trials expand and treatment improves, options for borderline personality patients are sure to grow. In the meantime, knowledge about the symptoms and what to expect can help both patients and loved ones.

Coping With a BPD Diagnosis

Because of the emotionally intense and unstable nature of BPD, it can be almost as difficult for friends and family members to cope with the disorder as it is for patients themselves.

For this reason, it may also be helpful for others involved to participate in therapy, both for their own mental well being and that of the loved one. As NIMH puts it, “The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative's symptoms.”

If a loved one has, or is suspected of having BPD, NIMH recommends, that loved ones “Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with borderline personality disorder.”

With the right support, treatment and time people with borderline personality disorder can improve and enjoy a more stable, balanced life.

Review Date: 
June 6, 2012