Borderline Personality Disorder Symptoms: Signs, Causes And Treatment

Borderline personality disorder, or BPD, is a mental health condition in which a person has very intense emotions that shift quickly, a shaky sense of who they are and relationships that swing between closeness and conflict. According to the NIMH, it severely affects a person’s ability to regulate their emotions, which can increase impulsivity, affect self image and strain relationships.

Many people with BPD are told they are “too sensitive,” “dramatic” or “difficult.” That is unfair and untrue. BPD is a real, recognized and treatable condition, and with the right care people can build stable lives and relationships. This guide explains the symptoms, how they can show differently in women and men, what causes it and how it is treated. Contact us if you need any help or just want to talk. Your message is confidential.

This page cannot diagnose you or someone you love. Only a trained clinician can diagnose a personality disorder, after a careful assessment.

What is borderline personality disorder?

Personality disorders are long standing patterns of thinking, feeling and relating that cause distress or problems in daily life. They usually begin in the teenage years or early adulthood. BPD is one of the best known. The word “borderline” is a historical label and does not mean someone is “on the border” of anything.

The NHS describes people with borderline personality disorder as often having intense but unstable relationships, difficulty controlling emotions, impulsive behavior and a fear that others will abandon them. Some clinicians also use the term emotionally unstable personality disorder.

Borderline personality disorder symptoms

Clinicians look at a pattern of symptoms across areas of life. Usually several of the following are present, and they have been there for a long time, not just during a bad week:

1. Intense fear of abandonment. Strong efforts to avoid being left, real or imagined, such as repeated calls, pleading or panic when someone is late.
2. Unstable, intense relationships. Seeing someone as perfect and then, after a disappointment, as terrible. Relationships may start fast and end suddenly.
3. An unclear or shifting sense of self. Not knowing who you are, what you value or what you want. Goals, friends, beliefs or even identity may change often.
4. Impulsive, risky behavior. For example reckless spending, unsafe driving, binge eating, risky relationships or substance use.
5. Self harm or suicidal thoughts and behavior. Thoughts of self harm or suicide, threats or acts of self harm, often during intense distress.
6. Rapid mood swings. Strong shifts in mood over hours or a day, such as sudden anxiety, sadness or irritability.
7. Chronic feelings of emptiness. A lasting sense of being hollow or numb.
8. Intense anger. Anger that is hard to control and out of proportion to the trigger, followed by shame.
9. Stress related paranoia or feeling detached. Under heavy stress, feeling suspicious or cut off from yourself or the world, for a short time.

For a diagnosis, a clinician usually looks for five or more of these over time, in more than one setting, and rules out other causes.

If you or someone near you is in immediate danger or is thinking of self harm or suicide, go to the nearest emergency department now, or ask a trusted person to take you there. Do not wait for an appointment.

Symptoms of BPD in women

Women are more often diagnosed with BPD in clinical settings. The symptoms are the same, but some patterns are commonly seen:

• Strong emotional reactions, tearfulness, anxiety and depression
• Intense fear of abandonment in close relationships and marriage
• Self harm that is hidden, so family may not know
• Eating problems or harsh self criticism
• Overlap with depression, anxiety and trauma related symptoms, which can lead to BPD being missed

In Pakistan, women often face family pressure, limited privacy and stigma, so distress may be dismissed as “moodiness” or a “bad attitude” for years. Early, respectful assessment matters.

Symptoms of BPD in men

Men can have BPD too, but it may be mistaken for something else. Anger, impulsivity, substance use or risk taking may be what others notice, and the emotional pain behind them is overlooked. Men may also be less likely to talk about feelings or seek help.

Is it BPD, bipolar disorder or depression?

BPD is often confused with mood conditions, and the conditions can occur together.

• Mood swings in BPD change within hours or a day, often in response to relationships and stress. In bipolar disorder, mood episodes usually last days to weeks and have a clearer pattern. See our Bipolar Disorder Treatment page.
• Depression involves a low mood that lasts. People with BPD may also be depressed, and many have chronic emptiness. See our Depression Treatment page.
• Anxiety, PTSD and substance use are common alongside BPD. The NIMH notes that BPD often occurs with depression, PTSD, bipolar disorder, anxiety disorders, substance use disorder and eating disorders.

Because of this overlap, a careful assessment by a psychiatrist and a clinical psychologist is important.

What causes borderline personality disorder?

There is no single cause. Research points to a mix of:

• Inherited tendencies, such as a sensitive temperament and a family history of mental illness
• Early experiences, such as childhood neglect, loss, abuse or an unstable home
• Brain and stress responses that make strong emotions harder to settle
• Later stress and relationships that strengthen unhelpful patterns

Not everyone with these risks develops BPD, and having BPD is not your fault or your family’s fault. It is not a flaw of character.

How is BPD treated?

BPD is treatable. Many people improve substantially over time, especially with consistent therapy.

Talking therapy is the main treatment. The NIMH names dialectical behavior therapy (DBT) as an established treatment. DBT teaches skills for managing intense emotions, tolerating distress, staying present and improving relationships. Other structured therapies exist, and a clinical psychologist chooses what suits you. The NHS notes that talking therapy can last months or years.

Medicine does not treat BPD itself, but it can help related problems such as depression, anxiety or sleep. The NHS notes that antidepressants may be used for moderate to severe depression that occurs alongside it. A psychiatrist decides what is suitable.

Treating other conditions at the same time. If alcohol, drugs or sleeping tablets are involved, treating them together with the BPD gives better results. See our Dual Diagnosis Treatment page.

Family support. Relatives often feel confused or exhausted. Understanding BPD helps them respond calmly and set healthy limits. Our Family Support Program is there for this.

Our approach is explained on our Personality Disorder Treatment page, with Counseling and Therapy from our clinical psychologists.

How to support someone with BPD

• Learn about the condition, so you see the fear and pain behind the behavior.
• Stay calm during an emotional storm. Listen first and try to solve later.
• Set clear, kind limits and keep to them.
• Do not threaten to leave, and do not make promises you cannot keep.
• Take every mention of self harm or suicide seriously and get urgent help.
• Look after yourself. Caring for someone with BPD is tiring, and you need support too.

Borderline personality disorder test

You will find many online “BPD tests.” They cannot diagnose you. At best they point to symptoms worth discussing with a professional. If you want a starting point, our Free Mental Health Self Check uses the PHQ-9 and GAD-7 questionnaires for depression and anxiety. It does not test for BPD, but it can help you decide whether to book an assessment.

When to see a professional

Book an appointment if:

• Your emotions feel out of control and are harming your relationships, work or study
• You have harmed yourself, or have had thoughts of doing so
• You act on impulse in ways you later regret
• You keep fearing being left, and it is straining your relationships
• You rely on alcohol, tablets or drugs to cope
• Someone close to you has asked you to get help

At FCRC you can arrange a private assessment with our clinical team in Bani Gala, Islamabad.