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Recommended reading: Psychological therapies for people with borderline personality disorder

People with borderline personality disorder, are often anxious, depressed, self‐harm, in crisis and are difficult to engage in treatment. In this review of the talking/behavioural therapies for people with borderline personality disorder, we identified seven studies involving 262 people, over five separate comparisons. Dialectical behaviour therapy (DBT) included treatment components such as prior... more

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A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011.

A.D.A.M. Medical Encyclopedia.

Borderline personality disorder

Personality disorder - borderline

Last reviewed: November 15, 2010.

Borderline personality disorder is a condition in which people have long-term patterns of unstable or turbulent emotions, such as feelings about themselves and others.

These inner experiences often cause them to take impulsive actions and have chaotic relationships.

Causes, incidence, and risk factors

The causes of borderline personality disorder (BPD) are unknown. Genetic, family, and social factors are thought to play roles.

Risk factors for BPD include:

  • Abandonment in childhood or adolescence

  • Disrupted family life

  • Poor communication in the family

  • Sexual abuse

This personality disorder tends to occur more often in women and among hospitalized psychiatric patients.

Symptoms

People with BPD are often uncertain about their identity. As a result, their interests and values may change rapidly.

People with BPD also tend to see things in terms of extremes, such as either all good or all bad. Their views of other people may change quickly. A person who is looked up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships.

Other symptoms of BPD include:

  • Fear of being abandoned

  • Feelings of emptiness and boredom

  • Frequent displays of inappropriate anger

  • Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting

  • Intolerance of being alone

  • Repeated crises and acts of self-injury, such as wrist cutting or overdosing

Signs and tests

Like other personality disorders, BPD is diagnosed based on a psychological evaluation and the history and severity of the symptoms.

Treatment

Many types of individual talk therapy, such as dialectical behavioral therapy (DBT), can successfully treat BPD. In addition, group therapy can help change self-destructive behaviors.

In some cases, medications can help level mood swings and treat depression or other disorders that may occur with this condition.

Expectations (prognosis)

The outlook depends on how severe the condition is and whether the person is willing to accept help. With long-term talk therapy, the person will often gradually improve.

Complications

Calling your health care provider

Call your health care provider if you or your child has symptoms of borderline personality disorder. It is especially important to seek help right away if you or your child is having thoughts of suicide.

References

  1. Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 39.

Review Date: 11/15/2010.

Reviewed by: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Copyright © 2012, A.D.A.M., Inc.

What works?

  • Drug treatment for borderline personality disorder Drug treatment for borderline personality disorder
    Many people with borderline personality disorder (BPD) receive medical treatment. However, there are no drugs available for BPD treatment specifically. A certain drug is most often chosen because of its known properties in the treatment of associated disorders, or BPD symptoms that are also known to be present in other conditions, such as depressive, psychotic, or anxious disorders. BPD itself is characterised by a pervasive pattern of instability in affect regulation (with symptoms such as inappropriate anger, chronic feelings of emptiness, and affective instability), impulse control (symptoms: self‐mutilating or suicidal behaviour, ideation, or suicidal threats to others), interpersonal problems (symptoms: frantic efforts to avoid abandonment, patterns of unstable relationships with idealization and depreciation of others), and cognitive‐perceptual problems (symptoms: identity disturbance in terms of self perception, transient paranoid thoughts or feelings of dissociation in stressful situations). This review aimed to summarise the current evidence of drug treatment effects in BPD from high‐quality randomised trials.
See all (4)...

Drugs of interest

  • Olanzapine
    Olanzapine is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods) in adults and teenagers 13 years of age and older.Olanzapine is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
  • Quetiapine
    Quetiapine tablets and extended-release (long-acting) tablets are used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions). Quetiapine tablets and extended-release tablets are also used alone or with other medications to treat or prevent episodes of mania (frenzied, abnormally excited or irritated mood) or depression in patients with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Quetiapine extended-release tablets are also used along with other medications to treat depression. Quetiapine tablets may be used as part of a treatment program to treat bipolar disorder and schizophrenia in children. Quetiapine is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
  • Lamotrigine
    Lamotrigine extended-release tablets are used with other medications to treat certain types of seizures in patients who have epilepsy. All types of lamotrigine tablets other than the extended-release tablets are used alone or with other medications to treat seizures in people who have epilepsy or Lennox-Gastaut syndrome (a disorder that causes seizures and often causes developmental delays).All types of lamotrigine tablets other than the extended-release tablets are also used to increase the time between episodes of depression, mania (frenzied or abnormally excited mood), and other abnormal moods in patients with bipolar I disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Lamotrigine has not been shown to be effective when people experience the actual episodes of depression or mania, so other medications must be used to help people recover from these episodes. Lamotrigine is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain.
  • Topiramate
    Topiramate is used alone or with other medications to treat certain types of seizures in people who have epilepsy. Topiramate is also used with other medications to control seizures in people who have Lennox-Gastaut syndrome (a disorder that causes seizures and developmental delays). Topiramate is used to treat patients who continue to have seizures even when they take other antiseizure medications. Topiramate is also used to prevent migraine headaches but not to relieve the pain of migraine headaches when they occur. Topiramate is in a class of medications called anticonvulsants. It works by decreasing abnormal excitement in the brain.
  • Aripiprazole
    Aripiprazole is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used alone or with other medications to treat episodes of mania or mixed episodes (symptoms of mania and depression that happen together) in adults, teenagers, and children 10 years of age and older with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Aripiprazole is also used with an antidepressant to treat depression when symptoms cannot be controlled by the antidepressant alone. Aripiprazole is also used to treat children 6 to 17 years of age who have autistic disorder (a developmental problem that causes difficulty communicating and interacting with others). Aripiprazole may help control irritable behavior such as aggression, temper tantrums, and frequent mood changes in these children. Aripiprazole is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

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