Borderline Personality Disorder: Symptoms and Causes
What’s one of the most misunderstood, misdiagnosed, and maligned mental health disorders? It’s borderline personality disorder (BPD).
Although only 1-2% of the general population has been diagnosed with BPD, this complex and challenging mental health condition has the potential to substantially impact both individuals and society.
For example, studies note that up to 10% of these individuals die by suicide each year, a rate 50 times higher than the general population. BPD is associated with a range of additional consequences, including cognitive, mental, economic, and public health impairments. In fact, people with BPD comprise up to 20% of those undergoing inpatient psychiatric treatment and 10% of those in outpatient psychiatric care.
Because the effects of BPD can be so widespread and possibly devastating, it’s important to learn more about the signs of borderline personality disorder, as well as its causes, diagnosis, and most effective treatments.
Research shows that over 40% of people with borderline personality disorder have been previously misdiagnosed with another mental health condition.
SYMPTOMS OF BORDERLINE PERSONALITY DISORDER
True to its name, BPD is a type of personality disorder, a category of mental illnesses characterized by abnormal and unhealthy thinking and behavioral patterns. Someone with borderline personality disorder may experience a distorted sense of self, troubled interpersonal relationships, and strong or extreme emotions, such as anger. People with borderline personality disorder may also experience persistent feelings of emptiness. They commonly engage in impulsive and self-destructive behaviors, like reckless driving, unprotected sex, gambling, binge eating, overspending, and substance abuse. Additional symptoms of borderline personality disorder include:- Black-and-white thinking
- Difficulty coping with life’s challenges
- Self-harming behaviors, from cutting to suicide attempts
- Extreme swings in perspective or mood
- Lack of empathy
- Intense fear of rejection or abandonment
- Hostility and uncontrollable rage
- Intense feelings of anxiety, depression, and worry
- Feeling disconnected from the body (dissociation)
- Experiencing paranoid thoughts when stressed
BORDERLINE PERSONALITY DISORDER CAUSES AND PREVALENCE
In addition to the 1-2% of diagnosed cases, experts believe that many more Americans could have BPD—up to 15 million, or 5.9% of the population. Furthermore, this type of personality disorder often co-occurs with other mental health disorders. As many as 20% of those with BPD also have bipolar disorder, for example. Other conditions, like ADD/ADHD, depression, anxiety disorders, PTSD, eating disorders, and substance abuse problems, may also be present in those with BPD. Women are much more likely to be diagnosed with BPD; they make up about 75% of cases. But experts believe that borderline personality disorder often remains undetected in men, who are more likely to be diagnosed with conditions like PTSD and depression when they may have BPD. Regardless of gender, there are several causes of borderline personality disorder, including adverse childhood experiences (ACEs). People with the condition have often survived traumatic events, including physical, emotional, or sexual abuse, neglect, or abandonment, during their childhood. In other cases, genetics plays a role. People with a close family member who has the disorder are 5 times more likely to also have it. Additional factors are environmental. Toxins such as toxic mold, traumatic brain injuries, infections like Lyme disease, substance abuse, hormonal imbalances, and immune system issues can all impact brain function. Therefore, they may contribute to the mood and personality changes that are associated with the mental health condition.DIAGNOSING BORDERLINE PERSONALITY DISORDER
According to The British Psychological Society’s Borderline Personality Disorder: Treatment and Management, a book referenced by the National Library of Medicine, BPD remains “one of the most contentious of all the personality disorder subtypes.” Part of the reason for this is its likelihood of co-occurring with other types of personality disorders. “Pure” borderline personality disorder is estimated to exist in only 3-10% of cases. Most commonly, it overlaps with other “Cluster B” personality disorders, which include histrionic personality disorder, narcissistic personality disorder, and antisocial personality disorder. And, as mentioned, BPD also frequently co-occurs with anxiety and mood disorders. It’s no surprise that research shows over 40% of people with BPD have been previously misdiagnosed with another mental health condition. Frequently co-existing disorders, as well as potential misdiagnosis among men, are just two reasons why it’s crucial to receive the proper diagnosis and treatment plan for borderline personality disorder. Another reason for misdiagnosis is the tendency of traditional psychiatrists to evaluate symptom clusters alone—without looking at the root cause of the issue, the brain. As with any mental health condition, borderline personality disorder is associated with imbalances in the brain. In decades past, these people might be labeled as “bad” or “difficult,” but modern diagnostic methods help reduce stigma. Neuroimaging, such as functional SPECT scans, help pinpoint the underlying brain patterns behind mental health conditions like BPD. On SPECT scans at Amen Clinics, which has built the world’s largest database of functional brain scans related to behavior, BPD is associated with abnormal activity in areas of the brain that regulate emotion, fear, and impulse control. One review of scientific studies on the neurobiology of the disorder published in Psychiatric Times points to several abnormalities in the BPD brain. For example, the research shows:- Decreases in brain volume in the left amygdala (the brain’s fear center) and right hippocampus (involved in memory, mood, and learning)
- Heightened activity in the left amygdala, posterior cingulate cortex, and left hippocampus
- Reduced activity in the frontal lobes
- Impaired connectivity between the frontal lobes and limbic system (the brain’s emotional center)
- Network connectivity issues among the brain’s default network (self-referential thinking), salience network (where we place our attention), and medial temporal lobe network (processing negative emotions)
BORDERLINE PERSONALITY DISORDER TREATMENT
BPD, while considered a chronic condition, doesn’t need to be a life sentence. Despite the seriousness of borderline personality disorder, the recovery statistics are encouraging: One study found that after 10 years after treatment, 85% of patients experienced remission. Getting a functional brain scan, such as a SPECT scan, can help you get an accurate diagnosis, which leads to a more personalized treatment plan. By taking both the brain and body into account, your recovery process will be more effective. In some cases, medications may be prescribed. However, prescription drugs should never be the first or only line of defense. No medications are specifically formulated for borderline personality disorder, but antipsychotics, antidepressants, anxiolytics (anti-anxiety pills), and mood stabilizers may help address symptoms. In addition, there are many effective natural treatments for borderline personality disorder, including:- Therapy: Eye movement desensitization and reprocessing (EMDR), dialectical behavioral therapy (DBT), and cognitive behavioral therapy (CBT) are a few helpful approaches.
- Diet: Adopt a brain-healthy diet that’s free of allergens (sugar, soy, dairy, gluten, corn, artificial dyes, preservatives, and food additives). Avoid alcohol and other recreational drugs, and limit caffeine. Supplement with omega-3 fatty acids, magnesium, vitamin D, and probiotics.
- Lifestyle habits: Exercise helps boost mood and fights symptoms like depression. Mindfulness practices can help soothe the anxiety that’s common with BPD. It’s important to reduce stress through healthy lifestyle habits as much as possible.
