{"id":1250,"date":"2023-03-31T17:38:05","date_gmt":"2023-03-31T17:38:05","guid":{"rendered":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/chapter\/borderline-personality-disorder\/"},"modified":"2026-01-20T16:06:04","modified_gmt":"2026-01-20T16:06:04","slug":"borderline-personality-disorder","status":"publish","type":"chapter","link":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/chapter\/borderline-personality-disorder\/","title":{"raw":"Personality Disorders: Learn It 2\u2014Borderline Personality Disorder","rendered":"Personality Disorders: Learn It 2\u2014Borderline Personality Disorder"},"content":{"raw":"<h2>Borderline Personality Disorder<\/h2>\r\n<section class=\"textbox keyTakeaway\">\r\n<h3>borderline personality disorder<\/h3>\r\n<p class=\"p1\"><span class=\"s1\"><b>Borderline personality disorder (BPD)<\/b><\/span> is a mental disorder marked by persistent difficulty regulating emotions, maintaining a stable sense of self, and navigating close relationships. These patterns are long-lasting (not just a \u201cphase\u201d), tend to begin by early adulthood, and can lead to serious distress and impairment in daily life.<\/p>\r\n<\/section>\r\n<h3><b>Core features of BPD<\/b><\/h3>\r\n\r\n[caption id=\"attachment_4095\" align=\"alignright\" width=\"446\"]<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2017\/03\/31203048\/7370270038_1e2363b823_z.jpg\"><img class=\"wp-image-4095\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2017\/03\/31203048\/7370270038_1e2363b823_z.jpg\" alt=\"Photograph of a woman's face as she holds a mask in front of half her face.\" width=\"446\" height=\"286\" \/><\/a> <strong>Figure 1<\/strong>. Those with borderline personality disorder may quickly change their mood or behavior.[\/caption]\r\n\r\n<p class=\"p3\">BPD commonly involves <span class=\"s2\"><b>a cycle of intense emotional reactions and rapid shifts in mood<\/b><\/span>, often in response to interpersonal stress (for example, feeling suddenly rejected, criticized, or abandoned). Other common features include:<\/p>\r\n<ul>\r\n\t<li class=\"p1\"><b>Unstable relationships: <\/b>Relationships may feel \u201call-or-nothing\u201d\u2014someone can be idealized in one moment and then viewed as uncaring or hostile after a disappointment or conflict.<\/li>\r\n\t<li class=\"p1\"><b>Unstable self-image or identity: <\/b><b><\/b>Self-concept may shift quickly (values, goals, friendships, plans), leading to feeling unsure about who one is or what matters most.<\/li>\r\n\t<li class=\"p1\"><b>Fear of abandonment: <\/b>Strong sensitivity to separation\u2014whether real or perceived\u2014can lead to frantic efforts to avoid being alone or left out.<\/li>\r\n\t<li class=\"p1\"><b>Impulsivity: <\/b>Risky, self-defeating behaviors may occur in areas like spending, substance use, unsafe sex, reckless driving, or binge eating\u2014especially during intense emotions.<\/li>\r\n\t<li class=\"p1\"><b>Self-harm and suicidal behavior: <\/b>Some cases include suicidal ideation, suicidal behavior, or <span class=\"s1\">non-suicidal self-injury<\/span>, often linked to emotion regulation difficulties and crisis-level distress.<\/li>\r\n\t<li class=\"p1\"><b>Intense anger or difficulty controlling anger: <\/b><b><\/b>Anger may feel sudden, overwhelming, or hard to manage, sometimes followed by guilt or shame.<\/li>\r\n\t<li class=\"p1\"><b>Stress-related changes in thinking or perceptio: <\/b>Under high stress, brief <span class=\"s1\">dissociation<\/span> (feeling unreal, detached, \u201cnot in your body\u201d) or short-lived paranoid thoughts can occur.<\/li>\r\n<\/ul>\r\n<h3><b>How common is it?<\/b><\/h3>\r\n<p class=\"p3\">National estimates vary depending on how BPD is measured and which samples are studied. In U.S. adults, commonly cited estimates cluster around <span class=\"s2\"><b>about 1\u20132%<\/b><\/span> in the general population, while rates are <span class=\"s2\"><b>much higher in clinical settings<\/b><\/span> (especially inpatient care).<span class=\"Apple-converted-space\">\u00a0 <\/span><\/p>\r\n<h3><b>Why does BPD develop?<\/b><\/h3>\r\n<p class=\"p3\">BPD does <span class=\"s2\"><b>n<\/b>ot<\/span> have a single cause. Research supports a <span class=\"s2\">biopsychosocial<\/span> explanation\u2014meaning risk increases through the interaction of temperament, biology, and environment.<\/p>\r\n<p class=\"p3\">Common risk factors include:<\/p>\r\n<ul>\r\n\t<li class=\"p1\"><span class=\"s1\">Temperament and emotion sensitivity<\/span> (for example, strong emotional reactivity, difficulty returning to baseline after stress)<\/li>\r\n\t<li class=\"p1\"><span class=\"s1\">Genetic influences<\/span> on traits like impulsivity and negative emotionality<\/li>\r\n\t<li class=\"p1\"><span class=\"s1\">Chronic invalidation or unstable environments<\/span> (repeated experiences of being dismissed, ignored, or punished for emotions)<\/li>\r\n\t<li class=\"p1\"><span class=\"s1\">Trauma and adversity<\/span>, including higher rates of childhood neglect or abuse among those diagnosed (though trauma is <span class=\"s1\">not<\/span> required for the diagnosis)<\/li>\r\n<\/ul>\r\n<p class=\"p3\">A helpful way to think about BPD is that the disorder often reflects <span class=\"s2\">emotion regulation difficulties in a context of high stress and vulnerability<\/span>, where impulsive behaviors or relationship conflicts can become short-term \u201csolutions\u201d that accidentally make long-term functioning worse.<\/p>\r\n<p class=\"p1\"><span class=\"s1\"><b>Psychotherapy is the first-line treatment<\/b><\/span> for BPD, and improvement is common with effective care and support.<\/p>\r\n<p class=\"p1\">Evidence-based approaches for treatment include:<\/p>\r\n<ul>\r\n\t<li>\r\n<p class=\"p1\"><span class=\"s1\"><b>Dialectical behavior therapy (DBT)<\/b><\/span>: focuses on skills for mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. A systematic review of randomized controlled trials found DBT improved outcomes such as suicidality and related symptoms (often with small-to-moderate effects), and it may reduce emergency visits and hospitalization.<span class=\"Apple-converted-space\">\u00a0 <\/span><\/p>\r\n<\/li>\r\n\t<li>\r\n<p class=\"p1\"><span class=\"s1\">Other structured therapies with evidence include <\/span>mentalization-based therapy (MBT)<span class=\"s1\">, <\/span>schema therapy<span class=\"s1\">, and <\/span>transference-focused psychotherapy<span class=\"s1\"> (TFP).<span class=\"Apple-converted-space\">\u00a0 <\/span><\/span><\/p>\r\n<\/li>\r\n<\/ul>\r\n<p class=\"p1\">Medication is <span class=\"s1\">not<\/span> considered a primary treatment for BPD itself, but it may be used to address <span class=\"s1\">co-occurring conditions<\/span> (like major depression, anxiety disorders, PTSD, or substance use disorders) when appropriate.<span class=\"Apple-converted-space\">\u00a0 <\/span><\/p>\r\n<h3><b>A hopeful note<\/b><\/h3>\r\n<p class=\"p1\">BPD is often portrayed as \u201cunchangeable,\u201d but that is not accurate. With consistent, skills-based treatment and supportive relationships, many symptoms can lessen substantially over time, and functioning can improve.<\/p>\r\n<section data-depth=\"2\">\r\n<section class=\"textbox tryIt\">[ohm2_question height=\"200\"]4489[\/ohm2_question]<\/section>\r\n<\/section>","rendered":"<h2>Borderline Personality Disorder<\/h2>\n<section class=\"textbox keyTakeaway\">\n<h3>borderline personality disorder<\/h3>\n<p class=\"p1\"><span class=\"s1\"><b>Borderline personality disorder (BPD)<\/b><\/span> is a mental disorder marked by persistent difficulty regulating emotions, maintaining a stable sense of self, and navigating close relationships. These patterns are long-lasting (not just a \u201cphase\u201d), tend to begin by early adulthood, and can lead to serious distress and impairment in daily life.<\/p>\n<\/section>\n<h3><b>Core features of BPD<\/b><\/h3>\n<figure id=\"attachment_4095\" aria-describedby=\"caption-attachment-4095\" style=\"width: 446px\" class=\"wp-caption alignright\"><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2017\/03\/31203048\/7370270038_1e2363b823_z.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4095\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2017\/03\/31203048\/7370270038_1e2363b823_z.jpg\" alt=\"Photograph of a woman's face as she holds a mask in front of half her face.\" width=\"446\" height=\"286\" \/><\/a><figcaption id=\"caption-attachment-4095\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Those with borderline personality disorder may quickly change their mood or behavior.<\/figcaption><\/figure>\n<p class=\"p3\">BPD commonly involves <span class=\"s2\"><b>a cycle of intense emotional reactions and rapid shifts in mood<\/b><\/span>, often in response to interpersonal stress (for example, feeling suddenly rejected, criticized, or abandoned). Other common features include:<\/p>\n<ul>\n<li class=\"p1\"><b>Unstable relationships: <\/b>Relationships may feel \u201call-or-nothing\u201d\u2014someone can be idealized in one moment and then viewed as uncaring or hostile after a disappointment or conflict.<\/li>\n<li class=\"p1\"><b>Unstable self-image or identity: <\/b><b><\/b>Self-concept may shift quickly (values, goals, friendships, plans), leading to feeling unsure about who one is or what matters most.<\/li>\n<li class=\"p1\"><b>Fear of abandonment: <\/b>Strong sensitivity to separation\u2014whether real or perceived\u2014can lead to frantic efforts to avoid being alone or left out.<\/li>\n<li class=\"p1\"><b>Impulsivity: <\/b>Risky, self-defeating behaviors may occur in areas like spending, substance use, unsafe sex, reckless driving, or binge eating\u2014especially during intense emotions.<\/li>\n<li class=\"p1\"><b>Self-harm and suicidal behavior: <\/b>Some cases include suicidal ideation, suicidal behavior, or <span class=\"s1\">non-suicidal self-injury<\/span>, often linked to emotion regulation difficulties and crisis-level distress.<\/li>\n<li class=\"p1\"><b>Intense anger or difficulty controlling anger: <\/b><b><\/b>Anger may feel sudden, overwhelming, or hard to manage, sometimes followed by guilt or shame.<\/li>\n<li class=\"p1\"><b>Stress-related changes in thinking or perceptio: <\/b>Under high stress, brief <span class=\"s1\">dissociation<\/span> (feeling unreal, detached, \u201cnot in your body\u201d) or short-lived paranoid thoughts can occur.<\/li>\n<\/ul>\n<h3><b>How common is it?<\/b><\/h3>\n<p class=\"p3\">National estimates vary depending on how BPD is measured and which samples are studied. In U.S. adults, commonly cited estimates cluster around <span class=\"s2\"><b>about 1\u20132%<\/b><\/span> in the general population, while rates are <span class=\"s2\"><b>much higher in clinical settings<\/b><\/span> (especially inpatient care).<span class=\"Apple-converted-space\">\u00a0 <\/span><\/p>\n<h3><b>Why does BPD develop?<\/b><\/h3>\n<p class=\"p3\">BPD does <span class=\"s2\"><b>n<\/b>ot<\/span> have a single cause. Research supports a <span class=\"s2\">biopsychosocial<\/span> explanation\u2014meaning risk increases through the interaction of temperament, biology, and environment.<\/p>\n<p class=\"p3\">Common risk factors include:<\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Temperament and emotion sensitivity<\/span> (for example, strong emotional reactivity, difficulty returning to baseline after stress)<\/li>\n<li class=\"p1\"><span class=\"s1\">Genetic influences<\/span> on traits like impulsivity and negative emotionality<\/li>\n<li class=\"p1\"><span class=\"s1\">Chronic invalidation or unstable environments<\/span> (repeated experiences of being dismissed, ignored, or punished for emotions)<\/li>\n<li class=\"p1\"><span class=\"s1\">Trauma and adversity<\/span>, including higher rates of childhood neglect or abuse among those diagnosed (though trauma is <span class=\"s1\">not<\/span> required for the diagnosis)<\/li>\n<\/ul>\n<p class=\"p3\">A helpful way to think about BPD is that the disorder often reflects <span class=\"s2\">emotion regulation difficulties in a context of high stress and vulnerability<\/span>, where impulsive behaviors or relationship conflicts can become short-term \u201csolutions\u201d that accidentally make long-term functioning worse.<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Psychotherapy is the first-line treatment<\/b><\/span> for BPD, and improvement is common with effective care and support.<\/p>\n<p class=\"p1\">Evidence-based approaches for treatment include:<\/p>\n<ul>\n<li>\n<p class=\"p1\"><span class=\"s1\"><b>Dialectical behavior therapy (DBT)<\/b><\/span>: focuses on skills for mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. A systematic review of randomized controlled trials found DBT improved outcomes such as suicidality and related symptoms (often with small-to-moderate effects), and it may reduce emergency visits and hospitalization.<span class=\"Apple-converted-space\">\u00a0 <\/span><\/p>\n<\/li>\n<li>\n<p class=\"p1\"><span class=\"s1\">Other structured therapies with evidence include <\/span>mentalization-based therapy (MBT)<span class=\"s1\">, <\/span>schema therapy<span class=\"s1\">, and <\/span>transference-focused psychotherapy<span class=\"s1\"> (TFP).<span class=\"Apple-converted-space\">\u00a0 <\/span><\/span><\/p>\n<\/li>\n<\/ul>\n<p class=\"p1\">Medication is <span class=\"s1\">not<\/span> considered a primary treatment for BPD itself, but it may be used to address <span class=\"s1\">co-occurring conditions<\/span> (like major depression, anxiety disorders, PTSD, or substance use disorders) when appropriate.<span class=\"Apple-converted-space\">\u00a0 <\/span><\/p>\n<h3><b>A hopeful note<\/b><\/h3>\n<p class=\"p1\">BPD is often portrayed as \u201cunchangeable,\u201d but that is not accurate. With consistent, skills-based treatment and supportive relationships, many symptoms can lessen substantially over time, and functioning can improve.<\/p>\n<section data-depth=\"2\">\n<section class=\"textbox tryIt\"><iframe loading=\"lazy\" id=\"ohm4489\" class=\"resizable\" src=\"https:\/\/ohm.one.lumenlearning.com\/multiembedq.php?id=4489&theme=lumen&iframe_resize_id=ohm4489&source=tnh&show_question_numbers\" width=\"100%\" height=\"200\"><\/iframe><\/section>\n<\/section>\n","protected":false},"author":20,"menu_order":28,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Personality Disorders\",\"author\":\"OpenStax College\",\"organization\":\"\",\"url\":\"https:\/\/openstax.org\/books\/psychology-2e\/pages\/15-11-personality-disorders\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at https:\/\/openstax.org\/books\/psychology-2e\/pages\/1-introduction\"},{\"type\":\"cc\",\"description\":\"Self-portrait image\",\"author\":\"Sodanie Chea\",\"organization\":\"Flickr\",\"url\":\"https:\/\/www.flickr.com\/photos\/sodaniechea\/7370270038\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"}]","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"part":1222,"module-header":"learn_it","content_attributions":[{"type":"cc","description":"Personality Disorders","author":"OpenStax College","organization":"","url":"https:\/\/openstax.org\/books\/psychology-2e\/pages\/15-11-personality-disorders","project":"","license":"cc-by","license_terms":"Download for free at https:\/\/openstax.org\/books\/psychology-2e\/pages\/1-introduction"},{"type":"cc","description":"Self-portrait image","author":"Sodanie Chea","organization":"Flickr","url":"https:\/\/www.flickr.com\/photos\/sodaniechea\/7370270038","project":"","license":"cc-by","license_terms":""}],"internal_book_links":[],"video_content":null,"cc_video_embed_content":{"cc_scripts":"","media_targets":[]},"try_it_collection":null,"_links":{"self":[{"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/pressbooks\/v2\/chapters\/1250"}],"collection":[{"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/wp\/v2\/users\/20"}],"version-history":[{"count":9,"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/pressbooks\/v2\/chapters\/1250\/revisions"}],"predecessor-version":[{"id":7588,"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/pressbooks\/v2\/chapters\/1250\/revisions\/7588"}],"part":[{"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/pressbooks\/v2\/parts\/1222"}],"metadata":[{"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/pressbooks\/v2\/chapters\/1250\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/wp\/v2\/media?parent=1250"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/pressbooks\/v2\/chapter-type?post=1250"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/wp\/v2\/contributor?post=1250"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/content.one.lumenlearning.com\/introductiontopsychology\/wp-json\/wp\/v2\/license?post=1250"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}