Borderline personality disorder

A child who is nurtured by caring and loving parents can develop a deep sense of attachment and security. With age, that child also creates bonds with other people, such as friends, colleagues or a spouse. These bonds are important and it is normal to have a little fear of losing them.

There are many types of personality disorders. The most known is borderline personality disorder. People with borderline personality disorder have an intense fear of losing loved ones. They feel easily rejected or abandoned by others, which creates conflicts in their social relationships. Therefore, they have a strong need to be reassured that people around them are present and that these relationships are important.

Borderline personality disorder affects how people suffering from it think. It impairs:

• Their emotions
• Their behaviour
• Their self-image and identity
• Their relationships with others

Symptoms of borderline personality disorder usually appear in adolescence or early adulthood.

Family and friends may notice several signs of borderline personality disorder in a person suffering from it. They include:

• Unstable relationships or conflicts with family and friends.
• Frequently negative self-image. Example: a tendency to devalue oneself or feel misunderstood.
• Frequent mood swings. Example: being in a good mood and then quickly becoming irritable, sad or anxious.
• Fits of rage. Example: suddenly getting angry at loved ones and then hating them.
• Hostile or strict attitude. Example: insisting on having the last word, or being demanding or jealous.
• Indecisiveness. Example: Changing career objectives or personal values often.
• Difficulty tolerating certain emotions. May become impulsive, deviant or self-destructive, resulting in the following for example:
  • Excessive drinking or use of drugs and medication;
  • Wasteful spending;
  • Reckless driving;
  • Theft;
  • Risky sexual behaviour;
  • Self-harm.
• Expressing suicidal thoughts or threatening to commit suicide.

A person suffering from borderline personality disorder can have varying degrees of symptoms.

The most common symptoms include:

• Fear of being abandoned or rejected by others.
• Difficulty being alone.
• Low self-esteem or changing self-perception. Example: finding oneself extraordinary and exceptional, and then soon after feeling useless and incompetent.
• A permanent sense of inner emptiness. Example: confessing to not having feelings, thoughts or dreams.
• Boredom.
• Being very sensitive to negative criticism from others.
• Being out of touch with reality in certain circumstances, especially in extremely stressful situations.

A person suffering from borderline personality disorder can have other mental disorders or problems at the same time:

• Depressive disorder
• Anxiety disorders
• Bipolar disorder
• Alcohol or drug addition
• Eating disorders

You may have difficulty recognizing symptoms if you are suffering from borderline personality disorder. Do not wait until you are unable to go about your daily activities before consulting.

See a doctor or another health-care professional if you are experiencing one of the following situations:

• You are living in distress
• You have difficulty with your social, professional and family obligations

A health-care professional can assess whether you have borderline personality disorder. It could be necessary to conduct a physical exam or laboratory tests. You will be proposed a treatment plan that is adapted to your needs.

See the Help and resources section to find resources available to you.

If you have suicidal thoughts and fear for your safety, or that of people around you, read Preventing suicide. You will find further information on available help and resources.

Effective treatments for borderline personality disorder are available. Clinical studies show that a person's condition improves significantly when the disorder is detected quickly and adequate treatment is provided.

Treatments allow patients to regain control of their life and their daily activities. However, some symptoms may reappear if the person experiences difficult events such as the death of a loved one or difficulties at work or at school.

In most cases, borderline personality disorder is treatable through psychotherapy. It is sometimes appropriate to combine different types of psychotherapies.

Some people must also take medication.

Psychotherapy 

Experts recommend various psychotherapies to treat borderline personality disorder. Psychotherapies are generally designed to help patients better understand and control their emotions and reduce their self-destructive behaviour.

• Dialectical behaviour therapy is based on problem resolution. It allows the person to better manage emotions without self-judgement and to reduce self-destructive behaviour.
• Cognitive behavioural therapy allows a person to examine his or her beliefs and views and to question them. It aims to change problematic thoughts and behaviour, and to replace them with responses that are appropriate to reality.

Patients may engage in psychotherapy either individually or in a group.

• Individual therapy helps a person to better understand the emotions at the root of his or her suffering and how to take control of them.
• Group therapy is based on exchanges between people experiencing the same situation. It allows them to discuss the problems that they have in common.

Medication

There is no medication specifically designed to treat people suffering from borderline personality disorder. However, some medicines are prescribed to allow the person to:  

• Better manage certain symptoms. These medicines can also help with other problems that may be affecting the person at the same time, such as depression, anxiety disorder and substance abuse.
• Improve day-to-day functioning.
• Benefit more easily from the positive effects of psychotherapy.

Different medication can be used, including:

• Antidepressants
• Anxiolytics
• Mood stabilizers

Your doctor will suggest medication that suits you best depending on your health condition.

Recommendations for taking medication

If your doctor prescribes you medicines, it is important to take them by carefully following instructions provided.

If you have uncomfortable side-effects due to the medication, discuss the issue with your pharmacist or your doctor promptly. If necessary, your medication can be adjusted or other medication may be recommended.

People with borderline personality disorder often try to control pain related to emotions they feel by drinking or using drugs. As such, they can develop an excessive consumption or a substance addiction.

Self-destructive behaviour such as self-harm and suicidal acts can lead to complications, physical scars or permanent handicap. 

Preventing symptoms of borderline personality disorder is not always possible. However, if you have symptoms associated with this disorder, you can act now. Advice for maintaining good mental health will help you change certain lifestyle habits. This subsequently allows you to eliminate factors that worsen or that maintain your condition.

Borderline personality disorder does not have a single cause. It is often a combination of many factors that lead to the development of the disorder. Here are examples of a few factors:

• Painful childhood experiences. Neglect, physical, psychological or sexual abuse, for example.
• Separation or grief experienced at a young age.
• Serious attachment issues resulting, for example, in a lack of continuity in the feelings of reassurance and safety offered by parents during childhood.
• Heredity, meaning that other people in the family are suffering or have suffered from borderline personality disorder.
• An impulsive nature.
• Extreme sensitivity beginning at birth.
• Living in an unstable family environment and having greater difficulty adapting to such an environment.

In adults, more women than men suffer from borderline personality disorder. 

Impact on people around

People around a person suffering from borderline personality disorder can be extremely affected by his or her illness and be preoccupied by the self-destructive behaviour. They can experience fear, anger and powerlessness. Just like the person suffering, they need help and support to understand this personality disorder.

If you would like to help a loved one suffering from a mental illness, read Living with a person suffering from mental illness to learn how to help within your limits. 

Prejudices

People with borderline personality disorder are often victims of prejudice. The person suffering may behave very similarly to what is socially acceptable. As such, some may believe that he or she can change with a bit of effort. The person's entourage may interpret the persistence of certain behaviors as a lack of will on his or her part.

Prejudices can:

• Reduce the chances that a person suffering gets the help he or she needs.
• Reduce his or her social support network.
• Lower his or her self-confidence. For example, the person could start believing that he or she will never be accepted by society.

To learn more about prejudices, their impact and how to fight them, read Fighting the stigma surrounding mental illness.

Help and support resources

Resources are available for help and to obtain more information about borderline personality disorder:

• Suicide prevention helpline: 1 866 APPELLE or 1 866 277‑3553
• Tel-jeunes  (Helpline for young people between 5 and 20 years old: 1 800 263‑2266)
• Réseau avant de craquer – Fédération d’organismes voués au mieux-être de l’entourage d’une personne atteinte de maladie mentale  (in French only)
• Association des médecins psychiatres du Québec  (in French only)

You can also consult the Mental illness page for more available resources. 

Resources for care and services

To receive care or services, or to find a psychotherapist with whom you are comfortable, contact one of the following resources:

• Your family doctor
• Your integrated health and social services centre (CISSS) or your integrated university health and social services centre (CIUSSS)
• The Ordre des psychologues du Québec