Northeast Health Services is dedicated to supporting your mental health. If you are experiencing suicidal thoughts, we encourage you to reach out for immediate support through your local crisis services by dialing 988, contacting your local emergency services, or visiting your local emergency room.

If you’ve come across the term borderline personality disorder, you might feel confused, overwhelmed, or unsure how it applies to you or someone you care about. You may be noticing patterns in your emotions or relationships that feel hard to explain. Those patterns can feel intense, especially when you don’t have a clear way to understand them.

Borderline personality disorder is one of the most misunderstood mental health conditions. It’s often surrounded by stigma, which can make it harder to recognize and talk about. It’s a treatable condition. With the right care, people learn to manage emotions, build more stable relationships, and feel more grounded in daily life.

This guide walks you through what borderline personality disorder is, how it shows up, what contributes to it, and what treatment can look like.

What is borderline personality disorder?

Borderline personality disorder (BPD) is a mental health condition that affects how you regulate emotions, how you see yourself, and how you relate to others.¹ It’s not a personality flaw or something that should be written off. People with BPD often experience intense emotional reactions, unstable relationships, fear of abandonment, and difficulty managing impulses.²

These experiences are not personality flaws. Borderline personality disorder is a recognized clinical diagnosis identified in the DSM-5. BPD typically begins in late adolescence or early adulthood and affects about 1.4% to 2.7% of adults in the U.S.²

Symptoms of borderline personality disorder?

BPD symptoms can affect emotions, relationships, identity, and behavior. These borderline personality disorder symptoms often feel intense and difficult to manage without support.

Emotional symptoms

Emotional symptoms of BPD can shift quickly and feel overwhelming.

Common experiences include:

• Intense emotions that change rapidly
• Mood swings that last hours or days
• Chronic feelings of emptiness
• Anger that feels hard to control

These reactions are real and can feel disproportionate to what triggered them. They reflect how BPD affects emotional regulation.

Relationship and interpersonal symptoms

Signs of BPD often show up in close relationships.

You might notice:

• Relationships that shift between closeness and conflict
• Strong fear of abandonment
• Emotional reactions to perceived rejection
• Patterns of conflict with loved ones

Some people describe this as feeling “all in” or “all out” with someone. This pattern is sometimes called “splitting,” where your view of someone shifts quickly depending on how you feel.

Identity and self-image symptoms

People experiencing borderline personality disorder symptoms may also notice:

• An unstable sense of self
• Frequent changes in values, goals, or opinions
• Ongoing feelings of emptiness

These shifts can make it difficult to feel grounded in who you are.

Behavioral symptoms

Behavioral symptoms of BPD often develop as ways to cope with overwhelming emotions.

These can include:

• Impulsive behaviors like spending or substance use
• Risky decisions such as reckless driving or unsafe sex
• Binge eating or other compulsive behaviors
• Self-harm behaviors
• Suicidal thoughts

If you are experiencing these symptoms, support is available today at Northeast Health Services. These behaviors often reflect how intense emotions feel internally, not a lack of effort or intention.

Thoughts of self-harm require immediate attention and support. Call 911, go to your nearest emergency room, or contact the 988 Lifeline by calling or texting 988.

What causes borderline personality disorder?

There is no single cause of BPD. Borderline personality disorder develops from a combination of factors over time.

These may include:

• Genetics or family history of mental health conditions
• Differences in how the brain processes emotions
• Life experiences such as trauma, neglect, or invalidating environments

Research shows that both biology and the environment play a role in the development of BPD.¹ This condition is not your fault. It develops through different life experiences that shape how you respond to emotions and relationships.

BPD vs. bipolar disorder: How to tell the difference

BPD and bipolar disorder can appear similar, especially when mood changes feel intense or unpredictable.

The patterns of each condition are different:

• Bipolar disorder: Mood episodes last days to weeks and involve changes in sleep, energy, and activity
• Borderline personality disorder: Mood shifts happen quickly, often within hours, and are usually linked to relationships or stress.

It’s not uncommon for BPD to be mistaken for bipolar disorder. A clear diagnosis helps guide the most appropriate treatment approach.

How BPD is diagnosed

Diagnosing BPD symptoms involves working with a trained mental health professional.

This process may include:

• A clinical interview
• Review of your history and experiences
• Use of DSM-5 criteria

To receive a diagnosis, a person must meet at least five of nine criteria related to BPD and how it presents.²

Online quizzes can raise awareness, but they’re not a substitute for a professional evaluation. Starting therapy services can help you better understand your experiences and explore the support you may need to manage your symptoms.

Treatment options for borderline personality disorder

Treatment for borderline personality disorder focuses on helping you manage emotions, improve relationships, and build stability over time.

Dialectical behavior therapy (DBT)

DBT is one of the most effective treatments for BPD.

It focuses on building skills in:

• Mindfulness
• Distress tolerance
• Emotional regulation
• Interpersonal effectiveness

DBT often includes individual sessions along with group therapy, where you can practice these skills with guidance and support.

Other therapy approaches

Other therapies can also support people with BPD, including:

• Cognitive-behavioral therapy (CBT)
• Mentalization-based therapy (MBT)
• Schema-focused therapy
• Transference-focused therapy

These are part of a range of approaches. Your care plan should be personalized to your needs and preferences.

Medication management

There is no single BPD medication that treats the condition itself. Medication can help manage related symptoms such as depression, anxiety, or mood instability. A psychiatric provider can help determine if medication should be part of your care plan.

And if medication is part of your care plan, then medication management can help monitor how it’s working, adjust dosages if needed, and support you in managing symptoms over time.

Living with BPD: There is hope

Borderline personality disorder is treatable, even though it’s often misunderstood.

It’s important to remind yourself that progress takes time. With consistent support, many people see meaningful improvements. Emotional reactions can become more manageable. Relationships can become more stable. Daily life can start to feel more predictable.

Research shows that many people no longer meet the full criteria for BPD after several years of treatment.² Support and treatment can make a difference.

Frequently asked questions