Borderline Personality Disorder: Unpacking Symptoms, Diagnosis, and Stigma

CW: Self-injury, depression and anxiety, mania, substance use, suicidality, and suicide ideation. 

Borderline personality disorder (BPD) is a mental health condition characterized by extreme mood swings, abandonment anxiety, self-injury, and suicidality. BPD has consistently been misrepresented in the media as a mental health condition that is characterized as  “crazy” or “erratic”. Characters in film and TV series who are stated to have borderline personality disorder are often villainized. This has led to the stereotyping of those with borderline personality disorder as inherently ‘bad’ people or partners. I was diagnosed with borderline personality disorder in 2020. This diagnosis felt daunting and dreadful when I first searched the internet for explanations. I was ashamed of my diagnosis because, as soon as I learned it was a possible explanation for my behaviors, I began to see depictions of serial killers in horror movies described as having a ‘personality disorder’. 

Borderline personality disorder is consistently more stigmatized than other mental health conditions. This is due to its symptoms that are often considered ‘taboo’. Many people with BPD are often misdiagnosed with Post-Traumatic Stress Disorder (PTSD). This is due to the misconception that BPD is strictly caused by an instance of a traumatic event. In reality, while some people with BPD also experience PTSD, the root causes of BPD may vary from person to person. According to the NHS, “there is no single cause of borderline personality disorder (BPD) and it’s likely caused by a combination of factors.” Some of the many factors that may impact the development of borderline personality disorder are genetics, environment, problems with brain development, and problems with neurotransmitters. Due to the nuances of this disorder, it is highly misunderstood. I myself surfed the internet in hopes of finding out why I had developed BPD. I may never have a singular cause or reason for my diagnosis, but I am no longer ignorant of the multifacetedness of this personality disorder. 

Some of the most prevalent symptoms of BPD are abandonment anxiety, unstable relationships, a changing view of one’s self, anger, emptiness, self-injuring behavior, and impulsivity. These symptoms can vary from person to person as there may be individuals who display all of these symptoms, whereas others may display only a few symptoms. Some of these symptoms can overlap, creating additional impacts in an individual’s life and resulting in other symptoms. For example, an individual’s abandonment anxiety can create unstable relationships, anger, and emptiness which may result in behavioral symptoms such as self-injury or suicidal ideation. Being knowledgeable about certain symptoms present in individuals with BPD can help reduce the stigma of befriending or being in a relationship with someone living with this personality disorder. It is also important to know that these symptoms can often be managed with medication and different types of therapy. 

The main evidence-based treatment for individuals with borderline personality disorder is dialectical behavior therapy (DBT). Dialectical behavior therapy was created by Marsha Linehan in the late 1970s who initially created this treatment method for multi-symptomatic suicidal women. At the time, there was no substantial knowledge or defining understanding of BPD. Dialectical behavior therapy is composed of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. These components can be implemented in both one-on-one therapy with a licensed clinician, group DBT, and individual reflections in a DBT workbook. This framework has evidently shown positive impacts on those not only with BPD, but also others with co-occurring symptoms and similar diagnoses that can benefit from dialectical behavior therapy. 

According to Harvard Health Publishing, “DBT focuses on teaching people skills to manage intense emotions, cope with challenging situations, and improve their relationships. It encourages people to learn and use mindfulness training in practical ways.” As somebody with borderline personality disorder, I underwent years of dialectical behavior therapy, which in turn allowed me to learn how to manage distressing emotions and improve my interpersonal relationships with loved ones. DBT is not the only form of therapy that can help individuals with BPD navigate their symptoms. Other therapeutic practices have proven to be beneficial to mitigate symptoms that may negatively impact an individual’s day-to-day life. Some of these include cognitive behavioral therapy, transference-focused psychotherapy, and emotion regulation training. 

It is vital that individuals who are not knowledgeable about borderline personality disorder continue to educate themselves through research and by listening to individuals with lived experience. This will continuously combat the ongoing stigma and dismantle misconceptions of those living with BPD as being ‘bad people’ or ‘crazy’ due to their diagnosis. After taking time to better understand the symptoms of my diagnosis, I urge others to do what they can to correct misinformation. It is important to provide resources to those who need more information to better understand and support individuals living with BPD. 

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org/chat.

Works Cited:

Borderline personality disorder. NAMI. (2024, May 1). nami.org/about-mental-illness/mental-health-conditions/borderline-personality-disorder

Chapman A. L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont (Pa. : Township)), 3(9), 62–68.

Corliss, J. (2024, January 22). Dialectical behavior therapy: What is it and who can it help?. Harvard Health. https://www.health.harvard.edu/blog/dialectical-behavior-therapy-what-is-it-and-who-can-it-help-202401223009  

Neff, M. A. (2024, February 29). DSM-5 criteria for BPD. Insights of a Neurodivergent Clinician.neurodivergentinsights.com/blog/dsm-5-criteria-for-borderline-personality-disorder 

NHS. (n.d.). Causes- Borderline Personality Disorder. NHS choices. nhs.uk/mental-health/conditions/borderline-personality-disorder/causes/ 

Sussex Publishers. (n.d.). Dialectical behavior therapy. Psychology Today. psychologytoday.com/us/therapy-types/dialectical-behavior-therapy