How can you tell if someone has borderline personality disorder

Medically Reviewed By William C. Lloyd III, MD, FACS

— Written By Jennifer L.W. Fink, RN, BSN

Updated on February 18, 2020

56

• Borderline personality disorder (BPD) is a mental health disorder characterized by rapidly shifting interests and beliefs, strong emotions, erratic mood swings, and a pattern of dysfunctional relationships. Symptoms usually begin by early adulthood and are most pronounced in a person’s 20s and 30s. 

  Evidence-based treatment can improve the quality of life for people with BPD. Recognizing the signs, symptoms and common traits of borderline personality disorder is the first step toward diagnosis, treatment and well-being.

• Intense Fear of Abandonment

  People with BPD are so fearful of being abandoned by those they care about that they often abruptly cut off communication with people they care about because they would rather end the relationship than take the chance the other person might abandon them. They may do so even if the other person has always been steadfast and faithful in their support. A person who frequently takes frantic action to avoid abandonment may have BPD.

• Impulsive Behavior

  Regularly engaging in impulsive or dangerous behavior, such as reckless driving, unsafe sex, spending sprees, or binge eating can be a warning sign of BPD. Many people with borderline personality disorder misuse drugs and alcohol as well. However, impulsive behavior can also be a sign of attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder. No one symptom indicates BPD; mental health professionals look for a cluster of symptoms before diagnosing the condition.

• Unstable Relationships

  It’s difficult for most people with BPD to maintain steady relationships. Their intense fear of abandonment can cause them to sabotage and walk away from relationships. Additionally, people with borderline personality disorder can fall in and out of love quickly. They may be convinced—in just a few moments or days—that someone is ‘the one’ for them and may just as rapidly decide the other person is all wrong for them (and a terrible human being to boot). This erratic behavior can confuse and frustrate friends, co-workers, family members and romantic partners.

• Self-Harm

  About 75% of people with BPD commit at least one episode of self-harm, which may include cutting or suicide attempts. Episodes of self-harm and suicidal thoughts should always be taken seriously. If a friend says, “Everyone would be better off without me,” don’t shut them down by saying, “Oh, you know that’s not true!” Though well-meaning, such a comment ignores their pain and closes the door to further conversation. Instead, say something like, “Tell me more.” You can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) at any time.

• Rapid Changes in Self-Identity

  By adulthood, most people have a fairly stable sense of self. They know what they like (and what they don’t) and have a consistent set of values they use to guide their decisions and actions. People with borderline personality disorder often do not have an accurate or consistent self-image. They may view themselves as bad people, despite the reassurances of others. Their interests and life goals may shift rapidly, especially as they enter relationships with new people.

• Mood Swings

  Everyone goes through mood swings. Extreme mood swings, though, can be a symptom of a mental health condition, including bipolar disorder and borderline personality disorder. Anyone whose moods shift dramatically—from ecstatic joy to deep depression, anger, shame or irritability—should be evaluated by a mental health professional. Appropriate diagnosis and treatment don’t limit a person’s ability to feel emotion; instead, moods become more manageable.

• Chronic Feeling of Emptiness

  Feeling bored or empty most of the time is a common symptom of borderline personality disorder. One woman with BPD, in a blog post for the National Alliance on Mental Illness, described this experience as “a persistent feeling of pure vacancy within that leaves you hungry for any sense of meaning, any sense of direction through the seemingly worthless interiors of our minds. We want to do something, anything for it to go away. Unfortunately, this often includes impulsive, reckless, and self-destructive behaviors.”

• Inappropriate, Intense Anger

  We all get angry. People with borderline personality disorder may become intensely angry and even emotionally or physically violent for no apparent reason (or in response to a minor provocation). Later, they may feel intense shame and guilt, which further fuels their poor self-image. These outbursts of anger are also difficult for those who interact with people with BPD, and often contribute to the demise of relationships.

• Paranoia and Loss of Contact with Reality

  As many as half of all people with BPD may experience brief periods of paranoia (the belief that others are out to get them), dissociation, and psychotic symptoms, often during times of great stress. Some people hear auditory hallucinations, or nonexistent voices or sounds. Paranoia and hallucinations are common symptoms of schizophrenia as well, but these symptoms typically last much longer in people with schizophrenia than in people with borderline personality disorder

56