How Do You Know If You Have BPD (Borderline Personality Disorder)?

Summary: The only way to really know if you have BPD is to receive a full psychiatric evaluation from a mental health professional with extensive experience in diagnosing borderline personality disorder (BPD).

Key Points:

• Borderline personality disorder is a complex mental health disorder with symptoms that overlap with several other mental health disorders, including major depressive disorder, anxiety disorders , bipolar disorder, and schizophrenia.
• The similarity with other disorders often results in misdiagnosis, which can delay effective treatment and exacerbate the disruption and disturbance caused by BPD.
• Diagnostic criteria for BPD include nine (9) types of symptoms, with BPD often appearing in four (4) distinct types.
• Self-assessment through online resources is not diagnosis, but can help you decide whether you need a BPD screening administered by an experienced mental health professional.

What is BPD and What Are the Symptoms of BPD?

If you want to know if you have BPD, you need to know what the disorder is and what the primary symptoms are.

First, here’s an excellent definition of BPD published by the Merck Manuals, a reliable resource for mental health information, designed for both mental health clinicians and the general public:

“BPD is a mental health condition that is characterized by a pervasive pattern of instability in relationships, self-image, moods, and behavior and hypersensitivity to possible rejection and abandonment. These symptoms often result in impulsive actions and problems in relationships. People with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.”

That’s the official definition of BPD. It offers an initial idea of how a person with BPD might experience the world. If you think you may have BPD, an initial takeaway from this definition is understanding the concept of instability as it applies to your feelings, your relationships, and your identity.

Next, let’s look at the symptoms of BPD as presented in the guide that mental health experts use to diagnose BDP, called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To meet criteria for a BPD diagnosis, you must show or report a pervasive pattern of symptoms that includes at least five (5) of the nine (9) symptom types below:

1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Inconsistent identity: Unstable, rapidly changing self-image/concept/perception of self
4. Impulsivity in at least two areas that cause harm (not including NSSI):

• • Spending
  • Sex
  • Substance abuse
  • Reckless driving
  • Binge eating

5. Recurrent suicidality/self-harm:
   • Talking about suicide
   • Threatening suicide
   • Planning suicide
   • Self-harm/NSSI
6. Affective instability due to emotional reactivity:
   • Intense mood swings
   • Extreme irritability and/or anger
   • Severe, short episodes of anxiety
7. Chronic sense of emptiness/severe low mood
8. Inappropriate, intense, difficult to control anger:
   • Temper tantrums
   • Persistent angry mood
   • Consistently getting in fights/physical altercations
9. Acute, severe, short-lived, stress-related paranoia and/or acute, severe, brief, dissociative symptoms.

That’s the official, clinical language used to identify the symptoms. However, it may be helpful to read them in a less formal style. We’ll rephrase – and expand – upon these symptoms below.

The Symptoms of BPD: Identifying What They Are and How They Feel

We’ll repeat that there’s only one real way to know if you have BPD:

You need a full psychiatric examination and comprehensive screening administered by a mental health professional. This article is not a diagnosis but can help you determine whether you should seek a professional evaluation and official BPD screening.

The Symptoms of BPD: Explanations and Examples of the Subjective Experience of BPD Symptoms

1. Excessive/extreme fear of being abandoned.

You may experience intense worry – i.e. fear/terror – that the people you love may leave you. You may go to extreme lengths to get reassurance, like calling someone over and over for hours if they don’t answer the phone. In some cases, you may create narratives in your head that reinforce your fears, but don’t match the behavior of the person you’re focused on.

For a person with BPD, this type of worry and fear is excessive, persistent, and pervasive, and applies to any relationship involving emotions and vulnerability.

2. Volatile relationships with friends, family, and peers.

Your opinion of the people in your life may shift rapidly, literally on a dime. In one moment, you may put a person on a pedestal, and in the next, you find only fault and negative intentions. This applies to family members, friends, and romantic interests. One day a person in you life may be a hero, and the next a villain, with your assessment unrelated and/or mismatched to their observable behavior.

For a person with BPD, this shifting idea of others’ place in your life is a common, recurring phenomenon.

3. Unstable identity/changeable sense of self.

Your concept of who you are, the things you like, and who you want to be may change quickly and often. You may not have a solid and consistent set of personal values or long-term goals. Your self-image and sense of self may change depending on the people you’re with, the situation you’re in, and how you feel in that moment. This is different than a bout of self-doubt followed by a rebound and return to firm self-esteem.

For a person with BPD, an unstable identity/identity disturbance is recurring, shifting, and without a solid reference point as a baseline.

4. Risk taking and impulsivity.

You may engage in behaviors that place you at elevated risk of real physical harm. Your behavior may also create real risk of physical harm to others. You may engage in risky/excessive alcohol or substance use or risky/unsafe sexual behavior. You may drive a car recklessly, run up credit card bills you can’t pay, or engage in unhealthy eating habits that harm your health.

For a person with BPD, risky behavior occurs independently of extreme mood swings. It’s a primary characteristic of externalizing BPD.

5. Suicidality and/or self-harm/non-suicidal self-injury (NSSI).

You may have recurring thoughts of suicide and may have a recurring impulse to harm yourself. You may have attempted suicide once or more, or engaged in self-harming behaviors like cutting, burning, branding, or scratching once or more. When interacting with others in emotional situations, you may frequently threaten suicide or self-harm, whether you intend to follow through on the threat or not.

For people with BPD, suicidality is common, but most people with BPD do not die by suicide. Recent evidence indicates that 80 percent of people with BPD engage in suicidal ideation, fifty-two percent attempt suicide, and six percent die by suicide.

6. Severe/extreme mood swings/unstable emotions.

Your moods may be extremely intense, overwhelming, and change rapidly. You may have powerful reactions to minor stimuli. Internally, a minor disappointment may escalate to a life-changing disaster or catastrophe in a few minutes, and it may take you several hours to return to a more stable baseline. You may not have a stable emotional baseline. That means it may feel like you move from one serious emotional event to another, with little or no break in between, i.e. from feeling okay to feeling enraged to hopeless and empty, all in one morning.

For people with BPD, life often feels like a rollercoaster of intense emotions. Periods of peace, calm, and feeling okay are relatively rare for people with BPD who’ve never engaged in treatment or learned to identify and manage emotions.

7. Persistent low mood/emptiness.

You may feel hollow inside, disconnected from yourself, or feel like there’s not a real person with feelings inside you, and no identifiable, individual identity that’s yours. You may feel like you have no emotions at all. The feeling may resemble sadness, but it’s better described as numbness, a lack of feeling, or an absence of connection to yourself and the world around you. You may feel this way all the time, some of the time, or the feeling of emptiness and void of self may come and go, unpredictably, in varying intensities.

For people with BPD, this is one of the most common symptoms, present in close to 90 percent of people with BPD. Evidence indicates this constant, persistent sense of emptiness is present about half the time, but long-term studies show this decreases to closer to 20 percent of the time over a period of about 25 years.

8. Anger/rage.

You may have frequent and extreme temper tantrums. A single word or gesture from a person may trigger uncontrollable rage. Your anger may appear suddenly – almost instantly – and take hours to fade. Your anger may cause you to get into fights or act out violently against property, or in rare cases, other people.

Not all people with BPD display excess anger and aggression. Evidence indicates that for people with BPD, outward expression of anger, i.e. acting out violently, is associated with presence of symptoms/emotions such as hostility, antagonism, impulsivity, and callousness toward others.

9. Dissociation and paranoia.

Dissociation means you may feel like you’re disconnected or detached from your own body, as if you’re watching yourself from the outside, similar to what people describe as out-of-body experiences. You may feel like you’re living in a movie, and neither you nor the world around you are actually real, or that somehow you’ve been transported to a reality that looks like yours but isn’t yours. In some cases, dissociation may mean your thoughts become foggy and unfocused, and you may temporarily lose track of what you’re doing and why you’re doing it.

For people with BPD, dissociation may be mild, moderate, or severe, and range from what resembles daydreaming to a complete departure from reality. Dissociation in BPD is often triggered by stress and may function as a self-defense mechanism to protect an individual from overwhelming emotions and consequences of extreme emotional reactivity.

You may also become suspicious, distrustful, or believe someone close to you has negative intentions or means to leave/abandon/betray you. This may happen during an intense emotional conflict with someone important to you and lead you to question their motives. In many cases, the suspicion can fade quickly, but you may experience it frequently, especially when under stress.

For people with BPD, paranoia is most often short-lived. It’s a non-delusional form of paranoia that’s different from paranoia associated with psychosis or conditions with psychotic features like schizophrenia.

We’ll discuss this information below, and help with what’s next of you want to know if you have BPD.

If You Think You Have BPD, What Should You Do?

The best thing to do if you think you have BPD is simple. You arrange a full evaluation administered by a mental health professional with extensive experience diagnosing BPD.

The next best thing to do is understand that you’re not alone. The latest data shows that about 2.4 percent of adult in the U.S. have BPD, which is nearly 6.5 million people.

The third thing to do – or learn, rather – is that effective, evidence-based treatment for BPD is available. Studies show the following treatment techniques can help people with mild, moderate, or severe borderline personality disorder:

1. Dialectical Behavior Therapy (DBT)
2. Mentalization based treatment (MBT)
3. Schema-focused therapy (SFT)
4. Transference Focused Psychotherapy (TFP)
5. Dynamic Deconstruction Psychotherapy (DDP)
6. Systems Training for Emotional Predictability and Problem Solving (STEPPS)

Evidence shows that engaging in treatment with those approaches, when delivered by an experienced, compassionate, nonjudgmental mental health provider, can lead to significant improvement and a positive outcome. Therefore, if you think you have BPD, please don’t give up hope.

The BPD Alliance is a non-profit organization committed to “reducing the suffering of those affected by borderline personality disorder and chronic emotional dysregulation.”  Their perspective on BPD treatment outcomes is positive and optimistic. Here’s their primary POV on BPD treatment:

Recovery is not only possible – it is probable with the right approach.

They indicate that “improvement does not mean all symptoms disappear,” but that people with BPD can learn to manage their emotions, reduce or eliminate self-harming and impulsive behavior, improve relationships and basic daily function, experience increased stability in identity, and generally improved wellbeing and satisfaction in life.

That’s good news for people with BPD. It’s a serious mental illness. But with commitment, time, the right treatment, and the right treatment team, it’s possible for people with BPD to live full and productive lives.

If you think you have BPD, the sooner you get an evaluation, the better. Early detection and treatment improves outcomes. The sooner you take steps to learn what’s going on with your mental health, the better.