Signs and symptoms

Borderline personality disorder is a diagnosis about which many articles and books have been written, yet about which very little is known based on empirical research.[8]
Studies suggest that individuals with BPD tend to experience frequent, strong and long-lasting states of aversive tension, often triggered by perceived rejection, being alone or perceived failure.[n 3] Individuals with BPD may show lability (changeability) between anger and anxiety or between depression and anxiety[9] and temperamental sensitivity to emotive stimuli.[10]

The negative emotional states specific to BPD may be grouped into four categories: destructive or self-destructive feelings; extreme feelings in general; feelings of fragmentation or lack of identity; and feelings of victimization.[11]

Individuals with BPD can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone. Self-image can also change rapidly from extremely positive to extremely negative. Impulsive behaviors are common, including alcohol or drug abuse, unsafe sex, gambling and recklessness in general.[12] Attachment studies suggest individuals with BPD, while being high in intimacy- or novelty-seeking, can be hyper-alert[8] to signs of rejection or not being valued and tend toward insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.[13] They tend to view the world generally as dangerous and malevolent, and tend to view themselves as powerless, vulnerable, unacceptable and unsure in self-identity.[8]

Individuals with BPD are often described, including by some mental health professionals (and in the DSM-IV),[14] as deliberately manipulative or difficult, but analysis and findings generally trace behaviors to inner pain and turmoil, powerlessness and defensive reactions, or limited coping and communication skills.[15][16][n 4] There has been limited research on family members' understanding of borderline personality disorder and the extent of burden or negative emotion experienced or expressed by family members.[17]

Parents of individuals with BPD have been reported to show co-existing extremes of over-involvement and under-involvement.[6] BPD has been linked to increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners, abuse and unwanted pregnancy; these links may be general to personality disorder and subsyndromal problems.[18]

Suicidal or self-harming behavior is one of the core diagnostic criteria in DSM IV-TR, and management of and recovery from this can be complex and challenging.[19] The suicide rate is approximately 8 to 10 percent.[20] Self-injury attempts are highly common among patients and may or may not be carried out with suicidal intent.[21][22] BPD is often characterized by multiple low-lethality suicide attempts triggered by seemingly minor incidents, and less commonly by high-lethality attempts that are attributed to impulsiveness or comorbid major depression, with interpersonal stressors appearing to be particularly common triggers.[23]

Ongoing family interactions and associated vulnerabilities can lead to self-destructive behavior.[6] Stressful life events related to sexual abuse have been found to be a particular trigger for suicide attempts by adolescents with a BPD diagnosis.[24]