Borderline Personality Disorder: Common Symptoms and Risk Factors

2. Unstable Relationships

BPD tends to make maintaining healthy relationships very challenging. This is because the affected individual tends to be quite needy, intense, and mistrusting, not only with romantic partners, but also with friends and family.

Additionally, a person with BPD tends to have a very black and white way of thinking about people, seeing them as “all good” or “all bad.” This causes frequently shifting attitudes towards others that range from “extreme closeness and love (idealization) to extreme dislike or anger (devaluation),” says the National Institute of Mental Health.

3. Unstable Self-Image

People with BPD also struggle with identity disturbances. Sometimes, they may feel good about themselves, but others times they may feel hatred toward who they are, perhaps seeing themselves as bad or evil. Additionally, this self-image can change depending on whom the person is with, as they often copy the actions and behaviors of others. “Their ability to be independent and autonomous is very impaired,” says John Oldham, MD, professor of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston, in speaking with Health.com.

They may also have constantly shifting ideas of who they are or what they want in life, resulting in frequent changes to “jobs, friends, lovers, religion, values, goals, and even sexual identity,” indicates HelpGuides.com.

4. Impulsive, Risky Behaviors

Impulsive, risky, and often self-destructive behaviors are also common for those with BPD. These behaviors can include gambling, spending sprees, shoplifting, or “sabotaging success by suddenly quitting a good job or ending a positive relationship,” says the Mayo Clinic.

In some cases these behaviors may even put the individual in danger, such as by driving recklessly, practicing unsafe sex, abusing drugs or alcohol, or binge eating. While engaging in these activities may help them feel better in the moment, they can do more harm than good to themselves and their close relationships in the long run.

5. Self-Harm and Suicide

Self-injury is another common symptom of BPD; in fact, the Centre for Addiction and Mental Health says that “up to 75 percent of people with BPD self-injure one or more times,” commonly by cutting, burning themselves with cigarettes, or an “overdose that can bring relief from intense emotional pain.”

While in most cases these self-harming behaviors are non-suicidal, that isn’t the case for everyone, as the source reports, “about 10 percent of people with BPD take their own lives.”

6. Intense Mood Swings

Another common symptom of BPD is emotional volatility, with intense mood swings that range from extreme happiness one moment to despair the next. These mood swings can be triggered by things that others would simply brush off or not even notice, such as “if a colleague was too preoccupied to say hello in the hallway” says Health.com.

While these mood swings tend to pass fairly quickly, typically lasting only a few minutes or hours, they may persist for several days at a time in some cases.

7. Chronic Feelings of Emptiness

People with BPD may also struggle with chronic feelings of emptiness, as if “there’s a hole or a void inside them,” says HelpGuides.com. In extreme cases, the source says that individuals may feel as if they are “nothing” or “nobody.”

Because this feeling of emptiness is uncomfortable, they “may try to fill the hole with things like drugs, food, or sex.” While these things may offer temporary relief, nothing seems to make it go away for good.

8. Explosive Anger

In addition to extreme mood swings, people with BPD may also struggle with intense anger. Although such anger is often triggered, Health.com says they “react in a way that seems exaggerated or disproportional to an event.”

These reactions can include “frequently losing your temper, being sarcastic or bitter, or having physical fights,” says the Mayo Clinic. Although this anger is most noticeable when it is directed outwardly toward others, HelpGuides.com notes that people with BPD spend a great deal of time being angry at themselves.

9. Paranoia and Dissociation

Paranoia is another common symptom of BPD, where an individual may have “suspicious thoughts about others’ motives,” says HelpGuides.com. As a result, they may struggle to trust others.

In some cases, often when under stress, people with BPD may also experience dissociation. In such a state, the National Institute of Mental Health says they may “feel cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality.”

Risk Factors

1. Genetics

BPD is believed to be caused by a combination of factors, one of which is genetics. If someone in your close family, such as a parent or sibling, has also been diagnosed with the mental illness, the NHS says the genes you inherit “may make you more vulnerable to developing BPD.”

But, so far, there’s no evidence of a BPD gene. Mind.org.uk says “Genetics might make you more vulnerable to developing BPD, but often it’s due to stressful or traumatic life experiences that these vulnerabilities are triggered and become a problem.”

2. Environmental Factors

What types of stressful or traumatic life events might trigger these genetic vulnerabilities? A few that are noted by the U.S. National Library of Medicine include “either real or fear of abandonment in childhood or adolescence,” “disrupted family life,” and “sexual, physical, or emotional abuse.”

The NHS adds that experiencing chronic fear or distress during childhood may also contribute, as can growing up around a family member that struggled with drug or alcohol abuse, or a mental illness like bipolar disorder.

3. Serotonin Abnormalities

Another factor that is believed to contribute to BPD is abnormalities with neurotransmitters—chemicals that transmit signals between cells in the brain. One neurotransmitter that is of particular concern is serotonin.

According to Healthline.com, “Serotonin is a hormone that helps regulate mood,” and improper amounts of it cause noticeable changes. These changes can include “depression, aggression and difficulty controlling destructive urges,” notes the NHS.

Dr. Gerald Morris

Gerald Morris, MD is a family medicine/internal medicine physician with over 20 years expertise in the medical arena. Dr. Morris has spent time as a clinician, clinical research coordinator/manager, medical writer, and instructor. He is a proponent of patient education as a tool in the diagnosis and treatment of acute and chronic medical conditions.