Borderline Personality Disorder (BPD)
  • An unstable sense of self, identity or self-image
  • A pattern of unstable and intense relationships that alternate between wholly positive feelings and wholly negative feelings about the other person
  • Frantic efforts to avoid real or imagined abandonment
  • Emotional instability including periods of depression and anger
  • Chronic feelings of emptiness
  • Impulsivity that is potentially self-damaging
  • Recurring suicidal behavior, gestures, threats or self-injury
  • Stress-related paranoia
  • Out-of-control emotions
  • Unstable interpersonal relationships
  • Concerns about abandonment
  • Self-damaging behavior
  • Frequently accompanied by depression, anxiety, or anger

The most distinguishing symptoms of BPD are marked sensitivity to rejection, and thoughts and fears of possible abandonment. Overall, the features of BPD include unusually intense sensitivity in relationships with others, difficulty regulating emotions and impulsivity. Other symptoms may include feeling unsure of one's personal identity and values, having paranoid thoughts when feeling stressed and severe dissociation.


- People with BPD can feel emotions more easily, more deeply and for longer than others do. Emotions may repeatedly resurge and persist a long time. Consequently it may take longer than normal for people with BPD to return to a stable emotional baseline following an intense emotional experience.

…they may feel overwhelmed by negative emotions, experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance and panic instead of nervousness. People with BPD are especially sensitive to feelings of rejection, isolation and perceived failure

- BPD diagnosis is strongly associated with a combination of three specific states:
1) feeling betrayed
2) "feeling like hurting myself"
3) feeling out of control


Impulsive behavior is common, including: substance or alcohol abuse, eating disorders, reckless spending and reckless driving. Impulsive behavior may also include leaving jobs or relationships, running away and self-injury.

People with BPD act impulsively because it gives them immediate relief from their emotional pain… A cycle often begins in which people with BPD feel emotional pain, engage in impulsive behavior to relieve that pain, feel shame and guilt over their actions, feel emotional pain from the shame and guilt and then experience stronger urges to engage in impulsive behavior to relieve the new pain. As time goes on, impulsive behavior may become an automatic response to emotional pain.

Self Harm and Suicide

Self-harming or suicidal behavior is one of the core diagnostic criteria in the DSM IV-TR.

The lifetime risk of suicide among people with BPD is between 3% and 10%

suicide attempts typically reflect a belief that others will be better off following the suicide.


People with BPD can be very sensitive to the way others treat them, feeling intense joy and gratitude at perceived expressions of kindness, and intense sadness or anger at perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative after a disappointment.

While strongly desiring intimacy, people with BPD tend toward insecure, avoidant or ambivalent, or fearfully preoccupied attachment patterns in relationships

Manipulative behavior to obtain nurturance is considered by the DSM-IV-TR and many mental health professionals to be a defining characteristic of borderline personality disorder. However, Marsha Linehan notes that doing so relies upon the assumption that people with BPD who communicate intense pain, or who engage in self-harm and suicidal behavior, do so with the intention of influencing the behavior of others. The impact of such behavior on others – often an intense emotional reaction in concerned friends, family members, and therapists – is thus assumed to have been the person's intention.

Diagnosing (DSM - IV)

F60.30 Impulsive type
At least three of the following must be present, one of which must be (2):
  1. 1. marked tendency to act unexpectedly and without consideration of the consequences;
  2. 2. marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
  3. 3. liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
  4. 4. difficulty in maintaining any course of action that offers no immediate reward;
  5. 5. unstable and capricious (impulsive, whimsical) mood.
F60.31 Borderline type
At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:
  1. 1. disturbances in and uncertainty about self-image, aims, and internal preferences;
  2. 2. liability to become involved in intense and unstable relationships, often leading to emotional crisis;
  3. 3. excessive efforts to avoid abandonment;
  4. 4. recurrent threats or acts of self-harm;
  5. 5. chronic feelings of emptiness.
  6. 6. demonstrates impulsive behavior, e.g., speeding, substance abuse[78]


Psychotherapy -

dialectical behavior therapy (DBT)
metallization-based treatment (MBT)
transference-focused psychotherapy
general psychiatric management
schema-focused therapy

They all work to treat BPD except schema-focused therapy, but all will work in reducing urges to self injure.

Dialectical behavior therapy (DBT) is a therapy designed to help people change patterns of behavior that are not effective, such as self-harm, suicidal thinking and substance abuse. This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings and behaviors that lead to the undesired behavior. DBT assumes that people are doing the best that they can, but either are lacking the skills or are influenced by positive or negative reinforcement that interfere with one’s functioning.