Understanding borderline personality disorder

An expert guide on BPD, including the causes, symptoms and treatment options.

borderline personality disorder
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Borderline personality disorder (BPD) – sometimes also called emotionally unstable personality disorder – is relatively common both in the UK and globally. Around one in 25 individuals have this condition, and although overall personality disorders have an almost equal incidence of men and women being affected, BPD is slightly more common in women.

But what exactly is BPD, what causes it and how is it treated? Family GP Dr Roger Henderson explains:

What is borderline personality disorder?

Borderline personality disorder is a type of mental illness. Those who suffer from BPD struggle to regulate their mood and emotions, resulting in them being unstable - sometimes for long periods at a time. It can cause problems in relating to other people, and often makes controlling impulses difficult.

What causes borderline personality disorder?

The exact cause remains unclear, but there is often an association between genetics and adverse life events. It has a variable course, with many people recovering over time although some continue to experience life-long social and interpersonal difficulties.

The diagnosis is made by mental health professionals following a comprehensive psychiatric interview.

Unfortunately, some people with BPD are more at risk of experiencing suicidal thinking and self-harm attempts. The connection between BPD and other mental illnesses is well established. People with BPD are at increased risk for anxiety disorders, depressive disorders, eating disorders and substance abuse.

Borderline personality disorder symptoms

There are two main types of BPD – impulsive and borderline. In the impulsive type, the main characteristics are a lack of control to impulses and emotional instability, sometimes with threatening behaviour in response to criticism.

The borderline type has some of the characteristics of emotional instability, plus difficulties with self-image, repeated emotional crises, low self-esteem and a sense of aimlessness in life.

Diagnosing borderline personality disorder

The diagnosis can be very tricky to make, and is made by mental health professionals following a comprehensive psychiatric interview that may include talking with a person's previous clinicians, review of prior records, a medical evaluation, and when appropriate, interviews with friends and family. There is no specific single medical test (such as a blood test) to diagnose BPD and the diagnosis is never made on a single sign or symptom.

To make a diagnosis, doctors will usually look to see if some or all of the following symptoms are present:


🔹 Inappropriate, intense or uncontrollable anger.

🔹 Impulsive behaviour that cause psychological distress, such as excessive spending, sexual encounters, substance abuse or shoplifting.

🔹 Recurring suicidal threats or episodes of self-harm.

🔹 Unstable, intense personal relationships, sometimes alternating between 'all good' and 'all bad'.

🔹 Persistent uncertainty about self-image, long-term goals, friendships and values.

🔹 Chronic boredom or feelings of emptiness.

⚠️ There are many possible conditions that can overlap with some of the symptoms of BPD. These include anxiety, alcohol and drug abuse, depression, eating disorders and post-traumatic stress disorder.

Borderline personality disorder treatments

Psychotherapy is the cornerstone of treatment for individuals who live with BPD, but it's very important that any psychological treatment should last at least three months or longer.

No one specific type of treatment appears better than another but one of the most commonly used here is dialectical behavioural therapy (DBT), which focuses on teaching coping skills to combat destructive urges, encourages practising mindfulness (eg meditation, regulated breathing and relaxation), involves individual and group work and is quite successful in helping people with BPD to control their symptoms.


Medications can sometimes also be used, but there's no single medication treatment that can 'cure' borderline personality disorder. Any drug used should be targeted at specific symptoms. Mood-stabilising drugs and second-generation antipsychotics may be effective in treating many of the core symptoms presented in BPD.

Referral to local mental health services is usually required when:

  • Patients request further help.
  • Treatment has not eased levels of anxiety or distress.
  • The risk of self-harm is increasing.

    Mental health support

    For additional support with borderline personality disorder, try one of the following resources:

    ✔️ Rethink Mental Illness: a charity helping those suffering with poor mental health.




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