Are you worried that your loved one has borderline personality disorder (BPD)? Only a licensed mental health professional can make a reliable diagnosis, but it helps to be educated about the disorder and to know what to look for. While some of the symptoms of BPD are not generally observable to others (such as feelings of emptiness), others are associated with observable behaviors. So you may be able to notice them in your loved one's day-to-day actions. Here are some signs that may indicate your loved one needs to be evaluated:
Intense Anger and Aggressive Behavior: Some people with BPD experience intense anger that they rarely or never express outwardly (making it very hard for family or loved ones to tell that they are experiencing anger). Others express anger openly, sometimes in the form of physical aggression. Angry behavior, ranging from sarcastic comments to physical violence against other people, is one sign of BPD.
Trouble in Relationships
Abandonment Sensitivity: People with BPD tend to have difficulties in their relationships. In particular, people with BPD can be very sensitive to abandonment. They may believe they are being left by someone when that is not actually the case. They may also engage in behaviors meant to provide reassurance that the other person still cares about them. For example, they may call someone on the telephone repeatedly asking for confirmation that the relationship is still intact. When they perceive that they are being abandoned, people with BPD may behave in a desperate or frantic way -- they may beg the other person not to leave them, or physically cling in an attempt to avoid abandonment.Unstable and Intense Relationships: BPD is associated with patterns of very unstable and intense interpersonal relationships. These relationships can be characterized by alternation between idealization and devaluation. The relationship may start in the idealization phase with the person with BPD feeling intensely connected to and positive about the other person, and wanting to spend a lot of time with this person. But, when the devaluation phase emerges, the person with BPD may see the other person as worthless, bad, or uncaring, and may attempt to distance herself from them. This alternating pattern can result in very stormy relationships.
Problems with Identity
Unstable Self-image or Sense of Self: The same instability in relationships can also apply to self-image or sense of self. A person with BPD may seem to believe that they are OK one moment, but the next may be extremely self-denigrating or hard on themselves (which can be a sign of underlying beliefs that they are a bad or worthless person). Their sense of self may also be unstable, which may lead them to behave differently in different contexts (such as they may act one way around one group of friends but another way entirely around another group).
Impulsive BehaviorsEngaging in Risky Impulsive Behaviors: Many people with BPD have difficulties with risky impulsive behaviors, such as shoplifting or other illegal activities, abusing drugs or alcohol, engaging in risky sexual behaviors, or driving recklessly. In addition to these behaviors, see if they are getting in trouble at school or work, or with the law.
Emotional Ups and Downs: Although this is not always something that can be observed from the outside, people with BPD tend to have intense and frequent mood changes (sometimes called "emotional dysregulation" or "affective instability") that usually occur in response to something happening in the environment. They may go from seeming OK to feeling upset in a matter of moments.
Self-Harm or Suicidality
Self-Harm: Some individuals with BPD engage in self-harming behaviors, and some make suicidal gestures or attempts. These are actually separate issues -- self-harming behaviors are not attempts to commit suicide, they are attempts to get rid of emotional pain or intensely uncomfortable feelings. People who self-harm rarely do it when others are present. But you may see signs of self-harm, including scarring or wounds from cutting, burning, or other forms of self-injury.
I Think My Loved One May Have Signs of BPD. Where Do I Get Help?
If you have observed one or more of these signs of BPD in your loved one, it may make sense to encourage him to see a professional for an evaluation. Referrals are available from a variety of online sources, including Ucompare Healthcare and the American Psychological Association. Although you cannot force your loved one to get treatment, you can let him know about your concerns, encourage him to get the help he needs, and let him know that excellent treatments are available when he is ready to reach out for help.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed, text revision. Washington, DC, Author, 2000.
Zanarini, MC, Frankenburg, FR, Sickel, AE, & Yong, L. Diagnostic interview for DSM-IV Personality Disorders. McLean Hospital, Belmont MA, and the Department of Psychiatry, Harvard Medical School, 1996.