Do you have Borderline Personality Disorder?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

personality disorder

What is borderline personality disorder?
Photo courtesy of Pixabay.com

What are the signs and symptoms of Borderline Personality Disorder?

Problems with identifying Borderline Personality Disorder.

Borderline Personality Disorder formerly called Borderline conditions has received a lot of attention recently. It is one of those troubling conditions that looks differently to different people.

If you have Borderline Personality Disorder you know the suffering having this disorder can cause. If you have lived with someone who has Borderline Personality Disorder you know how frustrating this can be. This difference in perspective is one of the problems with the increased attention to the disorder.

Many of the symptoms of Borderline Personality Disorder overlap or are the same as symptoms of other disorders. So when should someone get a Borderline diagnosis and when should we call it something else? Sometimes those iffy cases get a notation put on their chart “Borderline traits” rather than the full diagnosis. Electronic medical records are making it harder to leave notes like that and this may result in more people getting the full diagnosis.

For the record, diagnosis is not a do it yourself project. Mental Health, as well as physical health diagnosing, should be done by a professional. But so many people out there are being called Borderline these days and talking about it is so common, it is worth looking at the whole “what is Borderline Personality Disorder?” question.

There are efforts to come up with some kind of definitive test for borderline and other mental health conditions. At this time we can read research reports of “markers” and risk factors for many mental illnesses but we can’t be sure what is causing them. For example over 95% of people with Borderline Personality Disorder also have a sleep disorder.

Lacking a good test, mental conditions are diagnosed by looking at symptoms and seeing if someone has enough symptoms and if they are severe enough to need treating.

With so many Borderline symptoms overlapping or look just like symptoms of other mental illnesses, what name something gets called may depend on which symptoms are seen at any given appointment and the perspective of the viewer. We want to avoid normal problems of life being called diseases but this causes another problem.

Many mental illnesses are caused by identifiable life events. PTSD and other stress disorders need an identifiable stressor to get diagnosed. Many, but not all, people with Borderline Personality Disorder can point to some life event that started their symptoms.

As more people know about Borderline Personality Disorder more people are coming to believe that they have the condition. Family, Friends, and relationship partners are likely to blame all the interpersonal or relationship problems on someone having Borderline Personality Disorder. I suspect that professionals are going along with this and giving the diagnosis out more often.

Is Borderline Personality Disorder an illness or a lack of mental wellness?

Symptoms of Borderline personality disorder can vary from person to person and they may vary in intensity. This has resulted in an increasing amount of discussion, and a past counselors soapbox blog post about whether there may be Levels or Types of Borderline Personality Disorder.  There has also been some professional discussion about whether some clients have been given the diagnosis because they angered the treating professional.

Some of you have noticed from my other writings that I believe strongly in Wellness and Recovery. (See post on Mental Illness or Mental Health.)

Many of the things we call “Mental illness” are on a continuum. Those problems get better or they get worse. Sometimes in life, we get sad. When that sadness keeps you from working or enjoying life we call it depression and it deserves to get treated. The same thing is true of Borderline Personality Disorder. Many people with this condition do get better.

As we look at the symptoms of Borderline Personality Disorder below I will comment on some of the questions you might have about each one of the symptoms. This discussion is based on the SAMHSA publication titled An Introduction to Co-Occurring Borderline Personality Disorder and Substance Use Disorders. This publication was written primarily for professionals but I include it here in case any of you want to see the original source. The SAMHSA publication draws on the DSM-5 (DSM is a registered trademark of the APA,which some of you may also want to consult. The paraphrasing and comments are mine, so let’s hope I get this right. If you have or think you may have this condition please see a professional in your area.

Below are some of the typical features of Borderline Personality Disorder.

Borderline Personality is not common except in psychiatric hospitals.

Estimates of how common Borderline Personality really vary. In the general population, it is estimated at around one to two percent. In inpatient psychiatric facilities the rate of Borderline Personality Diagnosis can reach 20%. That suggests to me that this is a very impairing condition.

Notice as we go through these symptoms that many of these are things that have been considered “female” characteristics. Turns out that three out of every four people who get the Borderline Personality Disorder Diagnosis are female. Also, many of these symptoms are exactly what we would expect in someone with a Stress or Trauma Related Disorder as in Posttraumatic Stress Disorder or a Dissociative Disorder.

Borderline Personality Disorder is not simply a matter of being overly dramatic or wanting attention. Most, about 80%, attempt suicide and they die from suicide attempts at about 50 TIMES the rate of the general population. This does not need to happen as there are effective treatments for Borderline Personality Disorder available. Additionally about 80 percent of those with this diagnosis cut on themselves, which is often called Non-Suicidal Self Injury. Some people with this condition both cut and attempt suicide.

Symptom – Intense fear of abandonment and efforts to avoid it.

Many, not all, people with Borderline Personality Disorder were abused or neglected as children. Some had this experience in adult life. This suggests that these fears are both rationally based on experience and learned. If you learned to be fearful you can learn to not be fearful. But lessons learned very early in life may be much more difficult to unlearn. For many this fear of abandonment makes sense.

Borderline symptom – troubled, vacillating relationships with others.

In a single session with a therapist, someone high in borderline traits may tell the therapist that they love them and they are the only on that ever understood them and then later they will say that they hate the therapist and “you just don’t understand at all.”

The same thing happens in their personal relationships. They fall in love quickly and they fall out just as rapidly. They have overinflated views of their potential partners and then they feel tricked, deceived and angry. Relationships with someone who has Borderline Personality Disorder can include fabulous sex followed by violent fights.

Don’t know who you are and who you are keeps changing.

People with borderline conditions have more difficult than others in telling you what they like, who they are and they look to others to define themselves.

Impulsive acts are common in Borderline Personality Disorders.

Risky sexual behaviors are the most commonly noted behaviors. Over-spending and reckless driving are also included in this definition. Frequent conflicts with others are common.

Suicidal Behaviors or Self-Mutilation.

People with borderline personality disorder are often overwhelmed by emotion and then hurt themselves rather than express their anger towards the person that angered or hurt them. This kind of sudden flip in their feelings towards others and then their impulsive behavior can look a lot like Bipolar and turns out that many people get both diagnoses or they are moved back and forth. It is of course very possible for someone to have more than one disorder.

Borderline make people feeling empty.

Since people with Borderline do not know who they are and they fear being abandoned, this makes sense. If you look for your self-worth from others and then feel empty or nothing at all when you are not getting positive interactions from those others you can feel empty. Some of these characteristics may sound like an immature or selfish person. If you did not get enough food as a child you may be physically stunted. If you are abused or neglected as a child or abused drugs and alcohol, then you may not have learned the lessons you need to learn back then. The result is continuing to use coping strategies that may have kept you alive or got some of your needs met as a child but they are not working now. This is true of some people with Borderline Personality Disorder but not all.

Remember that these explanations are ideas about how things could happen but not precise formulas for how it did happen to any one particular person.

Episodes of strong, excessive anger.

There is no specific diagnosis for “anger issues” despite how common referrals to therapy for “Anger Management” are. Anger is a symptom reported in many other mental or emotional issues. What further clouds this picture is the high rate of Bipolar Disorder and Substance Use Disorders among those with Borderline Personality Disorder. Depression can also lead to irritability and then anger. What is looked for in Borderline Personality Disorders is sudden explosive anger often with fights and violence, that come on unexpectedly with someone who shortly before was a close friend or loved one.

Borderline may include Stress related Dissociation or Paranoia.

This can be a problematic symptom in practice. Part of the way we identify paranoia is that the fear is excessive. Men are taught to approach things they fear. Kill it if possible. This results in men getting acting out, violence related diagnoses. Women are taught to avoid danger and if you have been victimized in the past you recognize danger coming. So if you have been abused once the fear that your new boyfriend will abuse you sounds reasonable, not paranoid. See how this can be an issue?

It is also possible that “dissociation” gets pathologized. Some dissociating or “spacing out” is normal in children or those who are overwhelmed. People who suffer trauma may well dissociate. So it seems to me that cases of excessive dissociation may get swept into the Borderline Personality Disorder category rather than being recognized for what they are. As before someone could have both Borderline Personality Disorder and Dissociative Disorder.

Those are my thoughts on recognizing Borderline Personality Disorder and how it and other conditions may be getting mixed together. If you or someone you care about may have this condition consider professional help. If they do not have this problem please stop calling everyone you dislike Borderline. You may also want to check out other counselorssoapbox posts on Personality Disorders.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Levels or types of Borderline Personality Disorder

By David Joel Miller MS, Licensed Therapist & Licensed Counselor.

Are there different types of Borderline Personality Disorder?

personality disorder

Are there types of Borderline Personality Disorder?
Photos courtesy of Pixabay.

People with Borderline Personality Disorder (BPD) differ so much there might be more than one type of BPD or that we may be placing several different mental illnesses together under one label. Gunderson in his book Borderline Personality Disorder describes three levels of functioning in people with BPD. Hotchkiss appears to enlarge this idea into three types of borderlines.

Diagnostic criteria for mental health disorders are largely normal characteristics which have grown so large that they begin to interfere with everyday life. Everyone has sadness sometimes and we all are or should be anxious occasionally. That same concept of degree rather than nature is applicable to BPD.

Masterson wrote about Narcissistic Personality Disorder and described this as coming in low, medium and high levels. I think the use of that same sort of yardstick for measuring BPD might be useful.

Low Borderline characteristics or traits.

People with low BPD or beginning Borderline traits have or are able to sustain a primary relationship. This relationship may be rocky but the low borderline trait individual is able to have satisfying interactions with a partner. They will perceive this partner as supportive.

What brings a low symptom Borderline into treatment will be feelings of emptiness, loneliness or depression despite having a supportive partner. They may also suffer from chronic boredom or masochism. They want both a close relationship and fear that relationship because needing someone exposes you to becoming dependent on them.

As a result of the presence of that supportive person in their life, a mild BPD individual may go undiagnosed. They may lack the intense anger and have fewer and milder mood swings than those that appear in more severe cases. Their self-destructive behaviors will be fewer and less frequent and may be ascribed to life experiences like layoffs or fights with their S. O. rather than being recognized as BPD traits.

What tips the clinician off to the BPD traits is not the current relationship but a history of previous unstable relationships and a pattern of over-rapid entry into and speedy exit from relationships, as well as a history of being the victim of abuse or neglect.

Medium BPD.

As the symptoms of BPD become more severe you may experience more anger, more worries about losing your partner and more frantic efforts to keep your partner in the relationship. People with medium BPD are described as having difficulty seeing things from others point of view and devaluing others. They may manipulate as a way to get their needs met. They have the belief that asking will not get them what they need and that they need to force others to stay with them.

This level of borderline functioning is full of break-ups and make-ups, drama from current and previous relationships and recurrent self-harm or suicide attempts to force the partner to stay. Someone with medium intensity BPD may plan suicide with the thought that this will punish the other for not loving them enough.

High Borderline Personality Symptoms.

When BPD reaches this level the person with Borderline Personality Disorder is unable to maintain a relationship with a significant other. They are without a functioning support system and become increasingly lonely and angry. They may develop distorted thinking, delusions and eventually hallucinations. They may have episodes of panic involving various anxiety-provoking possibilities.

At this level of BPD symptoms, the most likely coping mechanisms are efforts to distract the self by using drugs and alcohol, abusing food, and acting out behaviors. Fights, promiscuity, self-mutilation or suicide attempts will be common.

Are relationships a cause or the result of the level of BPD?

There is some question as to whether having a significant relationship reduces the level of borderline traits or if people low in traits can maintain better relationships than those who are high in BPD traits.

One thing that seems clear is that if you have a supportive other in your life, especially in your primary relationship, you are more likely to be able to cope with your mental illness. Learning life skills can improve you functioning and increase the likelihood of finding a supportive partner. Healthy people attract healthy partners.

Are you doing all you can to create good relationships with others and to become the kind of person who can have happy supportive relationships?

Other posts on Borderline Personality Disorder are:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What Causes Borderline Personality Disorder?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

personality disorder

What Causes Borderline Personality Disorder?
Photo courtesy of Pixabay.com

Suggested causes for Borderline Personality Disorder (BPD)

Since this is a condition that is diagnosed by the presence or absence of a group of symptoms rather than any one specific test our understanding continues to change. Some authors have suggested that there are several levels or types of Borderline Personality Disorder. People with milder BPD symptoms can be described as having Borderline traits. It is possible that various levels of BPD symptoms may have different causes.

Like most other mental illnesses, Borderline Personality Disorder (BPD) appears to have both a genetic risk factor and an environmental risk factor. Having a risk factor does not mean that you are going to develop the disorder but the more the risk factors the more the risk.

Genetics is a risk factor for mental illness.

NIMH (National Institute of Mental Health reported some time back (2008,) that there appears to be a genetic risk factor for BPD. This study found that a particular mutation on chromosome nine created an increased risk for BPD. At some point in the human past, the characteristics we think of Borderline traits may have been helpful in certain situations.

Experience has made any one research report linking a particular chromosome and a disorder highly suspect. It would be nice if this study were correct and we could do a simple test for BPD, but with other disorders, we find that it is not one gene or chromosome that creates mental illness. It is the influences of several or a combination of large numbers of the many possible genes that result in an increased risk.

In this study, the contribution of genetics was 40%. Meaning that environment contributed the other 60% or put another way, your relationships and experiences increase the risk of developing BPD 150% as much as your genetics.

Environment can increase the risk for Borderline Personality Disorder.

One factor seems to contribute a huge amount of this environmental risk.

Growing up in a non-affirming place with people who did not validate you, is a hugely important cause of many of the symptoms that make up BPD and Borderline Personality traits.

Many people with borderline traits report that their family was not supportive. Their caregivers were either absent or constantly frustrating.

Many people with BPD grew up in homes that did not create the feeling of being valued as a human being. People with BPD may have been neglected, abused or simply did not have their emotional needs met. They may have found that direct requests for things did not work and that the only way to get their needs met was to engage in behaviors that forced the family to notice them. In adult life, their behaviors will be described as manipulative.

A borderline can be both clingy and distant, wanting a close intimate relationship but also fearful that to let someone get in close to them invites another abandonment.

People with BPD may associate any accomplishment with an increased risk of abandonment. They often quit school a week before finals or fail to show up for a job on the first day.

People with Borderline characteristics may end up slipping into a relationship with someone who has difficulty being close. Just like the co-dependent person who keeps marrying the alcoholic trying to get it right, someone with BPD may continue to enter a relationship with a partner who is unable to provide any warmth and closeness.

The classic expression of this feeling becomes “If I become fully me, will you stop loving me?” The recurring fear is that the significant person in their life will abandon them and they will fall apart without someone to support them.

One issue people with BPD may need to tackle is the inability to have and enjoy happiness or other positive feelings. If you came from an environment that said it was not OK to have or display feelings, it can be terrifying to allow yourself to feel happiness of any sort.

The person with PBD may feel empty, numb or bored without someone else in their life that provides for their needs. The theory here is that the more the person was let down by their support system, the less able they have been at becoming an independent person, the more likely they will be to develop borderline traits.

Learning to act Borderline.

Those with BPD often come from homes where the caregivers themselves had poorly regulated emotional lives. Parents can and do frequently provide genetic risk factors, environmental factors and learned behavior that support the continuation of BPD.

Is seems likely that living with or around a caregiver with BPD is likely to alter the way in which someone handles emotion.

The takeaway from all this is that whatever the reason someone has BPD there are treatments available that can help manage, reduce or eliminate the symptoms of Borderline Personality Disorders.

Other posts on Borderline Personality Disorder include:

What is Borderline Personality Disorder?

What causes Borderline Personality Disorder?

Levels or types of Borderline Personality Disorder

Treatment for Borderline Personality Disorder

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.