Signs and Symptoms of Borderline Personality Disorder

If you are worried that you or a loved one may have borderline personality
disorder (BPD), it's important to be informed about the illness and its
symptoms. While some of the symptoms of BPD are not easily identified, others
are associated with observable behaviors.

Borderline personality disorder symptoms include instability in interpersonal

relationships, self-image, and emotion, as well as a pattern of impulsive
behaviors. People with BPD often first experience these symptoms in young
adulthood and the symptoms tend to continue for many years. BPD may occur
in both men and women. The following signs and symptoms may indicate a
need to be evaluated by a healthcare professional.

Fear of Abandonment

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 at all.

Since the fear of abandonment can be so strong and pervasive, people with BPD
often engage in behaviors meant to provide reassurance that the other person
still cares about them. For example, they may call someone repeatedly asking
for confirmation that the relationship is still intact, or physically cling to others
when they attempt to leave.

Unfortunately, this scenario can be a double-edged sword. The more a person

seeks reassurance that their relationship with another is "safe", the more likely
they are to push that person away, sabotaging themselves in the process.

Unstable Relationships

BPD is often associated with patterns of very unstable and intense interpersonal
relationships. A pattern of alternating between idealization and devaluation in
relationships is common, a process referred to as "splitting".

A 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. When the devaluation phase emerges,
however, the person with BPD may see the other person as worthless, mean, or
uncaring, and may attempt to distance from them.
In addition, a relationship with someone with BPD is commonly characterized
by lots of conflicts, ups and downs, mistrust, neediness, and frequent arguments.
In fact, a person with BPD often feels disappointment in or even hatred towards
loved ones. They also have difficulty recognizing the feelings of others or
empathizing with others.

Impairment in Identity

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 successful one
moment, but the next may be extremely self-denigrating or hard on themselves.
Their sense of self may also be unstable, which may lead them to behave
differently in different contexts or social groups.

In addition, a person with BPD may feel non-existent or unsure about their
identity or role. They may feel like they don't know who they really are as a
person, or what they believe in.

Impulsivity

Many people with BPD exhibit risky, impulsive behaviors, such as:

 Spending sprees
 Having promiscuous sex
 Driving recklessly
 Misusing drugs or alcohol
 Binge eating
 Breaking the law (e.g., shoplifting)

These impulsive behaviors, in turn, often lead to problems with relationships,

physical health, or legal issues.

Self-Harm or Suicide Behaviors

Some people with BPD may 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. Self-harming behaviors (self-
mutilation) are attempts to get rid of emotional pain or intensely uncomfortable
feelings.

People who self-harm rarely do so when others are present. Instead you may see
signs of self-harm, including scarring or wounds from cutting, burning, or other
forms of self-injury.
People with BPD may also threaten suicide and may make suicide attempts.
Such threats or attempts should be taken very seriously. It's thought that
roughly 70% of people with borderline personality disorder will make at least
one suicide attempt during their life, and for nearly 10% of people with BPD,
the attempt will be successful.

Emotional Instability

People with BPD tend to have intense and frequent mood changes that usually
occur in response to something happening in the environment. A person with
BPD may go from seemingly content to feeling upset in a matter of minutes or
even seconds. They may also experience intense negative feelings in reaction to
day-to-day situations and/or intense sadness or irritability that can last for hours.

Feelings of Emptiness

A person with BPD often feels a chronic sense of emptiness, like there is
nothing inside or that they are emotionally dead. This feeling that life is of little
worth can lead to behaviors marked by emotional drama (such as hysteria,
raging, and more) in order to attract attention through a crisis.

It's important for loved ones to understand the origins of these behaviors.
Common reactions often serve to increase these feelings of hollowness for a
person with BPD.

Intense Anger and Aggressive Behavior

People with BPD tend to feel anger that is stronger than the situation warrants.
Some people with BPD experience intense anger that they rarely or never
express outwardly. Others express anger openly, sometimes in the form of
physical aggression. Angry behavior, ranging from sarcastic comments to
physical violence against other people, is a common sign of BPD.

Stress-Related Dissociative States

Roughly 75% to 80% of patients with BPD experience stress-related

dissociative states, including depersonalization, derealization, analgesia, and
emotional numbing. These dissociative symptoms have been linked to poor
therapy outcomes in patients with BPD, partly due to their impact on emotional
learning and memory.

If You Are Concerned About Yourself

People who are educated in BPD understand that annoying actions like repeated
phone calls are your attempt to cope with a fear of abandonment. Going from
seeing someone as wonderful to despising them may leave friends confused, yet
it is a protective mechanism your mind enacts to try and keep you from being
hurt.

Finding a good therapist can make a world of difference for people living with
this condition. Many of the issues that now make your life difficult can be
coped with much more easily when you recognize them for what they are. A
good therapist can help you discover your triggers and help you develop healthy
coping skills.

Aside from seeing a therapist, a psychiatrist can also be helpful to address

symptoms using medication management. In addition, there are various
community and residential type treatment programs modeled after dialectical
behavior therapy, which is specifically targeted for BPD.

If You Are Concerned About a Family Member or Friend

If you are wondering whether a friend or family member may have BPD, keep
in mind that help is available. That said, if you have watched your friend value
and then devalue other friends, you may be wondering when it will be your turn.
You may be worried that if you open your mouth, you will be the next one to be
"devalued" and labeled the black sheep.

Take a moment to learn about how to cope when a loved one with BPD is
"splitting". Family therapy can be very helpful. The important point to make is
that BPD can affect anyone involved and it's important to care for yourself as
well as your loved one.

It is important to remember that from time to time, many people may experience
some of the symptoms described above. However, people with BPD experience
several of these symptoms daily or almost every day for years. Also, people
with BPD experience these symptoms across different contexts. For example,
they will experience instability in many relationships, not just one or two or
even three.
Idealization and Devaluation in BPD

Idealization and devaluation and are defense mechanisms that help a person
manage their anxiety as well as internal or external stresses. While this
subconscious protection system can be found in a few personality disorders, it is
most often associated with borderline personality disorder (BPD).

This shift between idealization and devaluation found in BPD is known

as splitting, which signifies a disturbance in both thinking and emotion
regulation. It reflects challenges in maintaining an integrated view of the good
and bad in a person under stress.

In borderline personality disorder, idealization often alternates with devaluation.

For instance, a person with BPD may shift from great admiration for a loved
one (idealization) to intense anger toward or dislike of that person (devaluation).

This article discusses the cycle of idealization and devaluation and why people
with BPD might engage in this type of thinking. It also covers how splitting can
damage interpersonal relationships.

What Is Idealization?

Idealization is a psychological or mental process of attributing overly positive

qualities to another person or thing. It's a way of coping with anxiety in which
an object or person of ambivalence is viewed as perfect, or as having
exaggerated positive qualities.

Idealization reduces anxiety by protecting the person from emotional conflicts

that might emerge in a relationship. Rather than deal with the fear that the other
person isn't perfect or that the relationship might not work out, idealization
allows them to keep the fantasy of perfection intact.

It's common with borderline personality disorder for a person to idealize a

friend, family member, or loved one.

They feel intense closeness towards that person and place them on a pedestal.
This can quickly and unpredictably change to intense anger toward that person,
a process called devaluation.

What Is Devaluation?
In psychiatry and psychology, devaluation is a defense mechanism that is just
the opposite of idealization. It's used when a person characterizes themselves,
an object, or another person as completely flawed, worthless, or as having
exaggerated negative qualities.

Idealization can quickly turn into devaluation because there is often no middle
ground for a person with BPD. Feeling challenged, threatened, or disappointed
can quickly cause them to devalue the people they formerly idealized. Rather
than cope with the stress of ambivalence, devaluing functions to minimize the
anxiety caused by ambiguity.

People who are the subject of these cycles are often confused by the sudden
shift from being idealized to being devalued. The cycle between these two states
can make it difficult for people with BPD to maintain relationships with others.

Splitting as a Defense Mechanism

Splitting involves an inability to hold two opposing thoughts, beliefs, or

feelings. People who have BPD tend to view others in all-or-nothing, black-and-
white terms.

This self-protective defense mechanism aims to help people with BPD protect
themselves from getting hurt in relationships. By labeling people as "good,"
they are able to engage in relationships despite the emotional risks. If they feel
threatened, they can then quickly discard the individual or the relationship by
labeling them as "bad."

Like most defense mechanisms, someone with BPD may not be aware they are
engaging in devaluation and idealization. Splitting is a subconscious way to
protect themselves from perceived stress.

Splitting reflects the challenges associated with maintaining an integrated view

of the good and bad in a person under stress. Some researchers suggest that
some of the difficulty is rooted in the way the brain, particularly the amygdala
and prefrontal lobe, activates in these experiences for people with BPD. 4

Devaluation is not limited to people with borderline personality disorder. It may

be seen in other personality disorders, especially antisocial personality
disorder or narcissistic personality disorder.

Idealization is sometimes also seen in narcissistic personality disorder,

especially towards the self or the treating therapist. 1 Splitting, or the rapid
fluctuation between idealization and devaluation, is classically seen in
borderline personality disorder.
Do I Have BPD?

Devaluation and idealization are defense mechanisms commonly used in

borderline personality disorder.1 That said, just because you engage in these
defense mechanisms does not mean you have BPD—it's simply a feature of this
disorder.

Speak with your doctor or a therapist if you are concerned that you use
unhealthy coping strategies like these to deal with emotional conflict or stress.
A therapist can help you focus on developing new behavior and thinking
patterns that can improve your interpersonal relationships.