Borderline: what is it and how to recognize?

O Borderline Personality Disorder (BPD), also known as borderline personality or borderline personality, is one of the most studied and, at the same time, the most misunderstood mental health disorders.

According to data from National Institute of Mental Health, or TPB affects close to 1.4% of the general population, although the prevalence in clinical settings is significantly higher, reaching 10%.

In turn, the American Psychiatric AssociationIndicates estimates between 1.6% to 5.9%, suggesting that the number of diagnoses may vary.

Despite affecting a minority of the population, the emotional, relational and functional impact is profound, affecting the way people feel, think, react, build relationships, deal with rejection and perceive themselves. 🧠

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What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is a complex mental health disorder that profoundly influences the way individuals perceive themselves and relate to others.

People with BPD feel intense emotions with rapid changesthat can pose challenges to your relationships, self-image and overall well-being. It is crucial to recognize BPD as a genuine health problem, and not a mere personal choice or failure.

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Borderline: most common symptoms

BPD involves a persistent pattern of emotional, behavioral, relational, and identity instability.

These are some of the most commonly seen symptoms:

💔 Intense and unstable relationships: Individuals with BPD can quickly oscillate between idealizing and devaluing a person. This volatility causes turbulent relationships, both personal and professional.

🙃 Extreme emotional fluctuation: Emotional instability is central to BPD. The person can go from intense joy to deep sadness or intense anger in a short space of time, with sometimes disproportionate responses.

👤 Identity disorder:There is difficulty in maintaining a consistent self-image, which leads to changes in values, goals, preferences and behaviors.

⚠️ Impulsive behavior: Impulsivity can manifest itself in excessive spending, substance use, unprotected sex, dangerous driving, or compulsive eating.

😨 Intense fear of abandonment:Fear of abandonment (real or imagined) can trigger desperate behaviors to keep people close.

😞 Chronic feelings of emptiness: A constant feeling of emptiness or emotional “disconnection”.

🤕 Self-harm behaviors: Including self-mutilation and suicidal ideation (threats or real attempts).

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Borderline: physical symptoms exist?

Although BPD is an emotional and behavioral disorder, many individuals report physical symptoms associated with stressemotional, such as:

• Muscle tension
• Headaches
• Extreme Exhaustion
• Difficulty sleeping
• Changes in appetite
• Sensation of “knot in the stomach”
  
  

These symptoms are not directly caused by borderline personality, but by prolonged emotional intensity.

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What are the 4 types of borderline? (Millon subtypes)

Although are not part of the official DSM-5 criteria, the subtypes proposed by Theodore Millon are widely studied and help to understand different behavioral patterns within BPD.

They are:

1. Borderline Impulsive: Impulsivity predominates, Rejection sensitivityand risky behaviors.

2. Borderline Discouraged:It mixes traits of dependence, insecurity, self-criticism and an accentuated fear of abandonment.

3. Petulant Borderline:Easily irritable, resentful, angry person, with intense frustration.

4. Self-Destructive Borderline: It includes self-sabotaging behaviors, suicidal risk, and self-directed impulsivity.

These subtypes are not formal diagnoses and do not directly impact the type of treatment used, but they can help to understand individual nuances.

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What causes Borderline Personality Disorder?

TPB does not have a single cause. The research indicates a multidimensional model:

🧬 Genetic factors: There is evidence of significant heredity. When there is a family history, the likelihood of developing the condition can be up to five times higher!

👪 Family atmosphere and early experiences:History of emotional neglect, abandonment, abuse, trauma or unstable relationships may increase the risk.

🥹 Emotionally sensitive temperament: Some people are born with greater emotional reactivity.

🧠 Changes in neurobiology: Differences in brain areas responsible for emotional integration and impulse control.

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Diagnosis: How do I know if I have Borderline?

The diagnosis should be made by psychologists or psychiatrists who specialize in personality disorders.

It generally includes:

• Detailed clinical interview
• Life history and interpersonal relationships
• Patterns of emotional instability
• Assessment of impulsivity and risk behaviors
• Exclusion of other conditions (anxiety, bipolarity, trauma, depression)

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Borderline Disorder Treatment: What Works?

Contrary to what was believed a few decades ago, the TPB has treatment and improves with appropriate intervention. ✨

1. Psychotherapy (first line treatment)

The models with the most scientific evidence include:

• Cognitive Behavioral Therapy (CBT)
  Very effective for impulsivity, self-injury and emotional regulation.
  
  
• Mentalization-Based Therapy (MBT)
  It helps to perceive internal states and interpret emotions.
  
  
• Schema-Focused Therapy
  It works on deep emotional patterns.
  
  
• Transfer Therapy (TFP)
  Focused on interpersonal relationships and patterns.

2. Medication

It does not treat BPD directly, but it can help with some associated symptoms:

• Depression
• Anxiety
• Impulsivity
• Irritability

3. Psychoeducational intervention

Essential to help the person and family understand emotional functioning.

4. Emotional stabilization and routines

Structural changes on a day-to-day basis help reduce emotional crises.

We remember that the TPB is challenging, but is not a sentence— is a treatable condition.

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Final considerations about Borderline

Borderline personality disorder is a complex disorder, marked by intense emotions, emotional instability and difficulties in relationships. Understand what is borderline, its symptoms, causes and patterns is the first step to reducing stigma and promoting access to appropriate treatment.

If you notice intense emotional behaviors, impulsivity, difficulties with regulation or relational instability in yourself or your child, it is important to seek professional support.

A our teamcan help with a comprehensive assessment focused on the emotional development and mental health of the youngest.

Early intervention is one of the best ways to prevent future suffering and strengthen emotional skills throughout life. 💙

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References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed Text Revision (DSM-5-TR). Washington, D.C., American Psychiatric Association, 2022, pp 752.

Leichsenring, F., Heim, N., Leweke, F., Spitzer, C., Steinert, C., & Kernberg, O. F. (2023). Borderline Personality Disorder: A Review. CAVE, 329 (8), 670—679. https://doi.org/10.1001/jama.2023.0589

National Institute of Mental Health (NIH), 2025. Borderline Personality Disorder. Department of Health and Human Services, National Institutes of Health. https://www.nimh.nih.gov/health/publications/borderline-personality-disorder 

Stoffers, J. M., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with borderline personality disorder. The Cochrane database of systematic reviews, 2012 (8), CD005652. https://doi.org/10.1002/14651858.CD005652.pub2

Ten Have, M., Verheul, R., Kaasenbrood, A., van Dorsselaer, S., Tuithof, M., Kleinjan, M., & de Graaf, R. (2016). Prevalence rates of borderline personality disorder symptoms: a study based on the Netherlands Mental Health Survey and Incidence Study-2. BMC Psychiatry, 16, 249. https://doi.org/10.1186/s12888-016-0939-x 

Torgersen, S., Lygren, S., Oien, P. A., Skre, I., Onstad, S., Edwardsen, J., Tambs, K., & Kringlen, E. (2000). A twin study of personality disorders. Comprehensive psychiatry, 41 (6), 416—425. https://doi.org/10.1053/comp.2000.16560