Borderline personality disorder (BPD)

People with BPD often describe intense mood swings that can last hours, and rarely more than a few days. A small comment can trigger deep hurt, panic or anger that feels completely overwhelming.

Strong anger may be followed by shame or guilt. Many also feel a lasting sense of emptiness, as if something important is missing inside.

Fear of being abandoned is common in BPD. A partner being late or a friend not texting back can feel like proof that they are leaving. This can lead to clinging tightly, or pushing people away first so it hurts less.

Relationships may feel intense and swing between seeing someone as wonderful and seeing them as terrible. This “all good or all bad” thinking is exhausting for everyone, especially the person with BPD.

Many people with BPD have an unclear or changing sense of self. Goals, values, opinions, style or friend groups can shift quickly. Self-image is often harsh, with feelings of worthlessness or self-loathing.

Some people also feel detached from themselves or their surroundings during stress, as if watching life from outside. This is called dissociation.

When emotions are unbearable, people may act on impulse to get relief: risky spending, binge eating, reckless driving, unsafe sex or using substances. These bring short relief, then often regret.

Learning to pause, notice the urge and ride it out (“urge surfing”) is a skill taught in therapy. It gets easier with practice.

People with BPD are more likely to self-harm, and some have suicidal thoughts or make attempts. Self-harm is usually a way to cope with overwhelming pain, not “attention-seeking”.

Always take talk of self-harm or suicide seriously. Stay calm, listen, and help the person reach professional support.

People who have a close family member with BPD may be more likely to develop it. This points to some inherited sensitivity, not a fixed fate.

Research suggests people with BPD may have differences in the brain areas that control emotions and impulses. It is not clear whether these are risk factors or results of the condition.

The brain can learn new patterns. That is part of why skills-based therapy works.

Many people with BPD report traumatic life events, such as abuse, abandonment or adversity in childhood. Others were exposed to unstable, invalidating relationships or hostile conflict.

Not everyone with these experiences develops BPD, and some people with BPD did not have a traumatic childhood.

One way to understand BPD: a child who feels things very strongly grows up around people who dismiss or punish those feelings. The child never gets to learn how to calm big emotions safely.

NIMH describes high sensitivity to rejection, and efforts to avoid real or imagined abandonment, as part of borderline patterns. A small sign of distance can feel like proof that someone is leaving, and can bring panic, anger or despair within minutes.

What helps

• Pause before reacting: “What else could explain this?” (busy, phone died, asleep)
• Remind yourself of times this person did come back
• Soothe your body first: cold water on your face, a walk, slow breathing
• Wait 20 minutes before sending another message

A harsh inner critic means outside criticism can land very hard. One comment can feel like proof of being worthless.

What helps

• Ask for a pause: “Let me think about that and come back to you.”
• Separate the comment from your whole self: “This is about one task, not who I am.”
• Talk it through with someone who knows you well
• Write down what was actually said, word for word, once you’re calm

Cleveland Clinic notes that people with BPD may feel very strong emotions when they are alone. Time apart, even planned and short, can stir feelings of emptiness or fear of being forgotten.

What helps

• Agree on check-in times with your partner or friend
• Ask your therapist how to reach support during their time away
• Keep reminders of connection: a photo, a voice note, a letter
• Plan ahead for time apart: activities, calls, a routine

NIMH notes that many people with BPD have been exposed to unstable, invalidating relationships or frequent conflict. Today, being told your feelings are wrong or silly can reopen that old wound and make emotions spike higher.

What helps

• For loved ones: validate the feeling, even if you disagree with the behaviour
• Name what you need: “I don’t need you to fix it, just to hear me.”
• Practise validating yourself: “It makes sense I feel hurt, given what happened.”
• Take a break from the argument and agree when to return

Cleveland Clinic notes that extreme stress can bring disconnected thoughts or an out-of-body feeling for some people with BPD. Being exhausted, hungry, ill or drinking makes every other trigger hit harder and makes impulsive choices more likely.

What helps

• Go easy on alcohol and drugs, which loosen self-control
• Move your body daily, even a short walk
• Notice your own early stress signs and act on them early
• Protect sleep and regular meals, especially in stressful weeks

DBT was developed specifically for BPD. It teaches four sets of skills: mindfulness, managing emotions, getting through a crisis without making it worse, and handling relationships.

“Dialectical” means holding two things at once: accepting yourself as you are AND working to change. Therapists also practise validation, showing that your emotions make sense, even when the actions need to change.

What it usually involves

• A weekly skills group with other people
• Homework to practise skills in real life
• Phone coaching between sessions in some programmes
• Weekly one-to-one therapy

The NHS notes that DBT has proved particularly effective for women with BPD who have a history of self-harm.

“Mentalising” means thinking about what is going on in your own mind and in other people’s minds: thoughts, feelings and intentions. Under stress, this ability can switch off, which leads to misreading people.

MBT helps you step back from strong urges and ask, “What else might they be thinking? What am I feeling right now?” It usually combines individual and group sessions, often for around 18 months.

A 2020 review found MBT may help reduce self-harm, suicidal thoughts and depression compared with usual care.

Schema therapy looks at the deep beliefs (“schemas”) formed early in life, like “I will always be abandoned” or “I am defective”. It helps you understand how these beliefs drive today’s reactions.

Therapy works on meeting the needs that went unmet in childhood in healthier ways, and on building a kinder inner voice.

Other approaches

• Arts therapies (art, music, drama, dance): for people who find feelings hard to put into words
• CBT: spotting and changing unhelpful thoughts and actions
• Group therapy: practising new ways of relating with others
• Transference-focused psychotherapy (TFP): using the therapy relationship to understand self-image and emotions in relationships

Some people in the UK attend therapeutic communities: intensive group programmes where people learn and heal together.

Try this for one minute

1. Name five things you can see
2. Name what you feel in your body, like tight chest or hot face
3. Name the emotion: “This is fear.”
4. Remind yourself: “A feeling is not a fact, and it will pass.”

Mindfulness is the base for every other skill. You cannot change a feeling you have not noticed.

Quick body calmers

• Cold water on your face, or holding something cold
• Fast movement for a few minutes, like a brisk walk or stairs
• Slow breathing, with the out-breath longer than the in-breath
• Tensing and then relaxing your muscles, one group at a time

The goal is not to feel good straight away. It is to get through the peak without doing something you will regret.

Everyday basics

• Do one small thing each day that you enjoy
• Eat regular meals and protect your sleep
• Go easy on alcohol and drugs
• Move your body most days

A tired, hungry or stressed body has less room for big feelings. Looking after the basics makes the waves smaller.

A simple way to ask

1. Describe what happened, just the facts
2. Say how you feel about it
3. Ask clearly for what you want
4. Say why it would help you both

Example: “You said you’d call at 8 and didn’t. I felt scared and hurt. Could you text if plans change? It would help me stay calm.”

1. Notice the urge and name it
2. Rate how strong it is, 0 to 10
3. Breathe slowly and watch it rise, peak and fall
4. Rate it again after a few minutes

Urges usually peak and fade if we don’t act on them. Each time you ride one out, the next gets a little easier.

In the same study, relapse became less likely the longer someone had been feeling better.

Doing well at work and in relationships took longer: 60% reached at least two years of both feeling better and doing well in daily life. This is why support with jobs, friendships and routines matters too.

The NHS says that over time, many people with BPD overcome their symptoms and recover. Hard weeks along the way do not erase progress.

People with BPD are sometimes called “manipulative” or “attention-seeking”. In reality, behaviours like clinging or self-harm are usually desperate ways to cope with overwhelming emotions or fear of being left.

Seeing the pain behind the behaviour makes it easier to respond with care, while still keeping healthy boundaries.

TV and films often show people with personality disorders as villains. In reality, the person most at risk is usually themselves, through self-harm, suicide risk or other health problems.

Stigma makes it harder to ask for help. Kind, accurate words matter.

More women are diagnosed with BPD, but research suggests men may be affected about as often. Men may be misdiagnosed with conditions like PTSD or depression instead.

In a large U.S. survey, sex and race were not linked to how common personality disorders were.

Talk therapies like DBT and MBT have been tested in many trials, and long-term research shows most people improve a lot over time.

In BPD, mood swings often last hours, and rarely more than a few days. They are often set off by something that happens, especially in relationships.

Bipolar disorder is a separate condition with its own patterns and its own treatment plan.

Validation means letting someone know their feelings are real and understandable. It does not mean agreeing with everything, or approving of harmful actions.

Try saying

• “I can see how hurt you are.”
• “I’m here. Let’s take a breath together.”
• “It makes sense you felt scared when I didn’t reply.”

People usually calm down faster when they feel understood. Arguing about whether a feeling is “right” tends to make emotions bigger.

Boundaries are about what you will do, not controlling the other person. For example: “I want to talk, but I won’t stay in a conversation where I’m being shouted at. I’ll come back in 20 minutes.”

Be calm, consistent and caring. Follow through on what you say.

Encourage your loved one to keep going with treatment, and support daily structure and healthy routines. Family therapy can help the whole family learn new ways to communicate.

Take any talk of self-harm or suicide seriously. Encourage professional help, and call or text 988 if needed.

Family Connections is a free programme from BPD Alliance (the National Education Alliance for Borderline Personality Disorder). It is for family members and loved ones of someone with BPD traits or ongoing emotional struggles. A formal diagnosis isn’t needed.

Good to know

• It is completely free
• Mostly online on Zoom, with some in-person groups
• Options include 12 weekly two-hour classes
• You must be 18 or older; your loved one must be 13 or older

Meeting other families who “get it” is one of the most healing parts. Community can turn isolation into shared strength.

• Get your own counselling, ideally with a different therapist
• Keep up friendships, hobbies and rest
• Remember you cannot “fix” anyone. You can support, and they can grow