Borderline personality disorder

Borderline personality disorder (BPD) is a mental health condition in which feelings are very strong and hard to settle. These feelings can shake a person's relationships, sense of self and daily life. The term "borderline" is an old name that does not describe the condition well. It does not mean "almost" ill.¹

BPD can be painful, for the person and for the people who love them. It is also one of the most treatable personality disorders, and most people get better over time. This page explains the signs, the outlook and the treatments that work.

What are the signs of borderline personality disorder?

A personality disorder is a long-lasting pattern of thinking, feeling and relating that causes real distress and problems. You can read more on the personality disorders overview. In BPD, the pattern centers on how emotions are managed.¹

Common signs include:^3,4

• Intense emotions that change fast. Mood can shift within hours, to anger, anxiety, shame or sadness. After something upsets the person, it can take a long time to calm down.
• Fear of being left. Even a small sign of distance, such as a late text, can feel like rejection. Some people go to great lengths to keep others close.
• Unstable relationships. A person may see someone as perfect one week and as uncaring the next.
• An unstable sense of self. Goals, values, opinions and plans can change often. Some people feel they do not know who they are.
• Impulsive actions. Examples are reckless spending, unsafe driving, unsafe sex, binge eating, or misusing alcohol or drugs.
• Chronic emptiness. A deep, lasting feeling that something is missing.
• Strong anger that is hard to control, often followed by guilt or shame.
• Self-harm or suicidal thoughts. Hurting oneself is often a way to cope with emotional pain or feeling numb. It is also a sign that help is needed.
• Brief stress-related paranoia or "unreal" feelings. These last minutes to hours, usually under heavy stress.

Not everyone has every sign. Doctors look at the whole pattern over time, not one bad week. Read more on getting a careful diagnosis.

How common is BPD, and who gets it?

A large U.S. survey, done from 2001 to 2003, found that 1.4% of adults had BPD in the past year.² That is about 1 in 70 people.

NAMI reports that nearly 75% of people diagnosed are women. Newer research suggests men may be affected about as often but are more likely to be given another diagnosis, such as PTSD or depression.³

BPD usually shows up by early adulthood and tends to be at its strongest in the young adult years.⁴ Many things can play a part, such as family history and a hard childhood.^4,9 See causes and risk factors for more. No one is to blame for having BPD.

Conditions that often come with BPD

BPD often goes along with other conditions. These include depression, anxiety, PTSD, bipolar disorder, ADHD, eating disorders and substance use disorders.^1,4 This is one reason BPD is sometimes missed or mixed up with them. See bipolar disorder, PTSD, adult ADHD, depression, substance use and eating disorders.

Treating the whole picture matters. A good plan looks at each condition that is present.³

What is the outlook?

The outlook is better than many people think. This is the most important fact on this page.

In a long study that followed 290 people with BPD for 24 years, most reached remission. Depending on how long the person had to stay symptom-free (2 to 12 years), between 77% and 100% reached remission. Between 37% and 60% reached fuller recovery, which also includes steady work or school and relationships.⁶

There is a hard side too. Between 11% and 40% saw symptoms return, and some lost their recovery later. That is why ongoing support and a plan for rough times are valuable.⁶ Even so, a setback is not a failure. People often get well again.

Some symptoms ease with age. Mood swings, anger and impulsive behavior often calm down over the years. Worries about being left, self-image and relationships tend to take longer.⁴ Learn more about later life in personality disorders and personality change in later life.

What treatments help?

The main treatment is a structured talk therapy designed for BPD. The American Psychiatric Association's 2024 guideline strongly recommends it. It found several therapies that work, and no single "gold standard."⁵ Strong evidence

Therapy usually takes months to years, and it works best with a therapist trained in a BPD-specific method.^8,9 Brief treatment of under 3 months is not advised by the UK's NICE guideline unless it is part of a larger program.⁸

Short hospital stays may be needed in times of crisis or high risk. UK guidance suggests first trying other options, such as a home treatment team.^3,8

People with BPD should never be turned away from care because of the diagnosis or because they have hurt themselves.⁸ If a clinic or doctor makes you feel dismissed, ask to see someone else.

Making a plan for hard moments

A written crisis plan can help a lot. It lists your warning signs, calming steps, people to call and where to go if things get worse. Share it with your care team and a trusted person, and update it after any crisis.⁸ Our safety plan tool can help you start.

Supporting someone with BPD

Loved ones can make a real difference. Stay calm, speak kindly instead of criticizing, offer specific help and follow through. Take care of yourself too.³ NAMI offers free, peer-led family support groups.¹¹ See supporting someone with a personality disorder.

When to get help

See a doctor or mental health professional if strong emotions, risky actions or troubled relationships are causing you pain. Your primary care doctor is a good place to start. Our mental health check-in and help page can point you to next steps.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.