What is Borderline Personality Disorder (BPD)?
So many feel low self-worth and lose themselves when they get into their first adult romantic relationships due to their first few years of how they received love were chaotic. I wanted to share information on one of the main personality disorders I work with, often unbeknownst to them they enter into unhealthy relationships with more selfish people, also known as Narcissistic Personality Disorder (NPD) or those who fall more into the Antisocial Personality Disorder (APD) realms. This can breed an addiction to Volatility by those who have been impacted by childhood trauma and can increase intimate partner violence components. Many individuals who struggle with Developmental Trauma aka Complex Trauma, may demonstrate BPD traits. Today, we are going to review the causes, symptoms, co-occurring symptoms and effective treatments for Borderline Personality Disorder so we can be aware of the complexities of those who we identify as having BPD, we may love, or first showed us love.
Borderline Personality Disorder (BPD) is one of the most commonly misunderstood and stigmatized mental health conditions. These individuals are often the highest utilizers of crisis and emergency mental health services in our society in 2025. This disorder is characterized by intense emotional experiences, unstable relationships, and a distorted sense of self, BPD affects an estimated 1.4% of adults, with women being diagnosed more frequently than men, however that may be due to the stigma men face with attending mental health services. However, BPD is not a life sentence—it is a treatable condition, and evidence-based therapies are more effective than ever, offering hope for those who struggle with the disorder and the partners and families who support them.
This blog will provide an in-depth look at what causes BPD, the symptoms to watch for, and the most effective treatments available in 2025.
What Causes Borderline Personality Disorder?
The origins of BPD are complex and involve an interplay of genetic, environmental, and neurobiological factors. Understanding these causes is critical to reducing stigma and promoting compassion for those living with the disorder. It is often due to the attachment wounds of parents due to something in their own childhood (also genetic) who raise children with a lack of emotional regulation and resources, which implants the belief in the child “all bad child” perception in the child as the parent makes the child feel this way and paints the world in a more black and white - all good or all bad perception and causes immense mood swings and psychological blindness in their abilities to show or receive love by others appropriately.
Genetic Factors
While there is no single gene responsible for BPD, research has found that it tends to run in families. Studies suggest that individuals with a first-degree relative who has BPD are at a higher risk of developing the disorder themselves. Specific genes involved in the regulation of mood and emotional responses may contribute to heightened emotional sensitivity, which is central to BPD. Additionally generational trauma is real, it stays in the body and therefore there may be personality traits being transferred genetically.
Early Childhood Trauma and Attachment
Like we discussed in the beginning, early childhood trauma and attachment impacts the parents ability to develop and therefore the child has to parent the parent and causes a huge impact in the child’s mind for later attachment. A significant body of research points to early childhood trauma—such as physical, emotional, or sexual abuse, neglect by a mother or father—as a major risk factor for BPD.
Disrupted attachment relationships with one’s mother, such as controlling, neglectful or inconsistent caregiving, also play a crucial role in the development of the disorder for many individuals. As one can assume, these early experiences can leave long lasting impact on an individual’s emotional regulation and self-image, contributing to the emotional instability seen in those impacted by BPD. After watching Wicked in theaters recently with my daughters (Go See it if you haven’t yet, WOW so GOOD!) I re-read, Understanding The Borderline Mother by Dr. Christine Ann Lawson and found it to be very helpful in understanding the complexities of Borderline Personality Disorder as it ties to James Masterson (1988) classified borderline mothers into four sub-groups; these are: Lower Functioning BPD- Waif mother, Hermit mother & Higher Functioning BPD - Queen mother, and Witch mother. This is important for assessing and treating for BPD. Check it out when you have some time!
Many parents struggled with their parental stress inventory while raising children and were not mature themselves. Many were in unhealthy relationships and often the Father is missed when providing the biopsychocial framework for a client, however they shouldn’t be. Their impact is profound on the psyche. Fathers also struggle with BPD and a host of other issues as we will discuss in other blogs. However, as evidence of them also being diagnosed as well but their primary attachment is to spouse often but could also show more Narcissistic Personality Disorder (NPD) traits. Not everyone fits into a label or diagnosis cleanly, many have certain percentages of each personality disorder traits. As we know from previous blogs, having emotionally immature parents can have tremendous impacts on children. This forces the child to develop more quickly than they were meant too. Parents who are emotionally immature often do not develop in some areas of life which promotes rigidity, perfectionism, depression, and stubborn towards self-judgement and self-loathing in children.
Neurobiological Factors
There is evidence suggesting that BPD may be linked to changes in brain regions involved in emotional regulation, such as the amygdala (the brain’s "emotion center") and the prefrontal cortex (which helps control impulses and regulate emotions). People with BPD may experience heightened emotional responses to stress and have difficulty returning to a baseline emotional state after a trigger.
Symptoms of Borderline Personality Disorder
BPD is often characterized by a pattern of unstable moods, relationships, and self-image. In addition, they often struggle with co-morbid diagnosis which complicates this disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must exhibit at least five of the following symptoms for a diagnosis of BPD:
Fear of Abandonment: Intense fear of being abandoned or rejected, leading to frantic efforts to avoid real or imagined abandonment.
Unstable Relationships: Patterns of intense, unstable relationships, alternating between extremes of idealization and devaluation (i.e., seeing someone as all good or all bad).
Unstable Self-Image: A distorted sense of self-worth, with sudden changes in goals, values, and identity.
Impulsive Behaviors: Risky behaviors such as reckless driving, spending, or unsafe sex, often in response to stress.
Emotional Instability: Intense and rapidly changing emotions, often in response to interpersonal stress. This includes feelings of emptiness, irritability, or intense sadness. This often brings suicidiality, homicidality, self- injurious behaviors
Chronic Feelings of Emptiness: A persistent feeling of being empty or hollow inside.
Difficulty Controlling Anger: Intense episodes of anger or difficulty controlling emotions when upset, seeing everything as white and black.
Paranoia or Dissociation: Under stress, individuals with BPD may experience paranoid thoughts or dissociation—feeling disconnected from their body or surroundings.
Effective Treatments for BPD
The treatment landscape for BPD has evolved significantly over the years, with a focus on therapies that teach individuals how to manage emotions, build stable relationships, and improve their quality of life. While treatment for BPD often requires a combination of approaches, evidence-based therapies are the cornerstone of effective treatment.
Eye Movement Desensitization Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing, a psychotherapy technique that helps people heal from trauma. Developed by psychologist Francine Shapiro in the 1980s, originally used to treatpost-traumatic stress disorder (PTSD). It is now used to treat a variety of mental health issues, including anxiety, depression, and eating disorders which includes BPD. The protocol involves having a patient recall unpleasant memories while moving their eyes in a certain way or using bilateral stimulation tapping. Based on the idea that emotional distress can be processed during REM sleep activation of both sides of the brain. Some say it's effective, works faster than other therapies, and is generally considered safe for children and those who are impacted by health complications. The VA approves it for combat PTSD treatment.
Dialectical Behavior Therapy (DBT)
Originally developed by Dr. Marsha Linehan, DBT remains one of the most effective treatments for BPD. It is a type of Cognitive Behavioral Therapy (CBT) that focuses on helping individuals with BPD manage their emotions, tolerate emotional distress, and improve interpersonal relationships with specific skills. DBT combines individual therapy with group skills training in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The goal of DBT is to help individuals develop a “dialectical” mindset—accepting their current struggles while working to change destructive behaviors with conscious actions to reduce distress and gain critical skills. DBT has been proven effective in reducing suicidal behavior, self-harm, and hospitalizations, and it remains the gold standard for treating BPD in 2025. I highly recommend DBT Therapy and incorporating these strategies in all forms of therapy- couples therapy and conjoint parenting therapy with children to assist with reducing harm with the relationship instability.
Mentalization-Based Treatment (MBT)
MBT is another evidence-based therapy that focuses on helping individuals with BPD develop the ability to understand their own and others’ mental states (such as thoughts, feelings, and intentions). People with BPD often struggle to interpret social cues and may misread others' emotions, leading to interpersonal conflict. MBT aims to improve emotional awareness and reduce impulsive behaviors. Studies have shown that MBT can reduce self-harm and improve emotional regulation in people with BPD.
Transference- Focused Psychotherapy (TFP)
TFP is a psychodynamic treatment that focuses on the relationship between the therapist and the patient as a way to understand and change interpersonal patterns. In TFP, the therapist helps the patient examine their thoughts, feelings, and behaviors in the context of the therapeutic relationship. This allows the patient to identify patterns of distorted thinking and emotional responses, and to work toward healthier ways of relating to others. Research has shown that TFP can help reduce symptoms of BPD, including emotional instability and interpersonal difficulties.
Medication
While no medications are specifically approved to treat BPD, some people benefit from medications that address co-occurring conditions, such as depression, anxiety, or mood swings. Selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, psychedellic assisted therapies, and antipsychotic medications may be prescribed to help with these symptoms. However, medication is typically used in conjunction with psychotherapy services and not as a standalone treatment for BPD.
Schema Therapy
Schema Therapy, developed by Dr. Jeffrey Young, integrates elements of cognitive, behavioral, and experiential therapies. It focuses on identifying and changing deeply ingrained patterns of thinking and behavior (schemas) that have developed from early life experiences. For individuals with BPD, this can be particularly helpful in addressing dysfunctional patterns of attachment, self-image, and emotional regulation.
Living with Borderline Personality Disorder:
A Path to Recovery
Despite the challenges, many individuals with BPD go on to live fulfilling and meaningful lives with ongoing support. With the right treatment, which is more intensive in nature with individual therapy, group support, medications, and coaching, it’s possible to develop more stable relationships, a healthier sense of self, and better emotional regulation. It’s important to note that BPD is not a disorder of character—it’s a disorder of emotion regulation and can cause a lot of fear of abandonment for their relationships, especially with partners, children, and parents. Recovery often involves a combination of therapy, personal resilience, and support from loved ones. As more people begin to understand BPD through a trauma-informed lens, society is gradually reducing the stigma associated with the disorder, allowing for greater compassion and support.
For anyone struggling with BPD or BPD Traits or supporting someone who is, it’s important to seek professional help. I’m happy to help you as I primarily work with those diagnosed with BPD or CPTSD. Do not attempt to go at it alone as you will be at greater risk for decompensation and self-isolation. Treatment is available, and progress is possible. Help is here!
