BPD Signs and Symptoms
Learn about Borderline Personality Disorder (BPD), its signs, symptoms, diagnosis, and treatment options to manage emotions and relationships effectively.
Written by Dr Sonia Bhatt
Last updated on 3rd Jul, 2025
Borderline personality disorder (BPD) is a complex mental health condition that is characterised by emotional instability, impulsive behaviours, and difficulties in relationships. It can be hard to recognise BPD since many people with BPD are unaware that they live with this condition. It is a personality disorder that typically leaves people grappling with self-image and emotional regulation.
People with BPD fear abandonment intensely and struggle to regulate their emotions—anger in particular. They are also more likely to exhibit impulsive and dangerous behaviours, including reckless driving and threatening self-harm. This all makes it really hard for them to have relationships.
A borderline personality disorder is one of a cluster of conditions known as “Cluster B” personality disorders, which are defined by dramatic and erratic behaviours. Personality disorders are long-standing (enduring) dysfunctional behaviour patterns that are rigid, widespread, and causative of social discomfort and distress.
Emotional Dysregulation in BPD
Emotional dysregulation is among the most difficult aspects of Borderline Personality Disorder (BPD). It involves deep challenges like tolerating, interpreting, and responding to emotion. This dysregulation often leads to heightened emotional reactions that may appear disproportionate to the triggering events.
This condition can be further classified into the following:
1. Intense emotional responses
People with BPD often experience extreme emotional responses to situations that others might view as insignificant. They can change quickly and have a considerable impact on daily life and the ability to manage stressors.
2. Chronic feeling of emptiness
Another hallmark of emotional dysregulation prevalent in borderline personality disorder is the chronic feeling of emptiness. This feeling is not merely a temporary state of boredom or dissatisfaction but a deep, persistent void that many people have trouble expressing.
Unstable Interpersonal Relationship
People suffering from BPD often face difficulties interacting with other people, often creating patterns of instability, conflict, and misunderstanding. These challenges stem from the intense emotional experiences and cognitive distortions associated with the disorder. Relationships may fluctuate between closeness and distance, driven by the individual’s heightened sensitivity to rejection and difficulty maintaining balanced perspectives about others.
1. Idealisation and devaluation
People with BPD typically have a very identifiable pattern when it comes to relationships with others, often alternating between idealisation and devaluation. Those with BPD may over-idealise and see the other person as perfect, trustworthy, and completely fulfilling. During this phase, admiration increases as the person pours their emotions into the relationship and expects to be unconditionally supported and validated.Except, this idealisation is often tenuous and quickly goes to devaluation. Even minor disagreements, perceived slights, or unfulfilled expectations can bring about feelings of betrayal or disappointment.
2. Fear of abandonment
People with BPD often have a deep fear of abandonment or rejection. This fear can lead to clingy behaviours, constant reassurance-seeking, or preemptive withdrawal to avoid perceived abandonment.
Distorted Self-Image
Borderline personality disorder (BPD) can cause major disruptions in how people see themselves. This corrupted self-perception can result in a profound state of identity and self-esteem crisis, influencing several areas in life, from personal relationships to professional goalsIndividuals suffering from such a condition can often suffer from more problems, such as:
1. Unstable self-identity
For individuals with BPD, the sense of self is frequently unstable and inconsistent. At times, they may feel confident in their identity and values, but these feelings are often fleeting and quickly replaced by uncertainty. They may struggle to define who they are, what they believe in, or what they want out of life.
2. Fluctuating self-esteem
Self-esteem in individuals with BPD can fluctuate dramatically, ranging from feelings of self-loathing to periods of confidence. These shifts can be triggered by external events or internal emotional turmoil.
Impulsive Behaviour
One of the main characteristics of Borderline Personality Disorder (BPD) is impulsivity, which can lead to a variety of risky or dangerous behaviours. That is an example of what they do when they are experiencing emotional difficulty—to temporarily escape from psychic discomfort and lose themselves in these emptiness-inducing sensations.
Impulsive behaviour can often lead to:
1. Risky behaviours such as substance abuse
People who suffer from BPD can be impulsive in their behaviour: they might compulsively spend money, abuse substances, drive dangerously fast, or participate in unsafe sexual practices. These actions are usually insecurities in dealing with emotional pain and filling an internal void.
2. Self-harm and suicidal tendencies
Self-harm, such as cutting or burning, is a distressing symptom of BPD. Suicidal ideation and attempts are also prevalent, making it essential for individuals with BPD to receive immediate professional help if these tendencies arise.
Cognitive and Perceptual Distortions
Cognitive and perceptual distortions are less visible symptoms of BPD, and these symptoms can severely impact one's ability to function in day-to-day life and make sound decisions for themselves.
1. Paranoia and dissociation
When stressed, people suffering from BPD may feel paranoid or dissociate. Paranoia involves unreasonable fears of others’ intentions, and dissociation can feel like a disconnection from reality, making it hard to focus or ground oneself.
2. Split thinking and black-and-white perspective
People with BPD often view situations or individuals in extremes, such as entirely good or entirely bad. This black-and-white mindset can make relationships and decision-making more complex.
Diagnosis of BPD
Diagnosing Borderline Personality Disorder (BPD) is a complex process that should be made after a comprehensive evaluation by a qualified mental health provider. It cannot be determined by a single test or observation; rather, it is based on a thorough assessment of individual symptoms, history, and behaviours.
DSM-5 diagnostic criteria
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has clear and standardised criteria for diagnosis of BPD. As per the DSM-5, a person needs to show at least five of the symptoms below for a diagnosis to be made:
- Extreme fear of abandonment and attempts to evade real or perceived rejection.
- A trend of unstable and intense interpersonal relationships, marked by alternating between extreme idealisation and devaluation.
- Impulsive behaviours in at least two potentially self-damaging areas, such as reckless spending, substance abuse, binge eating, or unsafe sexual practices.
- Recurrent suicidal behaviours, gestures, threats, or self-mutilating acts.
Chronic feelings of emptiness or void.
These criteria help clinicians differentiate BPD from multiple mental health disorders because its symptoms can overlap with disorders such as depression, bipolar disorder, or anxiety disorders.
Treatment Options for BPD
BPD can be particularly difficult to manage, but there are many effective treatment options available for the individual that can help them manage this disorder. Some of them are:
1. Psychotherapy as the primary treatment
Therapies like dialectal behaviour therapy (DBT) and cognitive behavioural therapy (CBT) are the best treatments for BPD. These approaches teach emotional regulation, interpersonal skills, and coping mechanisms.
2. Medications used as adjunct therapy
While there are no medications specifically approved for BPD, some drugs may be effective in treating co-occurring symptoms such as anxiety, depression, or mood swings. Along with psychotherapy, antidepressants, mood stabilisers, and antipsychotics are a common course of treatment.
Conclusion
Borderline Personality Disorder (BPD) is a multifaceted mental health disorder characterised by emotional dysregulation, impulsivity, and difficulties in interpersonal relationships. Understanding its signs and symptoms is the first step toward providing individuals with the support they need.
Early diagnosis and intervention are crucial in managing BPD effectively. With advances in psychotherapy and medications, there is hope for individuals to lead meaningful lives. Encouraging and helping those suffering from BPD to seek support and build strategies to cope can have an astonishing impact on their path toward recovery.
Consult Top Psychiatrist
Consult Top Psychiatrist
Dr. Dinesh Reddy Panati
Psychiatrist
13 Years • MBBS, MD (Psychiatry)
Visakhapatnam
Apollo 24|7 Clinic - Andhra Pradesh, Visakhapatnam
Dr. Seema Jain
Psychiatrist
31 Years • MBBS, DPM, DNB ( Psychiatry)
Nashik
Apollo 24|7 Clinic - Maharashtra, Nashik
(50+ Patients)
Dr. Vunnam Shashanka
Psychiatrist
9 Years • MBBS, MD (Psychiatry)
Visakhapatnam
Apollo 24|7 Clinic - Andhra Pradesh, Visakhapatnam
(125+ Patients)
Dr. Pratik Kumar
Psychiatrist
10 Years • MBBS,DNB-PSYCHIATRY
North West Delhi
DELHI GLOBAL MIND CLINIC, North West Delhi
(75+ Patients)
Dr. Ankit Halder
Psychiatrist
7 Years • MBBS,MD(PSYCHIATRY)
Kolkata
Serenity Mindcare (A Neuropsychiatry Clinic), Kolkata
