Borderline personality disorder: symptoms, treatment and coping with intense emotions

What is borderline personality disorder?

Borderline personality disorder (BPD) is a mental health condition that affects your ability to regulate your emotions. As Cleveland Clinic describes it, your feelings can become intense after a triggering event, your sense of who you are can feel shaky, you may act on impulse, and your relationships are disrupted. Its core pattern is intense, shifting emotions, a deep fear of abandonment and close but unstable relationships.

If this is what you live with, you are not simply "difficult": you have a recognized condition that can be treated. In its page updated in 2025, Cleveland Clinic estimates that it affects about 1 in every 100 people in the United States. It is diagnosed more often in women, but research suggests men may be affected just as often and may be misdiagnosed with depression or post-traumatic stress disorder (PTSD).

There is no single test that detects it, Cleveland Clinic notes. Instead, a psychiatrist or psychologist makes the diagnosis after a detailed conversation about your symptoms and your personal and family history, and it is usually diagnosed in late adolescence or early adulthood, explains the US National Institute of Mental Health (NIMH). Factors linked to it include difficult childhood experiences such as neglect or abuse, and having a close relative with the disorder, such as a parent or sibling.

Borderline personality disorder symptoms: intense mood swings and fear of abandonment

Not everyone has every symptom, and how severe they are varies from person to person. Among the main signs described by NIMH, the UK's National Health Service (NHS) and Cleveland Clinic:

• An intense fear of abandonment that leads you to cling to people or push them away, or to move into and out of relationships quickly.
• Intense mood swings: waves of sadness, anger or anxiety that usually last hours and rarely more than a few days.
• Relationships that swing back and forth: the same person seems perfect today and a bitter disappointment tomorrow.
• An unstable sense of self: your opinions and interests change suddenly, and you may feel you don't know who you are.
• Chronic feelings of emptiness and loneliness.
• Intense anger that is hard to control, sometimes followed by shame or guilt.
• High sensitivity to rejection.
• Feeling cut off from yourself or from reality under stress. Some people hear voices for a few minutes at a time, which can feel like instructions to harm themselves or others; this needs help straight away.
• Impulsive behavior and self-harm.

These symptoms often come with depression, anxiety, PTSD or substance use, so the picture overlaps, which is why diagnosis needs a specialist. To learn what happens when substance use and another mental health condition occur together, read about dual diagnosis.

Impulsivity and self-harm: real pain that deserves help

A person with BPD may act on impulse through overspending, reckless driving, binge eating, or drinking alcohol and using drugs. As for self-harm, the NHS explains that it is most often a way of expressing or coping with severe emotional distress, of relieving distress that feels unbearable, or of punishing oneself.

But understanding the reason does not make it safe, and it is not "attention-seeking" to be ignored. NIMH says that rates of self-harm and of suicidal thoughts and behaviors among people with BPD are much higher than in the general population, and stresses that any talk of them should be taken seriously. This is where treatment begins: the therapist acknowledges that your pain is real, then teaches you safer ways to bear it.

BPD, love and marriage: why do relationships swing so much?

Love is where BPD often shows most clearly. The NHS describes a repeating cycle: the fear that someone you love will leave you brings intense anxiety and anger, so you try to keep them close with constant texts and calls, by clinging to them, or even by threatening to harm yourself; then you fear being smothered by the closeness and push them away. You may see them in "black and white" terms and swing between "go away" and "please don't leave me", which often ends in a break-up.

But this does not make love or marriage impossible, because these patterns are exactly what treatment targets: dialectical behavior therapy teaches skills for improving relationships. NIMH notes that therapy for family members is often helpful, helping them understand their loved one and learn skills to support them, although more research is needed on how much family therapy helps the disorder itself.

What is the difference between BPD and bipolar disorder?

Both involve mood swings and impulsivity, but a scientific review of the evidence published in 2019 concluded that they are distinct conditions, despite the overlap between them. The main differences, as explained by NIMH and that review:

• How long the swings last: hours or a few days in BPD, and longer mood episodes in bipolar disorder.
• The type of mood: irritability and anger can appear in both, so they alone do not tell the two apart. What points to bipolar disorder is episodes of mania or hypomania lasting several days or longer, in which several manic symptoms come together, such as raised mood and a clear rise in activity and energy. BPD symptoms happen without such episodes, and its swings are mostly anger, anxiety and sadness, usually set off by events and changing quickly.
• The course: bipolar disorder comes in episodes, while BPD traits are more constant in everyday life.
• Impulsivity: if it happens mainly during periods of raised mood and energy, another mood disorder may be the cause.

The two can also occur together: the 2019 review cites a meta-analysis finding that about 21% of people with bipolar disorder also have BPD. Because each is treated differently, telling them apart needs a specialist assessment. To learn more, read our article on bipolar disorder.

Treating borderline personality disorder: why is DBT therapy one of the most important options?

Psychotherapy (talking therapy) is the main treatment for BPD, according to NIMH, and one of its leading forms is dialectical behavior therapy (DBT), which was developed specifically for it. DBT combines acceptance, meaning the therapist recognizes that your emotions are real and valid, with work on changing the behavior that hurts you. As the NHS explains, a therapist may accept that intense distress leads you to self-harm, without accepting that it is the only way to cope with it.

DBT draws on mindfulness and teaches you skills to manage intense emotions, reduce harmful behaviors and improve relationships, through weekly individual and group sessions. Why does it stand out? Because it was designed for this disorder in particular, and because it is one of its most studied treatments. A Cochrane review published in 2020 brought together 75 randomized trials of different psychological therapies, most of them on DBT and mentalization-based treatment (MBT), and found that DBT reduced the severity of symptoms and self-harm and improved everyday functioning compared with usual care, although the quality of this evidence was low. The UK's NICE guidelines, published in 2009, recommend considering it for women with BPD when reducing repeated self-harm is a priority.

For MBT, the same review found that it reduced self-harm and suicidal thoughts and behaviors compared with usual care, again with low-quality evidence. Other therapies used include cognitive behavioral therapy (CBT) and schema therapy. Treatment takes time: according to the NHS, it may last a year or longer.

What role does medication play?

No medicine is currently licensed in the UK to treat BPD itself, the NHS notes, and NIMH says the benefits of medication for it are unclear and that it is not the first-line treatment. NICE guidelines advise against using medicines specifically for BPD or for its individual symptoms, such as self-harm and mood instability. A doctor may, however, decide on a medicine to treat a condition that comes with it, such as depression or anxiety, and NIMH notes that medication is sometimes added to psychotherapy for specific symptoms. NICE guidelines allow a sedative for a very short period during a crisis only, chosen by the doctor from medicines with a low risk of addiction and misuse. Never start, stop or change a medicine on your own, and don't take sedatives that a doctor has not prescribed for you.

How does treatment start at Oxygen Center?

The path starts with an appointment with a psychiatrist to assess your symptoms and anything that comes with them, followed by a plan of psychotherapy sessions suited to your needs, with your family involved when that helps and you agree to it.

How can families handle BPD crises without making them worse?

When your relative explodes in anger or threatens to harm themselves, NICE guidelines advise professionals to keep a calm, non-threatening attitude, to try to understand the crisis from the person's point of view, and not to play down its causes. Families can apply the same principles:

1. Calm yourself first: lower your voice, and avoid shouting, threats and arguing.
2. Acknowledge the feeling before the details: "I can see you're in a lot of pain right now." Acknowledging a feeling does not mean you agree with every action.
3. Don't play down what is upsetting them, even if it seems minor to you.
4. Take any talk of self-harm or suicide seriously, and get help straight away from the numbers above; if they are in immediate danger, don't leave them alone and call an ambulance on 123.
5. Keep yourself and everyone at home safe: if anger turns into aggression that threatens you or others, move to a safe place and get help immediately.
6. Save the discussion for when things are calm, then go over together what set off the crisis and what helped.
7. Make a crisis plan with the treatment team: what sets it off, what calms it, and who to call.

NIMH advises families to learn about the disorder, support the treatment plan patiently, encourage a structured daily routine, and seek emotional support for themselves. At Oxygen Center, families can come alone first to learn how to respond, even if their relative refuses to come.

Does borderline personality disorder get better? What the studies say

Yes. The NHS says many people overcome their symptoms over time and recover. In a US study published in 2012, researchers followed 290 people with BPD for 16 years. All of them started the study as hospital inpatients, and over the years most received non-intensive outpatient treatment:

• 99% reached a remission in which they no longer met the diagnostic criteria for at least 2 years, and 78% for 8 years.
• 60% achieved a fuller recovery for 2 years, combining symptom remission with a close, supportive relationship and full-time work or study.
• Symptoms returned in 36% of those whose remission had lasted 2 years, and in 10% of those whose remission had lasted 8 years, so relapse becomes less likely the longer the improvement lasts.

In other words, a diagnosis does not mean things will stay as they are. Cleveland Clinic notes that symptoms may ease with age, but advises against waiting for that, because treatment teaches you skills now that reduce suffering.

When should you get help?

Don't wait until you reach a crisis. Ask for a specialist assessment if:

• Mood swings and outbursts of anger are affecting your studies, work or home life
• Your relationships end again and again in the same painful way
• You have started turning to alcohol, drugs or reckless spending to calm your emotions
• Episodes of hearing voices last longer, or you have distressing beliefs that no one can talk you out of, which may be a sign that your condition is getting worse
• Immediately, without waiting: if you are harming yourself or thinking about ending your life, or you hear voices urging you to harm yourself or others, call an ambulance on 123 or go to the nearest emergency department, and don't stay alone; the mental-health line on 16328 and Oxygen Center's emergencies line on +20 100 006 6752 can support you as well, alongside the ambulance, not instead of it

At Oxygen Center, doctor appointments and psychotherapy sessions are open to men and women aged 15 and over, with a parent or guardian's consent for anyone under 18, while a stay in the inpatient psychiatry unit during a crisis is for males only. In an acute crisis, anyone, man or woman, can call an ambulance on 123 or go to the nearest emergency department. The first step is simpler than you think: you can contact us at any time.