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What Causes BPD

What Causes BPD, Symptoms, Diagnosis, & Treatment

What Is Borderline Personality Disorder?

BPD is among several personality disorders (such as paranoid personality disorder, narcissistic personality disorder, antisocial personality disorder). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [1], personality disorders are generally characterized by:

  • Entrenched patterns of behavior that deviate significantly from the usual expectations of the behavior of the individual’s culture.
  • Behavior patterns that are inflexible, pervasive, and resistant to change. Emergence of the disorder’s features no later than early adulthood (unlike depression, for instance, which can begin at any age).
  • Lack of awareness that behavior patterns and personality characteristics are problematic or differ from those of other individuals.
  • Impairment and distress in one or more areas of a individual’s life (often only after other individuals get upset about his or her behavior).
  • Behavior patterns that are not better accounted for by the effects of substance abuse, medication, or some other psychiatric disorder or medical condition (such as head injury).
What Causes BPD
What causes BPD? There’s no single reason why some people develop borderline personality disorder (BPD). Professionals can’t use things like blood tests or brain scans to help diagnose people.

BPD is a serious and complex psychiatric or mental illness. Individuals with BPD are often misdiagnosed and misunderstood. Childhood trauma history (e.g., sexual or physical abuse, early parental loss, neglect) is more common for people with BPD. Many individuals suffering from BPD may have developed BPD symptoms to cope with childhood trauma. However, it is essential to note that not all people with BPD have a history of childhood trauma.

It is also important to note that some of BPD symptoms overlap with those of several other DSM-5 diagnoses, such as bipolar disorder and posttraumatic stress disorder (PTSD). Thus, BPD diagnosis should be made only by an experienced and licensed mental health professional (whose range of practice includes diagnosing mental disorders) and then only after a comprehensive assessment over time. People with BPD frequently need considerable attention from their therapists and are typically considered challenging clients to treat. However, BPD may not be the chronic disorder it was once thought to be.

People with BPD often respond to proper BPD treatment and may have an excellent long-term prognosis, experiencing a remission of symptoms with a relatively low occurrence of relapse. The DSM-5 indicates that BPD is diagnosed more often in women than in men (75 percent and 25 percent, respectively).

Other research, however, has suggested that there may be no gender difference in prevalence in the general population but that BPD is linked with a significantly higher level of physical and mental disability for women than it is for men. In addition, the types of co-occurring conditions tend to be different for women than for men. The most common co-occurring disorders in women are major depression, anxiety disorders, eating disorders, and PTSD. Men with BPD are more likely to have co-occurring substance use disorder and antisocial personality disorder, and they are more likely to experience episodes of explosive or intense anger.

What Are the Symptoms of BPD?

The DSM-5 classifies mental disorders and includes specific diagnostic criteria for all currently recognized mental disorders. DSM-5 is a useful tool for diagnosis and treatment, but it is also a tool for communication, providing a standard language for researchers and clinicians to discuss symptoms and disorders.

According to the DSM-5, the symptoms of BPD include:

  • Intense fear of abandonment and efforts to avoid abandonment (real or imagined).
  • Turbulent, intense, and erratic relationships usually involve vacillating perceptions of others (from extremely positive to extremely negative).
  • Lack of a sense of self or an unstable sense of self.
  • Impulsive acts that can be hurtful to oneself (such as risky sex, excessive spending, reckless driving).
  • Repeated suicidal gestures or behavior or self-mutilating behavior.
  • Chronic feelings of emptiness.
  • Episodes of intense (and usually inappropriate) anger or difficulty controlling anger (such as repeated physical fights, inappropriate displays of anger).
  • Temporary feelings of paranoia (often stress-related) or severe dissociative symptoms (such as feeling detached from oneself, trancelike).

Anyone with some of these symptoms may need to be referred to a licensed mental health professional for a complete assessment.

Examples of Symptomatic Behavior (BPD)

Patterns of unstable and intense relationships Jonathan comes in to see his case manager, Luke, and announces that he plans to marry a woman he met at a speed-dating app the night before. Luke has heard this same story from Jonathan at least once a month for the past four months.

Emotions that seem to switch quickly from one extreme to another Susan has been working with a vocational rehabilitation counselor, Tom, for two weeks to prepare for job retraining. One day, just after Tom gets everything set up for Susan to start her training, Susan storms out of the office screaming at him, “You’re just trying to get rid of me! You don’t understand me at all! I hate you!” Later, when Tom calls to suggest that maybe Susan would prefer to work with another counselor, Susan starts to cry and says, “Please don’t drop me, Tony! I need you!”

Evidence of self-mutilation or self-harm. Joshua is a probation officer. During his weekly appointment with his client, Alice, Joshua notices a pattern of recent cuts across her left forearm. Joshua asks her about them, and Alice becomes defensive and says, “Okay, I cut myself sometimes, so what? It’s none of your business. I’m not hurting anybody!”

A pattern of suicidal thoughts, attempts, or gestures. Melanie is a nurse. As she looks over the health history of her new patient, Samantha, she notices that Samantha has been hospitalized three times in the past four years after suicide attempts, and that she has seen six different therapists. Samantha tells her, “Yeah, I get suicidal sometimes. I just can’t seem to find the right therapist who can help me.”

What Causes BPD
What causes BPD and should I be offered medication for treatment? There is no medication to treat BPD. But your doctor may offer you medication if you also have symptoms of another mental illness like anxiety or depression.

Intense displays of emotion that usually seem inappropriate or out of proportion to the situation. Julia is a social worker at a domestic violence shelter. She notices one of her clients, Elsa, sitting in the living room with a sketchpad in her lap. Julia asks if she can see what Elsa is drawing. Elsa turns the sketchpad around to reveal a beautiful, detailed drawing of the shelter house.

Julia admires it and says how beautiful it is, then says, “That’s funny, I thought that the house number was on the right side of the door.” Elsa, who had been smiling, takes the sketchpad from Julia, looks at the drawing, then rips it from the pad and begins tearing it up, saying, “You’re right, it’s all wrong! I’ll have to start all over again!”

Regarding the word gestures: It is dangerous to dismiss or label any suicidal behavior as a gesture. Anyone who exhibits suicidal thoughts or behaviors of any kind needs to be assessed by a licensed mental health professional.

What causes BPD

According to the National Institute of Mental Health (NIMH) [2], the cause of borderline personality disorder (BPD) is not yet clear, but research suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing borderline personality disorder.

Family History. People who have a close family member, such as a parent or sibling with the disorder may be at higher risk of developing borderline personality disorder.

Brain Factors. Studies show that people with borderline personality disorder can have structural and functional changes in the brain especially in the areas that control impulses and emotional regulation. But is it not clear whether these changes are risk factors for the disorder, or caused by the disorder.

Environmental, Cultural, and Social Factors. Many people with borderline personality disorder report experiencing traumatic life events, such as abuse, abandonment, or adversity during childhood. Others may have been exposed to unstable, invalidating relationships, and hostile conflicts.

Although these factors may increase a person’s risk, it does not mean that the person will develop borderline personality disorder. Likewise, there may be people without these risk factors who will develop borderline personality disorder in their lifetime.


There is no definitive medical test to diagnose BPD, and a diagnosis is not based on one specific sign or symptom. BPD is best diagnosed by a mental health professional following a comprehensive clinical interview that may include talking with previous clinicians, reviewing previous medical evaluations and, when appropriate, interviews with friends and family.

How common are personality disorders?

Personality disorders are among the most common severe mental disorders and often co-occur with other mental conditions, such as mood disorders (depression or bipolar disorder), substance abuse disorders (SUD), and anxiety disorders. It is estimated that 10 percent to 13 percent of the world’s population struggle in some form of personality disorder.

Most personality disorders start in the teen years when the personality continues to develop and mature. As a result, almost all individuals diagnosed with personality disorders are above the age of 18.

Some personality disorders—such as borderline personality disorder (BPD) and histrionic personality disorder—are more common in women, and others—such as obsessive-compulsive personality disorder and antisocial personality disorder—are more common in men. Many individuals in prison also have a diagnosable personality disorder.

BPD Treatment

What Causes BPD
What causes BPD, including its risk? It is common for people who live with BPD to self-harm. Some people find self-harming can help them to deal with painful feelings. But it can cause serious injury, scars, infections, or accidental death. A big focus of BPD treatment is to find other ways to deal with painful emotions.


Psychotherapy is the first-line treatment for people with a borderline personality disorder. A therapist can provide one-on-one treatment between the therapist and patient or treatment in a group setting. Therapist-led group sessions may help teach people with borderline personality disorder how to interact with others and how to effectively express themselves.

It is important that people in therapy get along with, and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with the disorder to maintain a comfortable and trusting bond with their therapist.

Two examples of psychotherapies used to treat borderline personality disorder include:

Dialectical Behavior Therapy (DBT): This type of therapy was developed for individuals with a borderline personality disorder. DBT uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. DBT also teaches skills that can help:

  • Control intense emotions
  • Reduce self-destructive behaviors
  • Improve relationships

Cognitive Behavioral Therapy (CBT): This type of therapy can help people with borderline personality disorder identify and change core beliefs and behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.


Because the benefits are unclear, medications are not typically used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat specific symptoms such as:

  • Mood swings
  • Depression
  • Other co-occurring mental disorders

Treatment with medications or medication-assisted treatment (MAT) may require care from more than one medical professional. Certain medications can cause different side effects in different people. Talk to your doctor about what to expect from a particular medication. 

Visit the We Level Up FL behavioral recovery center & talk with our addiction specialists. Tour the inpatient mental health treatment facility and see why we’re an established complex diagnosis treatment center. Visit patient community areas and lounges. There you can find outdoor areas for clients to recuperate and rebound. Witness for yourself how you too can feel at home at We Level Up FL’s behavioral center. The answers to your recovery, in large part, should include locating a reputed and well-qualified therapy program for your treatment.

If you have questions regarding your diagnosis or or want to learn more on what causes BPD, please contact us.

What Causes BPD
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[1] SAMHSA –

[2] NIMH –

[3] NCBI –