What Causes BPD? Symptoms, Diagnosis, & Treatment

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By We Level Up FL Treatment Center | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: April 28, 2023

What Causes BPD & What Is Borderline Personality Disorder?

BPD is among several personality disorders (such as paranoid personality disorder, narcissistic personality disorder, and 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 deviate significantly from the usual expectations of the behavior of the individual’s culture.
  • Behavior patterns that are inflexible, pervasive, and resistant to change. The emergence of the disorder 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 an individual’s life (often only after others get upset about their 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).

BPD is a severe 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 men (75 percent and 25 percent, respectively).

Other research 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 for men. In addition, the types of co-occurring conditions tend to be different for women than men. Women’s most common co-occurring disorders 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 Kind of Trauma Causes BPD? What are the Causes of BPD?

What trauma causes BPD? Several environmental factors seem to be widespread among people with BPD. These include:

  • Being a victim of emotional, physical, or sexual abuse.
  • Being exposed to long-term fear or distress as a child.
  • Being neglected by one or both parents.
  • Growing up with another family member who had a severe mental health condition, such as bipolar disorder or a drink or drug misuse problem.

A person’s relationship with their parents and family strongly influences how they come to see the world and what they believe about other people. Unresolved fear, anger, and distress from childhood can lead to a variety of distorted adult thinking patterns, such as: 

  • Idealizing others.
  • Expecting others to be a parent to you.
  • Expecting other people to bully you.
  • Behaving as if other people are adults and you’re not.
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.
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.

Learn More:

Borderline Personality Disorder Statistics

BPD is best managed with an interprofessional team, including psychiatrists, psychologists, pharmacists, mental health nurses, and social workers. In the United States, recent research has shown that 1.6% of the population has BPD. That number may seem small, but when you consider just how large the United States is, you may realize that 1.6% represents quite a large number of people. Borderline personality disorder is one of the most challenging mental health disorders to manage. [1]


It’s estimated that 1.4% of the adult U.S. population experiences BPD.

Source: NCBI


Nearly 75% of people diagnosed with BPD are women.

Source: NCBI


Surveys have estimated the prevalence of borderline personality disorder to be 20% in the inpatient psychiatric population.

Source: NCBI

Borderline Personality Disorder

Facts Sheet

Individual talk therapy may successfully treat BPD. In addition, group therapy and books about borderline personality disorder can sometimes be helpful. Medications have less of a role in the treatment of BPD. But in some cases, they can improve mood swings and treat depression or other disorders that may occur with this condition.

BPD Treatment

BPD was once thought untreatable. However, this isn’t the case, and we now know there are effective treatments for BPD. Many people with BPD find relief from distress through therapy.

Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) was developed by psychologist Marsha Linehan. This form of therapy teaches you to live and cope with difficult and overwhelming emotions. DBT is the most common form of treatment for BPD. Each skill set helps alleviate symptoms associated with BPD.

Dialectical behavioral therapy teaches you four main skill sets:

  • Interpersonal effectiveness
  • Emotional regulation
  • Distress tolerance
  • Mindfulness

Mentalization-Based Therapy

Mentalization-based therapy helps you develop an awareness of your inner state. Another significant focus of mentalization-based therapy is developing empathy for other peoples’ experiences.

Research in 2018 suggests that this therapy could significantly reduce the severity of BPD symptoms and the severity of co-existing conditions and improve quality of life. The authors note that more research is still needed, though.


No single medication is effective for BPD, but medications may relieve some symptoms.

For example, medications may help with mood stabilization. If you think medication might help you, consider talking with a doctor about your symptoms.

When to Contact a Medical Professional

See your provider if you or someone you know has symptoms of borderline personality disorder. It is especially important to seek help immediately if you or someone you know is having thoughts of suicide.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number immediately. DO NOT leave the person alone, even after you have called for help.

If you think you may benefit from borderline personality disorder therapies, you can contact We Level Up FL for treatment resources.
If you think you may benefit from borderline personality disorder therapies, you can contact We Level Up FL for treatment resources.

[2] Source: Borderline personality disorder – U.S. Department of Health and Human Services National Institutes of Health

What Are the Symptoms of BPD?

The DSM-5 classifies mental disorders and includes specific diagnostic criteria for all recognized mental disorders. DSM-5 is a valuable 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, and 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 or 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 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 suggests 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 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.
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 usually seem inappropriate or disproportionate 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. A licensed mental health professional must assess anyone who exhibits suicidal thoughts or behaviors.

What is BPD Caused By? What causes BPD?

What causes a person to have BPD? According to the National Institute of Mental Health (NIMH) [2], the cause of borderline personality disorder (BPD) (how do you develop borderline personality disorder) is not yet clear. Still, research suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role or may increase the risk of developing a borderline personality disorder. What are the main causes of BPD?

Family History. People with a close family member, such as a parent or sibling with the disorder, may be at higher risk of developing a 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 unclear 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 they will develop a borderline personality disorder. Likewise, people without these risk factors may develop borderline personality disorder in their lifetime.

What Causes BPD in The Brain? What Causes BPD to Develop?

Problem with brain chemicals

What is the cause of BPD? Many BPD sufferers are known to have issues with their brain’s neurotransmitters, especially serotonin. Your brain uses neurotransmitters, often known as “messenger chemicals,” to send signals between brain cells. Serotonin imbalances have been linked to sadness, violence, and difficulty resisting harmful urges.

Problem with brain development

BPD what causes it? The brains of those with BPD have been examined by researchers using MRI. Strong magnetic fields and radio waves are used in MRI scans to create a detailed image of the inside of the body. The scans showed that three brain regions exhibited very high or low activity levels in many BPD patients. Such components were:

  • The amygdala, which is crucial for controlling emotions, especially those that are more “negative,” such as fear, anger, and anxiety.
  • The orbitofrontal cortex, which is involved in planning and decision-making,.
  • The hippocampus, which aids in behavior regulation and self-control.

Issues with some brain regions may be a factor in the symptoms of BPD. Your early environment has an impact on the way certain brain regions grow. These regions of the brain are also in charge of controlling your mood, which may explain some of the difficulties people with BPD face in intimate relationships.


There is no definitive medical test to diagnose BPD, and a diagnosis is not based on one specific sign or symptom. A mental health professional best diagnoses BPD 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 Do People Get BPD? What Causes Someone to Have BPD?

What can cause BPD? Healthcare providers believe BPD results from a combination of factors, including:

  • Childhood abuse and trauma: Up to 70% of people with BPD have experienced sexual, emotional, or physical abuse as a child. Maternal separation, poor maternal attachment, inappropriate family boundaries, and parental substance use disorder are also associated with BPD.
  • Genetics: Studies show that borderline personality disorder runs in families. If you have a family history of BPD, you’re more likely — but not guaranteed — to develop the condition.
  • Brain changes: In people with BPD, the parts of their brain that control emotion and behavior don’t communicate properly. These problems affect the way their brain works.

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. Approximately 10 to 13 percent of the world’s population struggles with personality disorder.

Most personality disorders start in the teen years when the personality develops and matures. As a result, almost all individuals diagnosed with personality disorders are above 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


Psychotherapy is the first-line treatment for people with borderline personality disorder. A therapist can provide one-on-one treatment between the therapist and the 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 effectively express themselves.

People in therapy must get along with and trust their therapist. The very nature of borderline personality disorder can make it difficult for people with it to maintain a comfortable and trusting bond with their therapist.

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.
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.

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

Dialectical Behavior Therapy (DBT): This type of therapy was developed for individuals with 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 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 other people. Talk to your doctor about what to expect from a particular medication. 

Reach out today! What Causes BPD
Reach out today!

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

What Cause BPD? FAQs

  1. Can BPD cause hallucinations?

    BPD patients can experience hallucinations or even delusions similar to schizophrenia. Patients with BPD had higher scores in Psychotic Symptoms Rating Scales (PSYRATS) in the amount and degree of malicious content and distress from auditory verbal hallucinations than patients with schizophrenia.

How to Improve Mental Health? 8 Steps & Tips for Maintaining Your Mental Wellbeing Video

8 Steps for Mental Wellbeing & How To Improve Mental Health In The Workplace

  1. Staying Positive
  2. Practicing Gratitude
  3. Taking Care of Your Physical Health
  4. Connecting With Others
  5. Developing a Sense of Meaning and Purpose in Life
  6. Developing Coping Skills
  7. Meditation
  8. Relaxation Techniques
Search What Causes BPD Topics & Resources

[1] SAMHSA – https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4879.pdf

[2] NIMH – https://www.nimh.nih.gov/health/publications/borderline-personality-disorder

[3] NCBI – https://www.ncbi.nlm.nih.gov/books/NBK430883/

[4] 18 Signs You Grew Up With ‘Quiet Borderline Personality Disorder’ – The Mighty Available from: https://themighty.com/topic/borderline-personality-disorder/quiet-borderline-personality-disorder-bpd-signs-child/

[5] National Collaborating Centre for Mental Health (UK). Borderline Personality Disorder: Treatment and Management. Leicester (UK): British Psychological Society (UK); 2009. (NICE Clinical Guidelines, No. 78.) 2, BORDERLINE PERSONALITY DISORDER. Available from: https://www.ncbi.nlm.nih.gov/books/NBK55415/

[6] Borderline Personality Disorder – National Institute of Mental Health (NIMH)

[7] Subbarao BS, Silverman A, Eapen BC. Seizure Medications. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482269/

[8] Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017 Jun;19(2):93-107. DOI: 10.31887/DCNS.2017.19.2/bbandelow. PMID: 28867934; PMCID: PMC5573566.

[9] Olabi B, Hall J. Borderline personality disorder: current drug treatments and prospects. Ther Adv Chronic Dis. 2010 Mar;1(2):59-66. DOI: 10.1177/2040622310368455. PMID: 23251729; PMCID: PMC3513859.

[10] Borderline Personality Disorder – MentalHealth.gov U.S. Department of Health & Human Services