Signs & Symptoms
Symptoms
Symptoms of BPD are varied among sufferers and each individuals experience is unique, our psychologists will take care to analyse them and ensure that they are consistent and ongoing before making a diagnosis. BPD has nine main symptoms, and sufferers must consistently express at least five of these symptoms before a diagnosis can be made.
If you think you display some of these, it might be helpful to seek an assessment to clear your mind or begin your journey of recovery.
Quiet BPD
Someone with quiet BPD, will experience the same intense emotions of anger, shame, sadness and guilt. However, they tend to do so internally making it more difficult to identify. The symptoms are broadly the same but we have a page on the common signs of Quiet BPD (Discouraged BPD).
Chronic feelings of emptiness
People with BPD often describe feeling empty. Some describe it as a physical sensation in their chest or abdomen, like a hole that needs to be filled. These feelings can occur for a number of reasons, including being let down throughout life, expecting others to let them down, a lack of close relationships and shutting out feelings to stop the emotional surges. They often feel like there's something inherently wrong with them, and that it's their fault if bad things happen to them because they deserve them, like they’re a bad person, or not a real person at all. They may not be sure of these thoughts and may seek reassurance that they're not true. They often keep very busy to avoid feeling alone.
Intense, irrational fear of abandonment
People with BPD struggle to trust people. They can sometimes feel intense anxiety, fear or anger at the idea of being left alone or abandoned, even when this is unlikely to happen. They spend a lot of time anxiously looking out for signs that people might reject them. They might make efforts to try and prevent the perceived abandonment, such as begging, fighting, arguing or threatening.
However, they can feel that others are smothering, controlling or crowding them, which also provokes intense fear and anger. They may respond by acting in ways to make people go away, such as emotionally withdrawing, cutting contact or verbally abusing the other person.
All-or-nothing approach to relationships
People with BPD often view relationships in a black-or-white, all-or-nothing way, relationships quickly transition between idealisation (“I love everything about this person and can’t live without them”) to devaluation (“This person is the worst person in the world”), with no in between. Called: Splitting
This can be exacerbated by the another common symptom of paranoia (below) as after a splitting episode, behaviours by the partner or ex-partner are viewed with suspicion and considered to be with done with malice.
For many people with BPD, emotional relationships (including relationships with professional carers) involve "go away/please don't go" states of mind, which is confusing for them and their partners. Sadly, this can often lead to self-destructive cycles in close personal relationship and sometimes leads to sabotaging relationships for fear of abandonment, and break-ups are common.
Paranoia & dissociation
During times of stress, people with BPD may perceive threats or dangers that don’t exist. Paranoid ideation is a transient, stress-related type of paranoia in which the person baselessly feels threatened, persecuted, or conspired against and feel a deep mistrust and suspicion regarding the motives or intentions of others.
They may lash out at people they perceive as a threat or worry that others are judging them and respond by withdrawing from social groups in order to protect themselves from perceived dangers.
Dissociation refers to the feeling of being cut off or disconnected and detached from your body (depersonalisation) and one’s surroundings (derealisation). In this state, a person is removed or distanced from feelings, thoughts, and memories. Following dissociation memories of events can be permanently altered unless the person with the condition re approaches the memories which they often avoid due to the fear of more emotional distress.
Uncertain identity and/or low sense of self worth
People with BPD are prone to negative emotions with respect to themselves, such as self-disgust and shame. The feeling has been described as, like there's something inherently wrong with them, like they’re a bad person, or not a real person at all and that it's their fault if bad things happen to them because they deserve it. It’s common to people with BPD to fell as if no one understands them or they’re not like other people. The can also display perfectionist tendencies.
People with BPD might have sudden changes of mind about their careers, values, types of friends they have and other major life decisions. They might feel unsure about who they are as a person, or what they want to do in the future. People with BPD often report that they have no idea who they are or what they believe in. Sometimes, they report that they simply feel non-existent. Others even say that they are almost like a "chameleon" in terms of identity; they change who they are depending on their circumstances and what they think others want from them. Sometime this manifests in changing, names, personal appearances (hair styles, tattoos etc) and other inter personal facades (social media profiles etc).
Impulsiveness
People with BPD might behave impulsively as a way of easing their distress, despite the possible consequences. Some examples of impulsive behaviour are reckless driving, gambling, reckless spending, binge eating, unsafe sex and unsafe drug and alcohol use. Sometimes these behaviours are less obviously destructive such as changing jobs, hobbies, goals or plans.
Emotional sensitivity
People living with BPD are often emotionally sensitive. This means they can have sudden, intense emotional responses, even to minor events. Sometimes these emotions are positive and pleasant, but often they can be negative and overwhelming. It can take a long time for the person to return to a more stable mood. Managing these rapid, unpredictable surges in emotion can be overwhelming and leave the person feeling out of control. You may experience a range of often intense negative emotions, such as: sorrow, shame, panic, terror, rage & long-term feelings of emptiness and loneliness.
Suicidal or self-harming behaviour
People with BPD might deliberately physically harm themselves as a way to distract or get relief from emotional distress. Thoughts of suicide, and suicide attempts, are also common in people living with BPD, due to the intense emotional states they experience.
“Splitting”
Splitting is common symptom for people with BPD and one that if often the one first observed by others. Splitting is framing events or people in terms absolutes, good or bad, black or white, with no middle ground for discussion. This has a significant impact on relationships and leads to intense and self-destructive behaviours. Splitting also impacts self-esteem, as the “good or bad” thinking is applied to an individual's own self-image and how they perceive themselves.
“framing events or people in terms absolutes, good or bad, black or white”
They often lose the ability to accurately discern the behaviour or motives of others and stops them from being able to recognise or accept paradoxical qualities in someone or something, and doesn’t allow for any ‘grey areas’ in their thinking. It's a common defence mechanism that's done subconsciously in an attempt to protect against intense negative feelings such as loneliness, abandonment and isolation.
In order to limit the damage to their self-perception they will form a narrative to explain and externalise the perceived discomfort, making issues wholly the fault of another. They may abruptly lash out or sever contact with those they once idealised, appearing cold or cruel, causing a great deal of distress.
“lose the ability to accurately discern the behaviour or motives of others”
Seeing and responding to the world in these extremes, through either a filter of positivity or negativity, can leave a person with BPD exhausted and emotionally drained. It can also lead to strains or fractures in their relationships as those close to the person become more and more affected by their behaviour.
Life challenges
Borderline personality disorder can interfere with a person's ability to enjoy life or achieve fulfilment in relationships, work, or school.
Because it is a personality disorder, someone may not show signs of BPD until their personality develops, with diagnoses occurring only after patients are over 18 years of age.
Symptoms often appear and can create significant problems in the following areas:
Emotional instability is a key feature of BPD, there is often a marked sensitivity to rejection or criticism, and intense fear of possible abandonment. Individuals may feel like they're on an emotional roller coaster in life and their mood can shift quickly. The emotional reactions they experience are often intense and prolonged and disproportionate to the triggers. This is intensified by an acute sensitivity to the emotions of others, creating a destructive feedback loop where their distress impacts loved ones, which in turn exacerbates their own distress. These emotions are challenging to manage and can be overwhelming, leading individuals with BPD to employ various strategies to mitigate or escape the distress. These strategies may include rumination, thought suppression, experiential avoidance, emotional isolation, as well as impulsive and self-injurious.
They may also display emotional blunting or emotional numbing, characterized by reduced emotional reactivity and a limited expression of feelings verbally or nonverbally, even when discussing typically emotive topics. In this state, expressive gestures are infrequent and there is minimal animation in facial expressions or vocal tones, sometimes referred to as “shutting down” or appearing “cold”.
A diagnosis of BPD is commonly associated with feelings of betrayal, lack of control, and self-harm. The perception of rejection can impair one's ability to establish and maintain close relationships. While the sensitivity, intensity, and duration of emotional experiences in individuals with BPD can have positive aspects, such as enthusiasm, idealism, and a capacity for joy and love, it also makes them susceptible to being overwhelmed by negative emotions. This may include experiencing profound grief instead of mild sadness, intense shame instead of embarrassment, rage rather than annoyance, and panic over nervousness. They often feel trapped in intense emotional states, which can lead to destructive behaviours, feelings of fragmentation or identity loss, and perceptions of victimisation. Individuals with BPD endure chronic and substantial emotional suffering.
Emotions
Relationships
People with BPD face significant challenges in maintaining interpersonal relationships. A hallmark of BPD is a profound fear of abandonment by loved ones, which can result in difficulty trusting others and enormous efforts to avoid perceived or actual abandonment. This fear often leads to the belief that others have malicious intentions, placing considerable strain on relationships. Additionally, individuals with BPD exhibit heightened sensitivity to the behaviours and actions of others, making them acutely aware of and reactive to both perceived and real treatment by others. They may experience intense happiness and gratitude for perceived kindness, but also profound sadness or anger in response to perceived criticism or harm.
One notable aspect of BPD is the tendency towards idealisation and devaluation of others, known as "splitting." This involves oscillating between extreme admiration and deep mistrust or dislike, significantly impacting the dynamics of interpersonal relationships. Moreover, individuals with BPD typically exhibit internal splitting, fluctuating between viewing themselves as good individuals who have been mistreated (resulting in predominant anger) and bad individuals whose lives lack value (potentially leading to self-destructive or suicidal behaviour).
Despite a strong desire for intimacy, people with BPD may exhibit insecure, avoidant, ambivalent, or fearfully preoccupied attachment styles in relationships, complicating their interactions and connections with others. Family members, including parents of adults with BPD, may find themselves in a cycle of being overly involved in the individual's life at times and, at other times, significantly detached, contributing to a sense of alienation within the family unit.
Emotional dysregulation is another factor influencing relationship quality and overall satisfaction. Maintaining healthy relationships can be challenging for those who struggle with emotional dysregulation. Such individuals may externalise , internalise, or dissociate when exposed to stressors, attempting to regulate their emotions, though these behaviours are often ineffective in addressing relational stress.
Stress-related changes in thinking
Under conditions of stress, people with borderline personality disorder may experience changes in thinking, including paranoid thoughts (for example, thoughts that others may be trying to cause them harm) or dissociation (feeling numb, detached from their body or the world, dream like).
Dissociation
Individuals with BPD may experience dissociation, which can range from a mild to severe disconnection from physical and emotional experiences. Observers may detect signs of dissociation through reduced expressiveness in facial or vocal expressions, or an apparent detachment from emotional triggers.
Dissociation often occurs in response to distressing events or reminders of past trauma, serving as a psychological defence mechanism by diverting attention from the current stressor or blocking it out entirely. This process is believed to protect the individual from anticipated negative emotions and impulses that the current emotional situation might provoke and is rooted in the avoidance of intense emotional pain associated with past experiences. While this mechanism may provide temporary relief, it can contribute to unhealthy coping strategies and reduce the intensity of positive emotions, potentially hindering emotional insights important for informed decision-making in everyday life.
The experience of dissociation can include depersonalisation, derealisation, amnesia, identity confusion, and identity alteration.
Paranoid ideation
Paranoid ideation is a transient, stress-related type of paranoia in which the person baselessly feels threatened, persecuted, or conspired against. Someone experiencing paranoid ideation might feel a general suspicion regarding the motives or intentions of others. Research has identified the presence of both hallucinations and delusions in individuals with BPD who do not possess an alternate diagnosis that would better explain these symptoms.
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Is the feeling of being separate from your body. People who experience depersonalisation often say it feels like they are observing their own body from the outside, or as if they're in a dream.
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Like depersonalisation, derealisation is a feeling of being detached from the external world, including other people or objects. Familiar things can look strange, unreal, or unfamiliar.
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Some people experience periods of amnesia or "losing time"—from minutes to hours or even days. Even though they awake during these times, they cannot remember where they were or what they were doing.
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An experience of an inner struggle about who you really are. People might have a hard time figuring out who they are in relation to others.
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Is the sense that you are acting like a different person. For example, you see an object in your home that you don't recognize or perform a skill that you don't remember learning. Sometimes, you might become aware of identity alteration because other people in your life say that you are behaving like someone else.
Self image
People with BPD experience significant challenges related to the stability of their self-identity. They often report frequent fluctuations in self-perception, leading to confusion regarding their aspirations and goals in both personal relationships and career paths. These individuals may exhibit dramatic and rapid changes in their stance on life events, such as decisions about having children. Such inconsistencies contribute to a pervasive sense of emptiness and profound disorientation concerning their identity.
Their self-perception can fluctuate dramatically; one moment, they may feel good about themselves, but the next, they may think they are bad or even evil. This instability complicates their understanding of their own identity, including their roles in relationships, core values, self-standards, and their overall sense of place in the world. As a result, individuals with BPD might develop a fluctuating sense of self that is heavily influenced by their environment or the people they interact with, leading to a chameleon-like adaptation of identity. People with BPD often struggle with feelings that they are not good enough. They may doubt their actions, look for their faults, and be overly concerned with mistakes (see Perfectionism).
