Unlike other mental health disorders that cause symptoms for long periods of time, patients with borderline personality disorder (BPD) typically experience their symptoms in intense bouts that last from just a few hours to weeks or months. Patients with BPD may share characteristics associated with other mental disorders, including other personality disorders, anxiety disorders and schizophrenia. They have great difficulty controlling emotions and impulses and may experience frequent mood swings. Because their emotions are so unstable, they may experience disruptions in family, work life and long-term planning.

The instability associated with BPD may also disrupt the patient’s sense of self-identity. Marked impulsiveness is a hallmark of the disorder, and it is not unusual for people with BPD to suddenly shift their goals, values and opinions. They also may alter plans regarding their career or type of friends. Patients with BPD have a habit of undermining their efforts just as they are about to reach a goal. For example, they may drop out of school before graduating or quit therapy after making substantial progress. Patients with BPD may engage in risky behaviors, such as excessive spending, binge eating and unsafe sex.

People with BPD desperately need love and fear abandonment, but their regular, explosive mood changes make it difficult to maintain close relationships. They often have intense and stormy relationships in which they initially idealize potential caregivers and lovers, sharing intimate details of their lives early in the relationship. However, this may change quickly later on, and the patient tends to believe their loved one does not care enough about them. For example, a person with BPD may take a spouse’s late arrival for a prearranged meeting as a sign of the spouse’s abandonment. This may send the patient into rage or despair. The belief that the patient may have been abandoned can lead to dramatic shifts in self-image, thought, emotions and behavior.

When people with BPD feel isolated, they may undertake extreme efforts to avoid being alone. Patients with BPD can engage in self-destructive behavior, particularly when feeling abandoned. They have high rates of self-injury, such as cutting or burning themselves, though whether these are true attempts at suicide is still uncertain. Severe cases of BPD result in significant rates of suicide attempts and completed suicide.

Other symptoms associated with BPD include:

• Extreme sarcasm, bitterness and verbal outbursts, followed by periods of guilt
  
  
• Intense anger, including physical fights
  
  
• Chronic emotional numbness
  
  
• Fears of being alone
  
  
• Periods of paranoia
  
  
• Symptoms that resemble psychosis (e.g., hallucinations) during periods of stress