Individuals with borderline personality disorder, a mental health condition marked by unstable moods and reckless or impulsive behavior, often have trouble maintaining their friendships and romantic relationships. We’ll discuss the latest research on the condition, including findings that people with the disorder may have lower activity in the regions of the brain associated with empathy.

Ira Steinman, San Francisco-based psychiatrist and author of "Self Psychology and Psychosis: the Development of the SELF during the Intensive Psychotherapy of Schizophrenia and the other Psychoses"
Winston Chung, psychiatrist at Sutter Pacific Medical Foundation
Sanno Zack, clinical assistant professor, psychiatry and behavioral sciences, child and adolescent psychiatry at Stanford School of Medicine
Roopa Grewal, someone living with borderline personality disorder

  • Beth Grant DeRoos

    Does Borderline personality disorder (BPD) begin at any age,one gender over the other , or have similarities with schizophrenia or neurological issues like autism?

    • A Different Perspective

      BPD is one of the most complex and contested personality disorders, especially on account of its correlation with histories of trauma, abuse, developmental and attachment issues. Temperament and genetic disposition are vulnerability factors influencing any diagnosis. In particular, females are stereotypically diagnosed more often with BPD while males are characterized with Ant-Social Disorder (ASD).

    • Roopa

      I agree with Irvin, though I believe where females are stereotypically diagnosed with BPD, males are diagnosed with PTSD. BPD is a “personality” disorder while PTSD is an “anxiety” disorder. In my opinion, they are two sides of the same coin.

      • Andy M

        That is very interesting. I would think that the resistance to a BPD diagnosis & treatment by some might be circumvented by calling it PTSD. It is a “work around” but might get some people through the door and into treatment

  • loujudson

    My stepson was extremely abused psychologically by a BPD wife of 12 years, soon to be ex. Among the “Welcome to Oz” community, it is widely seen that many BPDs are unwilling to accept a diagnosis, simply putting the dysfunction on their partners. It is very close to a narcissitic condition, as they deny their problem almost universally. He exhibited all the symptoms of PTSD, and now over a year after separation is still in recovery from the abuse he suffered. I hope you can address the unwillingness to be diagnosed by BPDs!
    Also, how much of it can be attributed to parental influences, and will her daughter repeat the undiagnosed characteristics?
    Thanks for addressing this problem which is still too hidden.

    • Roopa

      Please listen when I am on in a few minutes….

      • loujudson

        Thanks you! I am all ears.

      • Another Mike

        Roopa sounded normal to me.

        • Roopa

          Thank you! I don’t consider myself normal, but I do feel that I am healthy.

        • Beth Grant DeRoos

          Is there any one that is actually ‘normal’? (smiling)

          • boso bohso bosso Bozo

            re: anyone normal: like they say everybody’s crazy except you and me and i’m not so sure about you — or krasny — ;-))

    • Roopa

      BPD is often accompanied by Narcissistic Personality Disorder. BPD is a huge umbrella under which people may have other conditions. Personally, I have depression and OCD under my BPD umbrella. Others have Bipolar Disorder, drug addiction, etc. BPD is a complex mental illness that sometimes contains other disorders.

  • Another Mike

    Maybe no one wants to do long-range diagnosis on current celebrities, so were there any historical figures who suffered from BPD?

    • Roopa

      Think of Lisa (Angelina Jolie) and Susanna (Wynona Rider) in “Girl, Interrupted” or Elizabeth Wurtzel in “Prozac Nation.” The books are even better than the movies. Some say Vincent van Gogh, Marilyn Monroe, Zelda Sayre Fitzgerald and Amy Winehouse had BPD. Angelina Jolie, Courtney Love, Brandon Marshall, Anna Nicole Smith, Darrell Hammond all exhibit symptoms of the disorder.

      • Jenny Smith

        Don’t forget Darth Vader

  • cynthia

    This is anecdotal, but seems to mirror much that research supports– that a combination of methodologies is most effective. I practiced DBT and psychodynamic psychotherapy as an intern. The patients with whom I was able to supplement the group DBT work with weekly hours of psychodynamic work had more success (subjectively speaking, but also in that these clients never dropped out of either the group or individual sessions. If I was not seeing the patient individually, the DBT group patients to a one disappeared frequently or all together.)

    • cynthia

      these of course were all patients diagnosed (or co-occurring) with BPD.

  • Karen

    Do women with borderline personality improve with hysterectomies?

    • Jenny Smith

      Not in my mother’s case

    • Madeline

      No. I had a partial hysterectomy at the age of thirty. Some of my angst was alleviated by the relief of the symptoms causing the procedure/fibroids/cramping/bleeding, but the BPD which was not diagnosed until I was in my late 50’s was still present. I guess that your question has to do with ovulation/cycles? I did go through menopause in my late 40’s but again would say that my BPD was still evident if not stronger. DBT, therapy and understanding more were very helpful. Medication was not helpful yet meditation has been extremely important.

  • KF

    If someone with BPD is resistant to therapy and will not handle a diagnosis, what tips do you have for family dealing with a high functioning BPD person? What do you recommend for our own self care, and what do you recommend to help modify their behavior (if possible) and help them at home?

    • Roopa

      Please check out the Family-to-Family program through your local NAMI affiliate. It is a ten-week class that meets once a week for family members of those who have a mental illness. It is taught by family members and is strictly for family members (not individuals with a mental illness).

    • george

      If you think you have it, see a doctor. This woman from Stanford sounds pretty good. If you don’t think you have it, stop obsessing about it.

  • Dan

    You were great Roopa and very courageous. Thank you for sharing your story.

  • I had the extreme misfortune of having a roommate with BPD. After doing a bit of reading on the subject, I learned that he suffered from “Cluster B” BPD–the most toxic type of this disorder that includes Narcissistic and Histrionic Personality Disorders. This individual was very self-aware of his disorder, even obsessed with it, and was continually seeking therapists whom he would discard as soon as he suspected that they were on to his game. He used his “diagnosis” as a means of eliciting sympathy, and as yet another victimhood status–his very own special “disability”.

    From the lay person research that I’ve done, Cluster B BPDs are pretty much impossible to treat in a therapeutic manner. Although this may sound harsh, this particular type of BPD seems to be psychiatry-speak for “irredeemable A-Hole”–quite simply, not a good person. I do realize that the non-Cluster B BPDs are not necessarily such dangerous and toxic individuals–perhaps just “difficult types” with their own set of challenges.

    I could write a book–and it would be a horror story–about my ex-roommate’s reign of terror, but I long ago decided to stop dwelling upon that unfortunate time of my life in order not give those memories any power over my current blessedly ordinary life. However, as a warning, if you have anyone close to you who exhibits any of the Cluster B BPD traits, take any and all actions to distance yourself as much as humanly possible from that person–for your *own* sanity!! (I was “lucky” enough to have the SFPD intervene when my ex-roommate was arrested and later convicted for a 6-figure credit card fraud scheme.)

    • Jenny Smith

      Not really sure what you mean by ‘non-cluster B’ BPD. BPD is part of cluster B. It can’t not be part of cluster B. Do you mean that he had all of the cluster B personality traits i.e., NPD etc along with BPD? I’d like to know what a non-cluster b BPD looks like…

  • Andy M

    I am in a relationship with a young man who sounds like he may be on the borderline spectrum. Ours is no longer a romantic relationship–more of a father son relationship now. I am at the at the end of my tolerance with our interaction–the chaos and drama overwhelms my life and I need to refocus on my own tasks and goals. He is a chronic pot smokers and I think he uses it to self-medicate his extreme emotions. I don’t know that I can remain in his life at this point–hearing,”I hate you, don’t leave me,” sounds familiar–but I love and care for him and would like to direct him to helpful services. What are opinions in the bay area for some one with insurance coverage?

    • Roopa

      Compared to ten years ago, it is very easy to get treatment now in the Bay Area. I would go to your insurance panel and look up DBT therapists. If they do DBT, they are comfortable treating those with BPD/PTSD and believe in their recovery.

      • Andy M

        Thanks. You are a wealth of information. And thank you for openness on todays forum.

  • Karla Clark

    In the latter part of the 20th century, Dr. James Masterson developed a theory of the etiology and treatment of borderline personality. He observed that the patient who became borderline often had a characteristic pattern of relationship with caregivers during childhood. Briefly, these children experienced caregivers as rewarding deviant or regressive behavior and subtly punishing the child for autonomy and/or psychological attempts to grow up by threatening emotional abandonment on the part of the caregiver.
    He developed a treatment protocol based on this theory which actually had a high rate of success in improving functioning. Problem was that the technique was very difficult to teach and took the practitioner a long time to learn. The patients got better, but that also took a long time.
    I was a student of Mastersons and spent much of my professional life treating borderline patients as well as those with related personality disorders. What can I say? It worked, was effective and powerful. I wonder if the panel is familiar with this work, whether elements of it are of use to you now?

  • Niuniu Teo

    Could the panel talk a little about what “correct” bpd treatment looks like? is it just a difference of meds or is there a difference in how to interact and connect to these patients as well?

    • Roopa

      For me, it was DBT, Dialectical Behavior Therapy, which included my weekly DBT group, my weekly appointments with a psychologist and staying on my meds. DBT is the key to getting better. Marsha Linehan developed it specifically for those with BPD and PTSD. Feel free to look it up.

  • Sam Badger

    I totally agree with the point about the name – the implication is that the BPD person has something akin to narcissism or sociopathy.

  • KF

    Does BPD appear more frequently in certain cultural groups? For example, my BPD person is a woman from Latin America. Many of these traits can often be seen as normal emotional expressions of a latin woman, so they go unseen or people let the extreme emotional reactions go untreated because we assume its just cultural.

    • george

      I believe it does. It is very common in Russian and Latin American women, especially women from Brasil. However, I know cases when a man has BPD, but keeps transferring it to a woman in order to appear normal.

  • Winjas

    Can someone please explain the difference between BPD and narcissistic personality disorder? I know NPD’s and they are bullies and a nightmare to interact with.

    • Patrick Mathia

      Actually they have many similarities and some personality researchers argue
      that borderline is the female equivancy of narcissism (more males are diagnosed
      with narcissism than females by a large proportion). The promary distinguishing
      feature is a history of abuse leading to a maladaptive coping mechanism. These
      women (I say women because they often are) often grow up in chaotic and
      demoralizing households and use these behaviors to cope, the problem is it
      sticks around and leads to long term negative behavior. Due to these early negative relationships they fear abandonment and over react whereas narcissists fear criticism and overcompensate through criticism and maladaptive responses. Women with BPD can recognize their errors and often feel shame and guilt for their responses. Through therapies such as DBT they can learn better coping mechanisms and recognize their mistakes
      whereas narcissists don’t see a reason for change.

      Here is a good link to learn more

  • Maya

    Thank you for this valuable discussion. Since borderline personality disorder has been stigmatized for so long, I think it’s especially important that we be careful of the language we use…a person is not “a borderline.” A person is many things and may be “living with” borderline personality disorder.

  • Angela M.

    My daughter had a bipolar diagnosis, with a possible diagnosis of borderline Personality Disorder. She fits all the diagnostic criteria, yet her doctor is reluctant to give a diagnosis because of her age (now 20). Would there be any benefit to her in terms of treatment to add the borderline diagnosis, and are there divergent treatments for each disorder?

    • Jenny Smith

      I believe that bipolar, being an Axis 1 disorder, is treatable via medication, whereas BPD, an Axis 2 disorder, is not (well, it’s not the main treatment anyway – psychotherapy is, especially DBT). So I think they are treated in different ways.

  • BB

    KQED – Could you please share the resources mentioned by Sanno Zack at the end of the show? Thank you.

  • MelFC

    I’m wondering how the genetics works for borderline. My mother was borderline, and she had a brother who was alcoholic and another brother with antisocial personality. Can the same genetic problem manifest as different disorders? I inherited depression/anxiety, which is luckily well-handled by medication.

  • Anne

    Any thoughts on the relationship between BPD and PDA? PDA, or Pathological Demand Avoidance, is a kind of high functioning autism spectrum disorder characterized by unstable mood, lack of empathy, inability to cooperate effectively or consistently, aggressive outbursts and underlying anxiety. It has developmental components as well, including passive infancy and being late to talk but showing rapid catch up. Google it; the UK has the most information.

  • Tamra Sattler

    As someone who works with the spectrum of bpd or borderline characteristics almost daily as a therapist and researcher… a wonderful source for support is, also a video is border _ on youtube as another resource (up to date statistics), i wish there was a therapist on the call to give the one on one weekly or bi-weekly point of view. A few points…get in your body (dance, yoga, walk, etc), get a wonderful therapist where you feel seen/validated, in addition to dbt group, and if there is a way to get distance and perspective on situations like meditation it may help with over personalizing. Thankfully I have seen incredible success from these wonderfully creative, wise, beautiful and courageous clients.

    • Fedros Samadani

      Hello Tamara, I saw your reply on KQED Forum discussion on BPD and am wondering if you are a practicing Psychiatrist or neurologist and if so where are you located?
      Fedros Samadani
      Los Gatos, CA

      • Tamra Sattler

        i am a therapist with a phd. and i am located in boulder colorado and still have an mft in california;-)

  • Ruth

    I know of a young woman, 26 years old, who was just recently diagnosed with BPD. She has 2 year old twins and just started DBT. While she seems to be doing well with her treatment plan,( her children are not living with her know) CPS will be returning the kids to her care. I am a bit afraid that the kids maybe in some physical harm, which is why they were removed in the first place. any advice ?

    • Blackyogini

      That’s something CPS has a lot of experience with and its really between her, CPS and her treatment team. The fact that she’s getting help at all should be enough to reassure you that she has her children’s welfare at the forefront of her concern

  • Bobby

    Can you pls explain treatment for co-occuring disorders with BPD, pls. My 21 daughter is diagnosed with BPD and suffers an ED which I’ve been told cannot be treated by an ED specialist but rather need to be treated by a BPD specialist using perhaps DBT?? Does anyone have an experience or advice on this pls.

    • Blackyogini

      There are treatment centers that treat BPD and ED which are very often coocurring with women such as Timberline Knolls in Illinois

  • greedierthanyou

    Brava to the woman with BPD who volunteered to speak out about her condition. What a huge service to society. Thank you.

    • Lisa Anne Skonieczki

      I am just realizing that I too have BPD 1st I was looking at Bipolar and a link brought me to a website…I broke down in tears onowing all the hurtful things Ive done to the man I love amd oushed him and blamed him for everything. ..I am so going to beat this and change I want to be happy and allow love in my life…its only a prison sentence if we allow it…speaking of what I believe I have has already helped me feel better…I am not ashamed rather know something is wrong then to think I am just this unstanle…good luck to all..have faith n conquer! Xo Peace!

  • Dharan

    This was so very informative. I cannot believe I live just a mile from Stanford and had not heard of DVT. My sister has been suffering from mental illness – until today only one of our friends who is a psychiatrist has diagnosed her (without seeing her) with BPD. Rest here as well as in India swear she is either just clinically depressed or has Bipolar disorder. She is 46 now Roopa and it is a shame the system has completely failed her. My aging parents who are 80 years old and her husband are having such a hard time understanding and helping her.

    Hard as it is to seek medical help, it is harder to feel the repercussions of misdiagnosis and treatment. From what I heard yesterday, it feels like she fits the bill for BPD.

    I wonder if I can talk to Dr. Zack some day, and to Roopa sometime. Is there some way I can reach you, Roopa. At least if I intervene now, there might be some semblance of normalcy we can hope to collectively achieve. Anything can be better than where we are.

  • liz

    I am interested in learning more about treatment for family members of the BPD. I have an extremely borderline mother who thinks there is nothing wrong with her. She is constantly splitting and lashing out, the insults she hurls are beyond cruel. Multiple psychiatrists and DBT therapists have refused to continue treatment with her because she is so combative and manipulative. This has been gut wrenching for my family. I don’t see her changing (she is 75 years old) but how can we survive this? Any suggestions would be appreciated.

  • Bubba Nicholson

    Borderline Personality and related disorders can be alleviate instantly and permanently with oral administration on a chewing gum vehicle of approximately 250mg of healthy adult male facial skin surface lipid “kissing daddy” pheromone in a single sitting.

  • I just listened to this podcast on the advice of a patient of mine. It’s a good introduction to a complex area. The crucial take-home message is that BPD is treatable and can get better. While it can be (often is) miserable for family, coworkers, lovers, and even treating therapists, it’s even more miserable for the person who has it. There are storms of overwhelming feelings. It’s hard to hold a job, keep friends, or maintain any sort of stability in one’s life. One of the common symptoms, not mentioned in the show, is self-harm, such as cutting or burning oneself. Not a fun way to live.

    As Dr. Steinman noted, there are several successful psychotherapy approaches. The most popular and well-known is DBT, which emphasizes controlling self-harm, and balancing awareness of feelings vs. being overwhelmed by them. Other types of therapy put more emphasis on trauma or abuse that may have triggered (or worsened) this condition in childhood. There may also be a role for medication — but it’s a supporting role at most, not the main treatment.

    The show is titled “The Latest Research on BPD,” yet the research raised more questions than it answered. Whether empathy centers in the brain are high, low, or indifferent doesn’t help us treat BPD or contain its damage. What matters is a willingness to get help for this miserable problem from a competent, engaged therapist or clinic.

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