Individuals with borderline personality disorder often appear more stable than they feel inside.
Fear of Abandonment
Individuals with borderline personality disorder fear abandonment, partly because they do not want to be alone.
Sometimes they feel that they do not exist at all, often when they do not have someone who cares for them.
They often feel empty inside.
When individuals with this disorder feel that they are about to be abandoned, they typically become fearful and angry. For example, they may become panicky or furious when someone important to them is a few minutes late or cancels an engagement.
They assume these missteps are caused by how the person feels about them rather than by unrelated circumstances.
They may believe that a cancelled engagement means the other person rejects them and that they are bad. The intensity of their reaction reflects their sensitivity to rejection.
Individuals with borderline personality disorder can empathise with and care for another person but only if they feel that other person will be there for them whenever needed.
Although they desire intimate relationships and care for others, it is difficult for them to sustain stable relationships.
They tend to have very high expectations of how the people they feel close to should act, and their feelings about a relationship may fluctuate rapidly and intensely.
Individuals with borderline personality disorder have difficulty controlling their anger and often become inappropriately and intensely angry.
They may express their anger with biting sarcasm, bitterness, or angry tirades.
Their anger is often directed at close friends, romantic partners, family members, and sometimes medical professionals because they feel neglected or abandoned.
After the outburst, they often feel ashamed and guilty, reinforcing their feeling of being bad.
Individuals with borderline personality disorder tend to change their view of others abruptly and dramatically. For example, they may idealise someone early in the relationship, spend a lot of time together, and share everything. Suddenly, they may feel that the person does not care enough and become disillusioned. Then they may belittle or become angry with the person.
They may be needy one minute and righteously angry about being mistreated the next. Their attitude fluctuates based on their perception of the availability and support of the others. When feeling supported, they can be vulnerable and needy, and when feeling threatened or let down, they can become angry and devalue others.
Individuals with borderline personality disorder may also abruptly and dramatically change their self-image, shown by suddenly changing their goals, values, opinions, careers, or friends.
The changes in mood usually last only a few hours and rarely last more than a few days. Mood may change because individuals with this disorder are so sensitive to signs of rejection or criticism in their relationships.
Impulsive Behaviour and Self-harm
Many individuals with borderline personality disorder act impulsively, often resulting in self-harm. They may gamble, engage in unsafe sex, binge eat, drive recklessly, have substance-use problems, or overspend.
Suicide-related behaviours, including suicidal attempts and threats and self-injury (for example, by cutting or burning themselves), are very common.
Although many of these self-destructive acts are not intended to end life, risk of suicide in these people is 40 times that of the general population.
About 8 to 10% of individuals with borderline personality disorder die by suicide. These self-destructive acts are often triggered by rejection, perceived abandonment, or by disappointment in someone they are close to.
Individuals may also harm themselves to express their feelings of being bad or to revive their ability to feel when they are not feeling real or feeling detached from themselves (called dissociation).
Individuals with borderline personality disorder often sabotage themselves when they are about to reach a goal, so that others will perceive them as struggling. For example, they may drop out of school just before graduation or ruin a promising relationship.
When these individuals feel very stressed, they may have brief episodes of paranoia, symptoms that resemble psychosis (such as hallucinations), or dissociation.
The stress is usually caused by feeling that no one cares for them (that is, feeling abandoned and alone) or feeling broken and worthless.
Dissociation includes not feeling real (called derealisation) or feeling detached from their body or thoughts (called depersonalisation).
These episodes are temporary and usually not severe enough to be considered a separate disorder