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Borderline: symptoms, diagnosis, forms of therapy

Borderline syndrome

One wrong word is enough to bring the barrel to overflow. A spilled glass is enough to change the mood. Without warning, an irrepressible anger erupts, despair spreads, and the emotional balance in people with borderline syndrome is imbalanced. Often those affected are not even 30 when the inner tension becomes unbearable, the level of suffering so high that they have to injure themselves just to feel themselves.

Borderline describes the roller coaster
between self-love and self-hatred.

The good news: stability and structure can help. Long-term therapies can give borderliners a life-affirming everyday life by building their self-esteem. In this way, many young adults manage to control their emotions and build stable relationships and even start a family.

The borderline syndrome in numbers

In Germany, around 2% of the population suffer from borderline syndrome, that is around 1.6 million people. Young people in particular suffer from the disease. They make up a share of 5%. In clinics that treat mental disorders as inpatients, around 15% of patients are borderline patients. Around 20% of outpatient therapies are used by people suffering from borderline diseases.

A high suicide rate of 5-10% and a self-harm rate of 69-80% are striking. The highest risk of suicide is between the ages of 20 and 30. Age. Although borderline disorder can be genetic, at least 70% of the time, chronic trauma, such as sexual abuse and / or emotional neglect, occurs in childhood. About 80% of the patients in therapy are female.


“Friend today, enemy tomorrow - people with borderline syndrome
suffer from their extremely unstable emotional world. Psychotherapy is demanding,
but the most effective means to enable functioning relationships. "
Marian Grosser, doctor

Definition of Borderline Personality Disorder: The Unstable Inside

Borderline syndrome is an emotionally unstable personality disorder characterized by impulsiveness and instability. It is the inability to control inner emotional states. These states of tension are felt to be unbearable.

The World Health Organization (WHO) distinguishes between two borderline types:

  • the impulsive borderline type, which is particularly noticeable through impulsiveness and unpredictability,
  • and the borderline type, which is mainly characterized by a disturbed self-image and relationship behavior.

To change these conditions, borderline patients develop certain strategies, such as self-harm by cutting their skin with knives or razor blades or getting burned. Drug use or other dangerous behaviors such as balancing on bridge railings or lawning on the highway are used as methods of stress relief.

The desire for a state of peace and security induces those affected to do so and calls up this pattern in situations of tension. The forms of self-harm are not to be understood as attempted suicide. It only serves to reduce tension and self-regulation. The intense tension results in a stress-dependent reaction that leads to the body no longer feeling pain.


Some sufferers see themselves in a fog and are no longer able to move or speak.


In addition to states of tension, borderline patients also experience intense emotions such as guilt, shame, powerlessness and self-contempt. This world of emotions influences their relationship life. The large fluctuations in self-esteem make a satisfactory relationship difficult. The fear of being abandoned is a central aspect of the disease and can reach an existential level.

Often there is a coexistence of a longing for security and a pronounced fear of social closeness. The constant apparent insecurities in the interpersonal area in turn lead to states of tension.

This creates a continuous cycle and it is seldom possible for those affected to break out on their own. Partnership relationships often fail because the healthy partner cannot cope with the emotional, mood and self-esteem fluctuations of the borderline patient, but interpersonal problems at work also have a negative effect on social functioning.

Diagnosis borderline: when the suspicion becomes certainty

The first step towards diagnosis is a thorough medical history by the specialist. For the anamnesis, not only the patient but also, if possible, other caregivers, especially the parents, are interviewed. For the diagnosis, other mental disorders, some of which are accompanied by similar symptoms, must be ruled out. These include, for example, schizophrenic disorders and behavioral disorders.

The following questions are important to determine if you have Boderline Personality Disorder:

  • Did the symptoms appear in childhood or adolescence?
  • Are the symptoms typical for the person affected? (e.g. aggressive behavior not only towards the mother but also towards classmates)
  • Do the symptoms occur in different life situations?
  • How high is the personal, psychological suffering of those affected?

In the case of the borderline personality, the experience and behavior of those affected deviate significantly from the norms in at least two of the following areas:

  • Cognition: Affected people see and interpret their environment differently than other people.
  • Affectivity: Your emotions are more intense than usual and they respond inappropriately.
  • Impulse control: Affected people have difficulty controlling their impulses and have the urge to satisfy needs immediately.
  • Relationships: Relationships with other people are disturbed.

In order to be able to make the diagnosis of a borderline personality disorder (according to ICD 10), at least three of the following characteristics must apply:

  • Clear tendency to act unexpectedly and without considering the consequences (lack of impulse control)
  • Clear tendency to quarrels and conflicts with others, especially if impulsive actions are prevented or reprimanded (anger)
  • Tendency towards outbursts of anger or violence with inability to control the explosive behavior
  • Difficulty maintaining actions that are not immediately rewarded
  • Choppy moods, mood swings, mood swings (affect instability)

In addition, at least two of the following criteria, which are specific to borderline syndrome, must be met:

  • Disturbances and insecurities of self-image, personal goals and preferences (including sexual ones)
  • Tendency to get involved in intense but unstable relationships, often resulting in emotional crises
  • Excessive efforts to avoid abandonment
  • Self-harming behavior, suicide threats and attempts
  • Persistent feelings of emptiness

Not every borderline patient suffers from all symptoms and behavioral patterns at the same time and to the same extent. Diagnosis is therefore not easy. In order to ensure this, an internationally standardized diagnosis code is available to specialists. In detailed, structured discussions and, if necessary, psychological tests, other (mental) illnesses are excluded or identified as concomitant illnesses:


People with borderline personality disorder (BPD) often have one or more additional diagnoses.

Comorbidities

Concomitant diseases that are based on clinical studies with inpatients and which usually show stronger symptoms compared to outpatients can be:

  • Depression: estimates between 30 and 87%.
  • Substance abuse: 64-66%
  • Post-traumatic stress disorder: 46–56%
  • social phobia: 23-47%
  • an obsessive-compulsive disorder: 16-25%,
  • a panic disorder: 31-48%,
  • an eating disorder: 29-35%
  • Attention Hyperactivity Disorder (ADHD): up to 60%

Recognizing borderline symptoms makes everything easier, including therapy

  • Insecure and impulsive: Difficulty controlling impulses and emotions are characteristic. Borderline patients freak out quickly, even with little things, and are contentious, especially when they are prevented from acting out their impulses. Anger is part of their everyday life. The reasons for this explosive occurrence are usually strong self-doubt. Your self-image is unstable, up to and including uncertainty about your own sexual orientation. Most have trouble pursuing a desired goal because their plans are constantly changing.
  • Tempest of emotions: Every day, people with borderline personality disorder experience a roller coaster ride of emotions they cannot control. The trigger for these intense emotions may seem insignificant, but borderliners are very sensitive to external events. They quickly feel overwhelmed or under pressure. Your feelings usually do not last long, but create a great deal of inner restlessness.
  • Self-harm and attempted suicide: A trigger for these mental disorders is not always recognizable for the patient. In order to relieve this tension in the body, many borderline patients cut themselves and sometimes inflict life-threatening injuries.
  • Other forms of self-destructive behavior: Overconsumption of alcohol and drugs, eating disorders, high-risk sports or high-risk sex.
  • Behaviors that seem like a suicide attempt are usually a desperate attempt to get the agonizing emotional states under control.

Symptoms of dissociation

With a dissociation, the perception changes like in a drug intoxication. Short-term memory losses or movement disorders can occur. This has to do with the splitting off of feelings that borderliners experience. This is often caused by traumatic experiences in childhood.

If the child does not have the opportunity to escape the traumatic situation, they move emotionally to another place. These dissociations also appear in later life, especially when negative thoughts and feelings arise.

Symptoms of derealization / depersonalization

Some borderline patients experience so-called derealizations or depersonalizations. In the event of a derealization, the environment is perceived as strange and unreal. With depersonalization, those affected perceive their own selves as alien. Their feelings appear to them as if they are detached from themselves.

Black and white thinking

Another borderline sign is the patients' “black and white thinking”, which affects issues as well as their fellow human beings. So they often idealize people in their environment first, only to devalue them extremely at the slightest disappointed expectation. Borderline can be recognized by such sudden changes.

Establishing stable relationships is therefore a major problem for people with borderline personality disorder. Symptoms include fear of being close to other people as well as fear of being alone. Their behavior therefore alternates between extreme clinging and rejection.

Feeling of emptiness

Feelings of emptiness and boredom are typical of borderliners. On the one hand, these feelings are related to the fact that borderline patients have difficulties with their own identity. They are unsure of who they are and what is good and bad for them.

As a result, they lack their own desires and goals that they can pursue and drive. On the other hand, they often feel alone and abandoned. Relationships with other people are difficult and very unstable and break easily due to the typical borderline symptoms.

Borderline as a parent, as a partner, in life

Borderline mothers and fathers

Borderline people expecting a child often have great self-doubts and worry about not doing the child justice. If one parent suffers from borderline syndrome, it does not mean that the children will have mental health problems too. Parents who are willing to seek therapeutic treatment and work on their borderline behavior can offer their child the necessary protection against the disease.

But even when parents have the best intentions for their children, they can overwhelm them. For example, mothers with borderline syndrome often have very high expectations of themselves and want their child to have a better life than theirs. There is a risk that they overprotect the children and that they therefore have little room for development.


Caring for a child is always a major challenge for people with borderline syndrome.


Caring for a child is always a major challenge for people with borderline syndrome. The child can bring back memories of traumatic events from their own childhood. As a result, those affected feel put back into the role of children and are often unable to adequately care for their own child. The parenting role overwhelms them, creates aggression and in some cases violence against the children.

School and job

Most of those affected have difficulty completing vocational training. Many spend years of their lives in psychiatric hospitals. Only around the age of thirty does the intensity of the borderline syndrome slowly decrease and the violent storms of emotion subside.

Children suffer too

If the borderline symptoms are severe, the children suffer greatly from the effects of the mental disorder. When children are helplessly exposed to the mood swings of their parents, they are unsettled by the rollercoaster of loving closeness and rejection.

Children then lose trust in their parents and strive to meet their parents' needs and put their own back. This reversal of roles usually creates psychological problems in the children that can last for a lifetime.

Parents with borderline syndrome should definitely seek help. The therapist can accompany the family on their way. With support, parents can learn to recognize their child's needs. If the children are educated about the illness of the mother or the father, they have a better understanding of difficult situations.

Causes and Risk Factors in Borderline: The Borderline Between Neurosis and Psychosis.

The causes of a borderline diagnosis have not yet been conclusively clarified. But there are risk factors that favor borderline disease, especially when they occur in combination.

The risk factors of borderline syndrome:

  • Inheritance: A certain diagnosis is that a genetic predisposition and early traumatic experiences can work together and trigger the disorder. The only twin study to date has shown that genetic factors have a major influence on the development of borderline personality disorder. Thus, borderline cannot be inherited, but the predisposition for it is.
  • Traumatic experiences: Traumatization significantly increases the risk of borderline syndrome. Research has shown that a large proportion of those affected were sexually abused in early childhood - especially within the family. Borderline patients have also experienced physical violence in many cases.
  • Mental abuse can result in borderline syndrome. Many of the patients were severely neglected in their youth. A lack of warmth in family relationships or unpredictable caregivers increase the risk.
  • Early experiences of separation through divorce or the death of a parent favor the disease.
  • No automatism due to trauma in the family. As conspicuous as the accumulation of trauma in patients with this mental disorder is, in some of the patients the personality disorder evidently develops even without harrowing experiences in the family.
  • Disorders in the brain: Borderliners experience all feelings much more intensely than healthy people. It is not yet clear whether this tendency is innate or whether it arises through traumatic experiences. Researchers assume that communication between certain brain centers that control emotional processing is impaired in people with borderline syndrome. Impairment of the frontal lobe has been reported in some studies. This brain region is important for impulse control, among other things, it could be related to the impulsive actions of borderline patients.
  • Emotional neglect: The borderline disorder often first shows up in early adulthood. 40 to 70 percent of those affected report a lack of emotional affection in childhood and a lack of recognition by important caregivers. Maltreatment and sexual abuse are also frequently mentioned reasons.
  • Fears of commitment: Borderline patients often find it difficult to establish stable interpersonal relationships. You look for the lack of personal appreciation in intensive contact with your counterpart, idealize it. At the same time, they are very afraid of being alone or of being abandoned.No partner can meet the high demands associated with this in the long run: At some point every borderline patient feels deeply disappointed, rigorously devalues ​​the previously idealized partner and separates from him.

In principle, mental health problems in the family as well as alcohol abuse, depression or schizophrenia increase the risk of developing borderline syndrome.

Borderline therapies: coping with stress in everyday life

The treatment of borderline syndrome belongs in the experienced hands of a psychotherapist or specialist in psychiatry and psychotherapy. Due to the self-endangering behavior, borderline personality disorder is considered a serious, serious illness.

The special challenges that borderline illness brings with it are not easy to master for both patient and therapist. Since borderline goes hand in hand with a high level of suffering, it is important to get professional help as early as possible.


Since borderline goes hand in hand with a high level of suffering, it is important to get professional help as early as possible.


Behavioral therapeutic methods have proven to be particularly effective, providing those affected with strategies to better control their extreme sensations and behavior. These so-called skills for coping with stress are used in various therapies:

  • Dialectical Behavioral Therapy (DBT) helps to deal with inner tension in a healthy way, to recognize negative emotions earlier, to control and to reduce them. In the first phase of therapy, the borderline patients are initially stabilized. The focus is on strategies that prevent the patient from harming themselves further or stopping therapy prematurely.
  • Scheme-Focused Therapy (SFT) aims to identify and discard unconscious stuck behavior patterns. Schema therapy begins with the fact that every person develops patterns from childhood on in order to deal with experiences. If the children's basic needs are not met, they develop unhealthy strategies and thought patterns. For example, borderline patients often assume they are abandoned and are suspicious of others. The aim of schema therapy is to recognize and work on negative thought and emotional patterns.
  • Mentalization Based Therapy (MBT) helps the patient to get along better with himself and with other people. Borderline people have difficulty assessing their own behavior and that of other people. In this therapy, the person affected learns to better interpret and understand the background to behavior.
  • Transfer-Focused Therapy (TFP) helps in coping with individual childhood experiences. Patients often have a pronounced black and white or good or bad thinking. The therapist is either idealized or perceived as threatening. The patient transfers old relationship experiences, for example with their parents, to the therapist. For example, the therapist could be seen as a strict father. This therapy works with the patient to recognize and change these transmissions.
  • Family therapy: It is particularly important to include the family in borderline therapy for young people. This makes it easier for relatives to deal with the affected family member. Working together with the family is an essential prerequisite for the young person to be able to successfully change his or her thinking and behavioral patterns. Family involvement is especially important when the disorder has at least part of its roots in the family. If there are abnormal relationship patterns in the family, family therapy can be useful.

Is borderline curable?

For a long time, the therapy of borderline patients was considered particularly problematic. As in the relationship with all other people, borderliners tend to idealize the therapist at first in order to devalue him extremely at the smallest disappointed expectation. Frequent changes of therapist and discontinuation of therapy are the result.

The prospect of a complete borderline cure is slim. However, the patient's chances of mastering the most serious effects of the disorder have increased significantly. Inpatient borderline therapy such as the one offered by the TWW in Berlin is important for patients who are prone to self-harm or who are even at risk of suicide. Younger people in particular benefit from the structured life in the facility.

Whether borderline is curable also depends on the severity of the symptoms and the social situation. This is how motherhood and marriage are designed to aid recovery. From the age of 30, the impulsive symptoms subside and dealing with the mental disorder becomes easier.

Medication during borderline therapy

Some patients also receive drug therapy. Borderline cannot be treated with medication alone - there are no special borderline medications. Mood stabilizers like lithium can help you get extreme emotional states under control.

Benzodiazepines can be used to treat patients with severe anxiety. However, they are highly addictive and should only be used for a short time. If depression also occurs, selective serotonin reuptake inhibitors (SSRIs) are used.

Being informed helps - relatives of borderline patients

Living with borderline personality disorder is often a great challenge for those affected, but also for partners, family and friends. The strong mood swings often cause incomprehension and put a lot of strain on relationships.

It is therefore important, as relatives and partners, to first of all find out about the disease in order to better classify the behavioral patterns of those affected. Above all, it is important to learn not to take the difficult behavior of the sick person personally:

It is best for relatives to support the person affected by showing him that they are there for him, supporting him, getting professional help and accompanying him in the therapy with understanding. It takes a lot of strength to keep an eye on your own emotional well-being. Exchanges with other relatives or a so-called relatives seminar can also help. The cause is the disease, not the person.