I’ll start by listing the 9 traits of BPD (of which at least 5 are required for diagnosis) as listed in the DSM.  After that, I’ll offer a framing on what drives these traits and how they are formed.

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1. Desperate attempts to avoid real or imagined abandonment.

2. A pattern of unstable and intense relationships, alternating between experiencing a relationship partner as completely perfect or deeply flawed.

3. Unstable self-image or sense of self.

4. Impulsivity.

5. Suicidal behavior, gestures, or threats.  Self-mutilating behavior such as cutting.

6. Intense emotional reactivity and mood swings typically over short durations of time.

7. Feelings of emptiness.

8. Intense anger.

9. Stress-related paranoid ideation, typically as relates to interpersonal relationships.  Dissociation.

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The above traits can be helpful in identifying BPD, but not so much for understanding and treating BPD.  BPD is a specific pattern of personality development in response to trauma, particularly sustained childhood trauma involving interpersonal relationships with key attachment figures.

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At the core of BPD is a deep sense of attachment insecurity and fear or even expectation of abandonment.  It is normal for all of us to at times feel like our relationships are at risk, like someone is lying to us, cheating on us, or doesn’t actually love us.  For those with more secure attachment styles, these thoughts and fears are relatively transitory or are based on the reality of the situation.  For those with BPD, these feelings are almost constant and are not necessarily grounded in the reality of the relationship.  For example, someone with BPD can have a relationship with someone who genuinely loves and cares for them and has no thought of leaving the relationship, but the BPD person can be fully convinced that the person is about to leave.  The traits of BPD begin to make more sense when seen through this lens.  If you constantly expect that all of your relationships are on the verge of abandonment, of course you will have intense emotional reactivity.  It makes sense that those with BPD would turn to impulsive behaviors to help regulate their intense emotional states.

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The other lens that, in combination with attachment insecurity, helps to understand the core of BPD is related to the concept of “self”.  When we are first born, we have no concept of the self as distinct from the outside world.  As we develop, we learn to make this distinction and also begin to reflect on our own experience and identity.  If all goes well, we enter adulthood with a relatively clear sense of who we are, what we care about, what our preferences are, and what our worth is.  So what happens with BPD?  It turns out that this development of “self” is a process that occurs within and relies upon our attachment experiences.  As developing humans, we need adults to attune to our emotional states and help us reflect upon them.  Our relationship with adults is the secure base through which we develop a sense of self.  Because those with BPD typically experiences abuse or neglect by their caregivers, this developmental process goes awry.  Hence the chronic feelings of emptiness that those with BPD experience.  One of the key things to understand is that those with BPD are desperately searching for attachment relationships that will help them feel like a “real” person.  The stakes are much higher for those with BPD because to them, the end of a relationship can feel like the end of their very identity.  This is what fuels the intensity of the emotional reactivity those with BPD suffer from.

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I hope this perspective I’ve offered helps to humanize those with BPD.  People with BPD are commonly cast as manipulative, abusive, or even evil.  While it is true that people with BPD can hurt and harm the people around them, it is important to understand that this is not because they want to hurt people.