Signs and symptoms of BPD usually appear in late adolescence or young adulthood.

Symptoms of BPD may worsen following a traumatic event. Over time, symptoms tend to decrease in intensity and frequency. Still, it’s critical to get treatment to prevent severe symptoms and learn coping skills to manage symptoms.

The following are signs and symptoms of BPD:

• Intense fear of abandonment. The fear of abandonment and being left alone is the driving characteristic of BPD. This fear leads to taking extreme measures to keep others nearby. Conversely, people with BPD often push others away to avoid rejection.

• Pattern of unstable relationships. People with BPD see their loved ones in extremes, leaving little room to build healthy relationships. For instance, they may idealize a romantic partner as perfect, but then devalue them completely if the other person fails to meet their idealized expectations. These abrupt and dramatic shifts create chaos and instability in relationships.

• Unstable self-image. Much like the person’s unstable view of others, people with BPD struggle with self-image. They might change their goals, personality, values, and friends suddenly. In addition, they often view themselves as bad—or even feel as if they don’t exist.

• Rapid mood swings. A person with BPD may change moods suddenly and unexpectedly. Their moods can fluctuate quickly between emotional states like anger, happiness, and intense shame. These abrupt mood swings usually last only a few hours.

• Temporary paranoia. Due to intense feelings of stress, people with BPD might experience temporary paranoia and dissociation. They might even have hallucinations or delusions during this time. However, these symptoms don’t last long and aren’t as severe as those with psychotic disorders, like schizophrenia.

• Impulse and reckless behaviors. Self-destructive actions are characteristic of BPD. The person might sabotage their career or abruptly break off a stable relationship. In addition, they might engage in dangerous behaviors, like substance abuse, promiscuity, fighting, or reckless driving.

• Uncontrollable anger. People with BPD can lose their temper easily. This might lead to verbal outbursts, bitterness, or even physical fights. Afterward, the person feels a deep sense of guilt, shame, and self-loathing. 

• Feelings of emptiness. An unstable sense of self and rapid changes in life goals can leave people with BPD feeling unfulfilled, bored, or empty. This can also lead to feeling worthless. These feelings can contribute to low self-esteem, a lack of confidence, and self-hatred.

• Black-and-white/all-or-nothing thinking. People with BPD often have extreme views of themselves, others, and the world around them. These views tend to oscillate between all good or all bad, with little room in between. Thus, they can be unforgiving for any mistakes made by themselves or others—however minor. 

• Self-injury or suicidality. Self-injury and self-harm are common among those with BPD. They might cut, burn, or injure themselves, and they also struggle with suicidal thoughts or actions. In addition, the person might use threats of self-harm or suicide in response to feeling abandoned or rejected by others.