Everyone can remember a time when they had an intense emotional reaction to something. Maybe it was when you had a nasty breakup, or when your favorite sports team lost the big game. It’s normal to feel strongly about things in our lives. But some people have emotions that are so overwhelming that they aren’t able to handle them in healthy ways. When that happens, it can be a sign of borderline personality disorder.

Borderline personality disorder (BPD) is a mental health condition where a person experiences extreme emotions that are hard to manage — which often leads to unstable relationships and self-destructive behavior, including suicide attempts.

People with BPD struggle with self-esteem and have trouble coping with very painful feelings. When they experience a powerful emotion, it’s very hard for them to calm down, causing them to react in ways that others may view as excessive. People with BPD are often overwhelmed by intense anger and feelings of abandonment, emptiness, shame, and self-loathing. They are hypersensitive to social cues and often interpret things negatively. Minor slights — or things misinterpreted as slights — are taken as evidence of abandonment, and the reaction can be swift and intense, causing rifts with friends, parents, and partners.

What causes BPD?

Borderline personality disorder develops during the teen years in people who are, by nature, more sensitive to their emotions. They feel more intensely and think and act faster on their feelings than others, says Courtney Tracy, LCSW, PsyD a licensed psychotherapist who was diagnosed with BPD in 2012. When these naturally sensitive people grow up in an environment that fails to recognize their feelings and make them feel understood, that’s when BPD can begin to take shape.

Oftentimes, kids who develop BPD have experienced abuse or neglect. But it can occur in children with loving, attentive parents, too. Many parents often dismiss their kids’ strong emotional reactions as just a part of growing up. But for highly sensitive children, a lack of emotional validation is disastrous, leading them to feel alone and unable to connect with others.

Mental health professionals used to refrain from diagnosing BPD in people under 18, tending to attribute symptoms of BPD to “typical teenage behavior.” But the disorder is now diagnosed and treated in teenagers when symptoms start to become noticeable.

Recognizing the signs and diagnosing BPD as early as possible is crucial for achieving better long-term outcomes and lowering the risk of self-destructive behavior.

What does BPD look like?

When left undiagnosed or untreated, borderline personality disorder can be extremely damaging to a person’s life. Here are some warning signs to watch out for:

• Feeling extremely angry, empty, or hopeless

• Believing you’re worthless

• Having trouble keeping stable relationships

• Fear of abandonment

• Quickly changing from loving or admiring someone to disliking or criticizing them

• Brief, intense moments of anxiety or depression

• Paranoid thinking and dissociation

• Impulsive behavior, such as risky driving, unsafe sex, or substance misuse

• Self-harm

• Suicidal behavior, gestures, or threats

How is BPD treated?

Until recently, BPD was difficult to treat and understand. But new insights into the condition have led to more effective treatment methods, allowing people with BPD to successfully manage their emotions and improve their lives.

The method proven to be most successful in treating BPD is called dialectical behavioral therapy, or DBT. DBT combines two sets of skills: mindfulness and cognitive behavioral therapy (CBT).

Mindfulness teaches a patient to understand and accept their difficult feelings without judgment, while cognitive behavioral therapy shows them ways to change how they respond to their feelings. “It’s basically ‘I’m doing the best I can’ on the one hand, and at the same time ‘I need to do better’ on the other,” says Alec Miller, PsyD, an expert in treating adolescents with BPD.

Borderline personality disorder can seem like an impossible obstacle — but it’s not a life sentence. DBT can make a dramatic improvement in the life of someone with BPD, helping them rework their thinking patterns to minimize symptoms and over time, even lead them to no longer meet the criteria for the disorder.