Is There a Test for Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is a serious mental health disorder that is characterized by difficulty managing emotions and behavior, a pattern of unstable relationships and self-image issues. This condition can cause a great deal of difficulty functioning in everyday life. Those who have BPD find that it affects how they behave and how they feel about themselves and others.

It’s not always easy to recognize when someone has BPD. Symptoms can resemble other forms of mental illness, and BPD doesn’t look exactly the same in everyone. In some women, the most noticeable problem is experiencing emotions with great intensity and having difficulty managing hypersensitivity to emotions. BPD affects approximately 1.4 percent of adults in the U.S. About three out of four of those affected are women.

Diagnosing BPD

There are no imaging tests or lab tests that can determine if a person has BPD. A doctor may begin the screening process by performing a complete medical history and physical examination. Bloodwork, X-rays and other tests may be ordered to rule out physical causes of symptoms such as mood swings and erratic behavior.

If no physical cause is found, the next step is an evaluation by a psychiatrist, psychologist or other mental health professional. A thorough interview is done, which includes a discussion of symptoms and medical histories of other members of the family including any history of mental illness. There may also be a written questionnaire or a discussion with family or close loved ones.

Key Signs and Symptoms of BPD

Screening for BPD is based on symptoms that usually have been present since adolescence or early adulthood. The key symptoms a person with BPD may have include:

• Extreme fear of abandonment and desperate efforts to avoid it
• Unstable or distorted sense of self
• Intense and unstable relationships often swinging from idealizing the other person to extreme feelings of dislike
• Intense mood swings that may last from a few hours to a few days
• Inappropriate anger or difficulty controlling anger
• Impulsive or reckless behavior such as driving recklessly, abusing substances, binge eating or shopping
• Feelings of emptiness
• Self-harm or suicidal threats or behaviors
• Feelings of dissociation, loss of touch with oneself

The severity of symptoms, how often symptoms are experienced, and how long they last can vary from one person to another. It’s not necessary to have every symptom to be diagnosed with BPD. It’s possible to have just a few of these symptoms or most of them.

Misdiagnosis or Underdiagnosis of BPD

There’s a good chance that statistics regarding the prevalence of BPD are underreporting the number of people who have this condition. BPD often occurs with other forms of mental health illness such as depression, anxiety, eating disorders or substance use disorder, which can make it difficult to diagnose properly. Many people with BPD are misdiagnosed with conditions that have some similar symptoms, such as bipolar disorder, which can be characterized by profound mood swings.

An individual with BPD may not relay to the doctor some of the symptoms they’re experiencing as their biggest concern, which can make it even harder for doctors to diagnose BPD. Conditions such as substance use disorder or eating disorders may exhibit symptoms that are easier to identify. An individual with BPD may tell the doctor about substance abuse or binge eating but not talk about feelings of disassociation or deep-rooted fear of abandonment.

While BPD was once considered difficult to treat, evidence-based treatment can help a person with BPD experience fewer or less severe symptoms and an improved quality of life. It’s important for a person with BPD to obtain an accurate diagnosis and to stick with a recommended treatment plan.