Untreated Borderline Personality Disorder (BPD) Consequences
Mental Health ConditionsBorderline Personality Disorder

What Are the Consequences of Untreated Borderline Personality Disorder (BPD)?

What Are the Consequences of Untreated Borderline Personality Disorder (BPD)?
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Updated on January 13, 2026
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Borderline personality disorder (BPD) is a mental illness marked by mood swings and self-image issues that, if left untreated, can lead to impulsive behaviors and relationship troubles, among other serious health problems.

 According to the National Alliance on Mental Illness, BPD is most commonly diagnosed in women.

 It is also more common in people who have a history of childhood abuse or neglect.

To diagnose BPD, a mental health professional may interview the patient to talk through their symptoms and review any family medical history.

Marra Ackerman, MD, a clinical associate professor of psychiatry at NYU Langone Health in New York City, says symptoms of BPD can include interpersonal difficulties, intense and inappropriate anger, suicidal ideation, and fear of abandonment.

What Happens if Borderline Personality Disorder Goes Untreated

Suppose someone exhibits the signs of BPD but isn’t aware of the symptoms or actively decides not to seek treatment. Over the course of this person’s life, they might experience the following.

Relationship Trouble

People with BPD have a black-and-white view of the world: Things (and people) are either good or bad, and how someone with BPD is feeling can change almost instantly.

Relationships in particular can be problematic. David Ryan Hooper, PhD, a clinical psychologist in private practice and an assistant clinical professor of psychiatry at the University of Illinois at Chicago, says people with BPD commonly have a love-hate approach to others. One day, a person with BPD might view their partner, friend, or family member as the best person in the world. The next day, he or she might do a 180 and decide that the “best person in the world” is now the worst.

Some of this can be traced back to the fact that people with BPD tend to fear abandonment. For instance, they might cut off communication with a loved one if they feel they’re at risk of being left behind.

This, of course, can lead to lots of interpersonal conflict and chronic difficulties with relationships, Dr. Ackerman says. Hence, relationship turmoil, divorce, and trouble maintaining positive relationships with family and friends can be common among people suffering from BPD.

Job Loss

The impulsive behavior that comes with BPD can also affect someone’s ability to maintain a steady job.

“Their life is in disarray,” Dr. Hooper says. The symptoms of BPD can be severe and debilitating, to the point where being unable to regulate emotions can “almost certainly wreck their life,” Hooper adds. “What you begin to see is a life described as instability.”

But that doesn’t mean everyone with BPD will fall into this camp. “There are some people with BPD who function quite well,” Ackerman says. “I wouldn’t say the diagnosis alone means someone might not be able to hold a job or get married if they wanted to.” (For example, Marsha Linehan, PhD, the creator of dialectical behavior therapy [DBT] and a professor emeritus of psychology at the University of Washington in Seattle, has acknowledged having BPD herself.)

Self-Harm

Many people with BPD harm themselves, such as by cutting, to try to deal with their overwhelming feelings.

 Some may even attempt to take their own lives.

Find Help Now

If you or a loved one is experiencing significant distress and needs immediate support, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7.

For more help and information, see these Mental Health Resources and Helplines.

Suicide attempts are so common among people with BPD that they are considered a symptom of the disorder. A majority of those with BPD engage in self-harm, and up to 10 percent of people with BPD die by suicide.

 This is a significantly higher rate of self-harm, suicidal thoughts, and behavior than among the general population.

Generally, this self-destructive behavior starts when a person’s mood is down. “That’s where the self-mutilation comes in, the really impulsive behavior,” Hooper says.

Often, this kind of behavior serves as a wake-up call for the person suffering, leading them to seek medical help.

 “For a lot of clients, the suicide attempt scares them, and it wakes them up to how threatening this is to their life,” Hooper says.

A Desire to Engage in Reckless Behavior

Dangerous and reckless behavior is another complication of BPD. If left untreated, the person with BPD may find themselves involved in extravagant spending, substance abuse, binge eating, reckless driving, and indiscriminate sex, Hooper says. The reckless behavior is usually linked to the poor self-image many BPD patients struggle with.

As a result of engaging in these dangerous activities, the person with BPD will have to face health and physical repercussions, Ackerman says.

A General Feeling of Unsteadiness

Hooper says living with BPD without treatment is like trying to walk on ice. “That’s how a person with BPD feels almost at all times, like they can just never get their footing,” he says. For instance, people with BPD can be preoccupied with the fear of abandonment (whether real or imagined) mentioned earlier. They may also have a skewed view of reality and feel like they’re cut off from themselves and viewing their body from the outside.

Other Illnesses

People with BPD who decline treatment are more likely to develop other chronic illnesses and make unhealthy lifestyle choices.

They may also experience additional conditions like the following:

  • Anxiety disorders
  • Posttraumatic stress disorder
  • Bipolar disorder
  • Depression
  • Eating disorders (notably bulimia nervosa)
  • Substance use disorders

Still, Ackerman says it’s entirely possible for a person to have BPD as their primary diagnosis.

Difficulties Diagnosing Borderline Personality Disorder

Despite its list of specific symptoms, BPD can be tough to diagnose, just like other personality disorders, says Hooper. He says that’s partly due to a lack of understanding. Personality disorders aren’t talked about often, and can be confusing to some people, which leaves many people suffering from BPD without ever realizing they have it.

Other times, a patient exhibiting the symptoms tied to BPD might be embarrassed to admit there’s something going on. “This is an illness that’s really been stigmatized because it’s a personality disorder, Ackerman says. One problem is in the name.

“When you call it a personality disorder, it makes people assume it’s not biologically driven,” Ackerman continues. On the contrary, Ackerman says there are biological underpinnings. Genetics, brain structure, and a history of traumatic events all play a role in putting someone at risk of BPD.

Finally, BPD is often misdiagnosed, usually as bipolar disorder, since there’s some overlap of symptoms — primarily unstable moods.

 Hooper says it can take as many as five interactions with the mental health system before BPD is identified as the root of the problem.

How to Treat Borderline Personality Disorder

The good news, though, is that receiving a BPD diagnosis can be a step toward healing. “BPD can absolutely be treated,” Hooper says. “People respond to treatment, both psychotherapy and medication.”

He estimates that about three-quarters of the BPD patients he’s worked with have taken medication. Normally, medication is used to treat a co-occurring disorder. For instance, an antidepressant might be prescribed to treat the depression that can go along with BPD.

 Psychotherapy, which is the first-line treatment for BPD, can help address the other symptoms.

 Over the past 10 years, DBT has become the gold standard in treating BPD, Hooper says.

But it won’t necessarily be easy. DBT can involve at least six months to a year of therapy, which typically includes 40- to 60-minute weekly one-on-one therapy sessions, group-based skills training, and telephone crisis coaching if needed.

 This type of therapy is primarily skills-based. Those in treatment will learn how to handle different situations that come up by practicing mindfulness, tolerating distress, regulating emotions, and engaging with others effectively.

If DBT isn’t successful for you, know that you have other psychotherapy options available. Other people may do well with good psychiatric management, while some may see success in transference-focused psychotherapy or mentalization-based therapy.

The Takeaway

  • Untreated BPD can lead to relationship struggles, job loss, other serious illnesses, and a high risk of suicidal behavior. Fortunately, people with BPD respond to treatment (both psychotherapy and medication).
  • Borderline personality disorder is largely misunderstood; there's a lack of awareness of the condition, and it tends to be misdiagnosed as bipolar disorder because of overlapping symptoms.
  • Not all people with BPD will identify with the situations described here. But if they do, these chaotic, unstable life events may push them to seek treatment.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Borderline Personality Disorder. National Institute of Mental Health. December 2024.
  2. Borderline Personality Disorder. National Alliance on Mental Illness. April 2023.
  3. Borderline Personality Disorder. Mayo Clinic. January 31, 2024.
  4. Borderline Personality Disorder. National Institute of Mental Health. 2025.
  5. Kaufman EA et al. Diagnostic Profiles Among Suicide Decedents With and Without Borderline Personality Disorder. Psychological Medicine. November 18, 2024.
  6. Borderline Personality Disorder. Johns Hopkins Medicine.
  7. Borderline Personality Disorder vs. Bipolar Disorder. Cleveland Clinic. July 21, 2025.
  8. Tomasetti C et al. Treating Depression in Patients With Borderline Personality Disorder: Clinical Clues on the Use of Antidepressants. Annals of General Psychiatry. May 30, 2024.
  9. Leichsenring F et al. Borderline Personality Disorder: A Comprehensive Review of Diagnosis and Clinical Presentation, Etiology, Treatment, and Current Controversies. World Psychiatry. January 12, 2024.
  10. Dialectical Behavior Therapy. Association for Behavioral and Cognitive Therapies.
  11. Dialectical Behavior Therapy (DBT). Cleveland Clinic. April 19, 2022.
  12. What Is DBT? Behavioral Tech Institute.
  13. Key AP. Treating Patients With Borderline Personality Disorder. American Psychological Association. April 1, 2025.
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Angela D. Harper, MD

Medical Reviewer
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Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.  

A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.

Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.

Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.

She and her husband are avid travelers and have been to over 55 countries and territories.

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Moira Lawler is a journalist who has spent more than a decade covering a range of health and lifestyle topics, including women's health, nutrition, fitness, mental health, and travel. She received a bachelor's degree from Northwestern University’s Medill School of Journalism and lives in the Chicago suburbs with her husband, two young children, and a giant brown labradoodle.
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