Skip to main content

Verified by Psychology Today


The Link Between Borderline Personality Disorder and Anger

What factors contribute to the tendency for such anger arousal?

Key points

  • Borderline Personality Disorder (BPD) involves instability of self-image, relationships and emotions.
  • The above symptoms contribute to a heightened sense of threat and related anger.
  • A number of biosocial developmental models explain the development of borderline personality disorder.

Borderline personality disorder (BPD) is a severe and complex personality disorder associated with instability in interpersonal relations, behavior, and emotions. Emotional dysregulation is a key contributor to BPD, involving difficulties in regulating emotions in order to support an individual’s pursuit of goals and behaving effectively in a variety of contexts.

Anger and aggression are key features associated with BPD — most often related to fears of abandonment, unstable relationships, an unstable self-image, emotional instability, and chronic feelings of emptiness. As such anger may be sudden, intense and difficult to calm down. When more intense, it is often described as “borderline rage”.

The character Alex Forrest (played by Glenn Close) offers a powerful representation of a woman suffering from borderline personality disorder in Fatal Attraction. In the pursuit of her relationship with Dan Gallagher (played by Michael Douglas) she exhibits many of the symptoms of BPD including rage, unstable self-image, fears of abandonment and violence.

The symptoms of borderline personality most often first appear during teenage years and early twenties worked with one young man early in my practice who clearly articulated the impact of “feeling empty”. On one occasion he stated, “How am I supposed to know what career I wish to pursue? I have no idea what I like. I don’t know who I am!” Another client reported getting drunk on weekends and seeking to have a physical altercation. It was as if this gave him some meaning against a blank slate presented by the weekend.

 Pedro Antonio Salaverría Calahorra / Alamy Stock Photo
Typed words for BPD
Pedro Antonio Salaverría Calahorra / Alamy Stock Photo

Factors that trigger anger

The fear of abandonment or rejection as well as sensitivity to frustration and stress can easily lead to a heightened sense of threat. The lack of a solid identity combined with feelings of emptiness leaves one with BPD vulnerable to feeling criticized, slighted or rejected, which consequently intensifies fears of being alone. The lack of a more solid self-image, coupled with a pattern of unstable interpersonal relationships combine to undermine the resilience to stress and challenging emotions.

Contributing factors to BPD anger

There are a number of biosocial developmental models regarding the development of borderline personality disorder. These emphasize developing in an environment that is invalidating and having adverse childhood experiences in combination with genetically linked vulnerabilities. Specifically, these might include impulsivity and emotional instability.

Some of these theories highlight specific areas of functioning as providing an understanding of emotional triggering for individuals with BPD. Some focus on emotional regulation. Others focus on cognitive aspects, including cognitive-emotional patterns that cause those with BPD to have greater expectations of rejection than those without BPD (Cavicchioli and Maffer, 2019).

In one study of individuals with BPD, it was found that half of the group also had suffered from two or more anxiety disorders (Quenneville, Kalogeropoulou, Lise-Kung, et. al., 2019). Additionally, greater childhood mistreatment was associated with greater severity of illness, impulsivity and trait anger.

Some researchers have found that those with BPD exhibit a negative bias in decoding social cues (Kleindienst, Hauschild, Liebke, et. al., 2019) They found that those who exhibited more chronic symptoms of BPD were more likely to assess happy facial expressions as being less happy than those without BPD.

Exploring the neuroscience of BPD, one group of researchers has found through magnetic resonance scanning with males, that those with BPD showed less activation of the prefrontal area of the brain during the viewing of happy and angry faces (Bertsch, Krauch, Roelofs, et. al., 2019). Additionally, they found that reduced functioning of this area of the brain was associated with impaired emotional control and with greater acting out of anger.

One study found that anger rumination was greater for those with BPD when compared to a healthier population (Oliva, Ferracini, Amoia, et. al., 2023). Anger rumination has been found to be positively associated with anger feelings and aggressive/impulsive behaviors.

Research regarding intimate partner violence (IPV) found that male and female perpetrators are more often found to have BPD than others (Johnson, Leone, and Xu, 2014). Another study found that individuals with BPD are more likely to be victims of IPV (Jackson, Sippel, Mota, et. al., 2015). It was hypothesized that emotional dysregulation may trigger such a reaction by the partner.

Trait anger (chronic) has been found to be higher for individuals with BPD than for others (Armenti and Babcock, 2018). Additionally, those with BPD, having higher trait anger, were more likely to engage in IPV than others.

It’s important to note that aggression associated with borderline personality disorder may be directed outward or inward. In one expansive study (36,309 respondents) exploring this issue, it was found that violence toward others was more associated with identity disturbance, impulsivity and intense anger, while violence directed inward was more associated with avoidance of abandonment, self-mutilating behavior, and feelings of emptiness (Hartford, Chen, Kerridge, et. al., 2018).

In the late 80s I worked in an inpatient program for women who self-injure. Most were diagnosed with BPD. While there were often several key contributing factors to such behavior, the self-injury served as a distraction from feeling empty and a way of feeling connected with oneself.

Research has also shown that there is a strong association between having an insecure attachment style and borderline personality disorder (Critchfield, Levy, Clarking, et. al., 2007). And when this is of the anxious insecure attachment style, there is a greater likelihood of reactive aggression. Additionally, self-harm was found to be associated with relational avoidance while anger and irritability were associated with anxiety.

For some disorders, symptoms tend to remit as an individual ages. While this may be true in general, one study of BPD found that, while younger adults with BPD were more likely to have emotional dysregulation, be impulsive, aggressive and self-injurious and have intense feelings of emptiness, older patients were still impaired primarily with regard to impulsiveness, emotional regulation and social functioning (Martino, Gammino, Sanza, et. al., 2020).


It’s reported that 45% of people treated for borderline personality disorder do not respond well to current psychological treatments (Woodridge, Reis, Townsend, et. al., 2021). The symptom complex associated with BPD undermines the capacity to form a trusting relationship with a therapist. In general, an integrated approach seems to be the most effective with this population.

A meta-analysis regarding such treatment, published between 1989 and 2019, identifies the most effective approaches as dialectical behavior therapy (DBT), schema therapy, psychoeducation, system training of emotional predictability and problem solving, and treatment using mentalization (Mungo, Hein, Hubain, et. al., 20.

DBT involves both a cognitive behavioral emphasis in conjunction with mindfulness, which includes individual therapy and skills training groups. Schema-Focused Therapy is an integrative approach that combines strategies from CBT, experiential, interpersonal and psychoanalytic therapy.

Individuals with BPD have difficulties forming relationships, managing their emotions and stress in general, and have an unstable self-image. Borderline personality disorder entails a constellation of symptoms that reflect and create an increased tendency for anger arousal. As such, it is essential that any psychotherapy for BPD also address anger management. Additionally, fears of abandonment and rejection undermine not only personal relationships but therapeutic relationships as well. However, there are a variety of well-researched therapeutic treatments that can help those with BPD live a more stable and fulfilling life.


Cavicchioli, M. & Maffei, C. (2020). Rejection sensitivity in borderline personality disorder and the cognitive-affective personality system: A meta-analytic review. Personality Disorders: Theory, Research, and Treatment, Vol.11 (1), 1-12.

Qenneville, A., Kalogeropoulou, E., Lise Kung, A., et. al. (2020). Childhood maltreatment, anxiety disorders and outcome in borderline personality disorder. Psychiatry Research, Vol 284, (2)

Kleindienst, N., Hauschild, S., Liebke, L., et. al. (2019). A negative bias in decoding positive social cues characterizes emotion processing in patients with symptom-remitted Borderline Personality Disorder. Borderline Personality Disorder and Emotion Dysregulation. Vol. 6, (17).

Bertsch, K., Krauch, M., Roelofs, K., et. al. (2019). Out of control? Acting out anger is associated with deficient prefrontal emotional action control in male patients with borderline personality disorder. Neuropharmacology, Vol. 156, (15)

Oliva, A., Ferracini, S., Amoia, R., et. al. (2023) The association between anger rumination and emotional dysregulation in borderline personality disorder: a review. Journal of Affective Disorders, Vol. 338 (1) 546-553

Johnson MP, Leone JM, Xu Y. ( 2014). Intimate terrorism and situational couple violence in general surveys: Ex-spouses required. Violence Against Women;20:186. (originally published online 6 February 2014).

Jackson, M., Sippel, L., Mota, N., et. al. (2015). Borderline personality disorder and related constructs as rick factors for intimate partner violence perpetration. Aggressive Violent Behavior, Sep-Oct: Vol. 24: 95-106.

Armenti, N. & Babcock, J., et. al. (2018). Borderline personality features, anger and intimate partner violence: an experimental manipulation of rejection. Journal of Interpersonal Violence, Vol. 36, (5-6).

Harford, T, Chen, C., Kerridge, B., et. al. (2018). Borderline personality disorder an violence toward self and others: a national study. Home Journal of Personality Disorders, Vol.33 (5). Published Online:October 2019.

Critchfield, K., Levy, K, Clarkin, J, et. al. (2008). The relational context of aggression in borderline personality disorder: using adult attachment style to predict forms of hostility. Journal of Clinical Psychooogy, Vol 64, (1) 67-82

Martino, F., Gammino, L, Sanza, M., et. al. (2020). Impulsiveness and emotional dysregulation as stable features in borderline personality disorder outpatients over time. The Journal of Nervous and. Mental Disease, Vol. 208, (9) 715-720.

Woodbridge, J., Reis, S., Townsend, M., et. al. (2021) Searching in the dark: shining a light on some predictors of non-response to psychotherapy for borderline personality disorder. Plus One:

Mungo, A., Hein, M., Hubain, P. et al. (2020). Impulsivity and its Therapeutic Management in Borderline Personality Disorder: a Systematic Review. Psychiatry Q 91, 1333–1362 (2020). Article

More from Bernard Golden, Ph.D.
More from Psychology Today