Borderline Personality Disorder

Understanding Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health condition that affects emotions, relationships, and a person’s sense of who they are. Feelings can become intense and difficult to manage. Fear of being abandoned, an unstable self-image, impulsive behavior, and persistent emptiness can make everyday life painful.^[1]

BPD is one of the personality disorders. The name does not mean that someone has a bad personality or cannot change. Treatment can help people manage symptoms, build steadier relationships, and work toward a life that matters to them. Experiences and progress differ from person to person.^[1]

Signs and Symptoms of BPD

BPD can affect how someone responds to stress, interprets other people’s actions, and feels about themselves. A delayed reply, for example, might feel like rejection and bring a rush of fear or anger. That example is not a test for BPD. A clinician considers the wider pattern and its effects on the person’s life.^[1]

The nine clinical features below organize that assessment. A clinician generally looks for at least five, together with the broader requirements for a personality disorder. Counting familiar experiences on your own does not show whether those requirements are met.^[2]

1. Intense fear of abandonment. Someone may make desperate efforts to prevent real or feared separation, even when the other person has not decided to leave.^[1]
2. Unstable, intense relationships. Feelings about another person may shift between seeing them as wonderful and feeling deeply disappointed or angry with them.^[1]
3. An unstable sense of self. A person’s view of who they are, what they value, or where they are going may change markedly.^[1]
4. Impulsive actions that can cause harm. Examples include dangerous driving, spending, substance use, or risky sexual behavior. The diagnostic feature concerns at least two harmful areas, rather than an occasional spontaneous choice.^[2]
5. Repeated suicidal behavior or self-harm. Suicide attempts, threats or gestures, and self-injury belong to one clinical feature. Self-harm does not always involve an intention to die, but it still deserves care.^[1][2]
6. Intense, changing moods. Anxiety, irritability, or deep sadness may rise quickly and last hours or sometimes longer.^[1]
7. A persistent feeling of emptiness. This can feel like an ongoing absence of meaning or connection, rather than ordinary boredom.^[1]
8. Intense anger or difficulty managing it. Anger may be hard to settle and can contribute to repeated conflict.^[1]
9. Stress-related suspicious thoughts or dissociation. Under stress, someone may become unusually distrustful or feel disconnected from themselves or their surroundings.^[1][2]

If you are thinking of harming yourself, call or text 988 in the United States. Call 911 in a life-threatening emergency.^[1]

The symptoms of BPD vary in frequency, intensity, and duration. Not everyone experiences all nine, and visible anger does not tell you how much distress someone feels.^[1]

Making Sense of Unfamiliar Terms

Emotional regulation means managing what you do when feelings become strong. Difficulty with it does not mean the feelings are fake. Dissociation describes feeling detached, such as experiencing your surroundings as unreal or feeling as though you are watching yourself from outside your body.^[1]

Splitting describes an all-good or all-bad view of yourself or another person, with little room for mixed qualities. Understanding the pattern can help you discuss what happens during conflict without using the term as an insult.^[1]

You may also encounter quiet BPD, an informal label for distress that is less outwardly visible. It is not a separate diagnosis in the clinical criteria described here. Tell a clinician about what happens internally as well as what other people notice.^[2][1]

Favorite person is community language for someone on whom a person depends heavily for reassurance and emotional support. A 2022 study explored the term through 207 online posts and comments. It could not verify all writers’ diagnoses, so its findings should not be treated as a description of everyone with BPD.^[5]

How Borderline Personality Disorder Is Diagnosed

A licensed mental health professional assesses symptoms, medical and family history, relationships, and the effect on daily life. They may ask when difficulties began, what makes them worse, and whether they occur across different situations. A medical evaluation can help identify other possible explanations.^[1]

A BPD screening questionnaire can help organize concerns for a conversation. It cannot establish the diagnosis or rule out another condition. You do not need a particular score before asking for help with distress, self-harm, or difficulties at home or work.^[1]

BPD and Other Mental Health Conditions

BPD can occur alongside depression, anxiety, post-traumatic stress disorder, eating disorders, bipolar disorder, or substance use disorders. Similar symptoms do not make these conditions interchangeable. Assessment should identify what needs treatment rather than force every difficulty into a single explanation.^[1]

Bipolar disorder involves distinct mood episodes, which can include unusually elevated or irritable mood and increased activity, called mania or the less severe hypomania. BPD involves a broader pattern of difficulties with emotions, relationships, and self-image. The full history matters. The speed of a mood change or whether something triggered it cannot settle the diagnosis by itself.^[1][6]

Bring questions about BPD and bipolar disorder to an assessment, especially if previous diagnoses or treatment plans have differed. Describe your experiences rather than relying on one symptom to choose between the two.

Can Teenagers Have BPD?

Yes. Although BPD is usually diagnosed in late adolescence or early adulthood, a clinician may diagnose a person under 18 when symptoms are severe and persist for at least a year. Ordinary teenage changes are not enough to establish BPD. An assessment should consider development and other explanations.^[1]

What Causes BPD?

There is no single established cause. Research points to a combination of family history, brain function, and environmental or social experiences. Childhood abuse, abandonment, and unstable or invalidating relationships are associated with BPD, but not everyone with BPD has that history. Having a risk factor does not make the condition inevitable.^[1]

Brain studies have found differences in areas involved in emotion and behavior. Those findings do not provide a brain scan that diagnoses BPD. Researchers are still working out whether differences contribute to the condition, result from it, or reflect other influences. Describing someone’s brain as permanently broken is inaccurate and unhelpful.^[1]

When discussing BPD causes and risk factors, leave room for your own history. Understanding past experiences can be useful without having to identify one event or one person as the cause.

How Common Is BPD?

NIMH reports a historical estimate of 1.4% of U.S. adults meeting BPD criteria in the National Comorbidity Survey Replication, conducted in 2001–2003.^[7] The estimate used an older diagnostic system and a household survey. It is not a measurement of today’s population.^[7]

Prevalence means how common a condition is within the population and time period studied. Figures from a hospital, a prison, or an online questionnaire should not be treated as the rate among all adults. Even large numbers need that context.^[7]

Treatment for Borderline Personality Disorder

Structured psychotherapy, or talk therapy with a clear treatment approach, is the main treatment for BPD. The APA recommends a plan that addresses the condition’s core difficulties and reflects the person’s goals and preferences. Care also needs to address other conditions and immediate safety needs.^[3]

In OHSU’s account of the updated APA guideline, psychiatrist George Keepers, MD, said, “No therapy emerged as a ‘gold standard.’” Several approaches have supporting evidence. That does not mean every therapy is equally effective for every person. It means there is a reason to discuss suitable options rather than assume only one program can help.^[8]

What Different Therapies Involve

The comparison below explains some approaches a clinician may discuss. Program details vary. Ask what the service actually provides, how the clinician is trained, and how you will review progress together.^[9]

A 2018 review of 20 randomized trials involving 1,375 adults found benefits from specialized therapies compared with some usual-care treatments.^[10] It also found uncertainty when comparing specialist therapies with each other or with other organized treatments. Most participants were women, and longer-term evidence was limited. The review supports treatment while leaving room for individual choice and better research.^[10]

When a service offers DBT, ask which parts of the program it provides. Discuss the range of BPD treatment options with a clinician if availability, cost, or your needs make a particular program difficult to use.^[9]

Cognitive behavioral therapy (CBT) can also address patterns of thinking and behavior. For example, therapy may help you examine the thought “They have not replied, so they must hate me” and consider other explanations before acting. Ask how a proposed therapy will address your particular difficulties rather than choosing from its name alone.^[1]

The Role of Medication

Medication is not the first-line treatment for BPD itself. A clinician may prescribe it for a specific symptom or another condition, such as depression. The APA suggests that medication used for BPD be time-limited, aimed at a measurable symptom, and used alongside psychotherapy.^[3]

Ask what each medication used for BPD is intended to help, how you will know whether it is helping, and when it will be reviewed. The guideline recommends reviewing medications at least every six months. Any reduction or discontinuation should be planned with the prescriber.^[3]

BPD and Addiction

BPD and substance use disorders can occur together. Alcohol or drugs may become part of how someone tries to handle distress, while substance-related problems can complicate assessment and care. A clinician needs to know about both. Symptoms during intoxication or withdrawal should not automatically be treated as evidence of BPD.^[11]

A 2018 review found alcohol use disorder in about 46% of participants with BPD across studies measuring current disorders, compared with about 59% across studies measuring lifetime disorders.^[11] Those combined figures came from different samples and settings. They are not the chance that any particular person with BPD will develop an addiction.^[11]

The practical point is to ask about coordinated care. Who will address substance use, who will provide BPD therapy, and how will they communicate with your permission? Co-occurring BPD and addiction is a form of dual diagnosis, meaning a mental health condition and a substance use disorder occur together.^[1][11]

Can People Recover from BPD?

People with BPD can improve substantially. It helps to distinguish remission, meaning symptoms fall below the diagnostic threshold for a defined period, from broader recovery in everyday life. Someone can have fewer symptoms while still needing help with relationships, employment, education, or independence.^[4]

In a study published in 2010, researchers followed 290 adults who had initially been hospitalized with BPD.^[4] Over ten years, 93% attained a period of symptom remission lasting at least two years.^[4] Half attained the study’s stricter recovery definition, which also required a supportive close relationship and consistent functioning in full-time work or school. Some later lost those gains.^[4]

Most participants were women, most were White, and all had needed hospital care at the start. Most received treatment during follow-up, but this was not a trial proving that one treatment caused recovery. The results show why improvement is possible and why a symptom checklist should not be the only measure of progress.^[4]

Lead author Mary Zanarini and her colleagues emphasized that social and work difficulties needed attention alongside symptoms. That is a useful question for treatment planning: “How will our work help me function in the parts of life I want back?” You can adapt that question to the goals that matter to you.^[4]

Making a Treatment Plan Useful Between Appointments

Therapy is a place to learn and practice responses you can use outside the session. NIMH encourages structure, a healthy routine, and support that fits the treatment plan. Progress may take time. Discuss setbacks so the plan can address what is actually happening.^[1]

A simple starting point is to bring one difficult situation to the next appointment. Write down what happened, what you thought it meant, what you felt, and what you did. Then ask your therapist to help identify a skill or response to practice. This is an example of preparing for therapy, not a diagnostic exercise.

Agree on what to do if distress becomes unsafe, including whom to contact and when to use urgent services. Between-session coaching, where offered, has its own hours and limits. Clarify those arrangements before a crisis rather than assuming a therapist or online platform is available at any time.^[9]

Finding a BPD Therapist Near You or Online

Look for a licensed clinician who has experience treating BPD and can explain their approach. A primary care clinician, community mental health center, insurer directory, or specialist program can be a starting point. Confirm the clinician’s license, experience, availability, and fees before assuming a listing is a suitable match.^[9]

In the APA’s expert Q&A, psychiatrist Mark Zimmerman, MD, emphasizes specific DBT training when choosing someone who offers that treatment. A website mentioning DBT skills does not tell you which parts of a program you will receive. Ask the service to describe them.^[12]

• Experience: “How often do you treat people with BPD, and what training have you completed?”
• Treatment format: “What would my week involve? Is there individual therapy, a group, or both?”
• Goals: “How will we track changes in symptoms and daily life?”
• Other conditions: “Can you coordinate with my prescriber or addiction treatment team?”
• Between-session needs: “What support is available, at what hours, and what should I do in a crisis?”
• Cost and access: “Do you accept my insurance? Are groups billed separately? Is there a waitlist?”

For online care, ask whether the clinician can treat you in the state where you will attend sessions, whether you have a private place to talk, and what happens if a session disconnects or urgent help is needed. Online availability alone does not establish BPD expertise. The treatment format should fit your needs and safety plan.^[13][9]

Supporting Someone with BPD

Listening, learning about the condition, and encouraging appropriate treatment can help you support someone without trying to become their therapist. NIMH also recommends support for family members themselves. Evidence about family therapy for BPD is still developing, so a particular family approach should not be presented as a guaranteed solution.^[1]

Zimmerman’s APA Q&A suggests starting with the distress a person is experiencing rather than confronting them with a diagnostic label. For example, you might say, “You seem exhausted after these arguments. Would you like help finding someone to talk with?” Use words that sound natural to you.^[12]

Support can include clear limits. An example is, “I want to hear what happened. I cannot continue while we are shouting. Let’s pause and agree on a time to talk.” A diagnosis does not require anyone to tolerate abuse or handle an immediate danger alone. If a situation is unsafe, prioritize safety over continuing the conversation.

If you are dating someone with BPD, ask what support the person wants and what you can realistically provide. Treatment decisions and crisis planning belong with the person and their care team.^[1]

Getting Help When You Need It

You can begin by naming the problem you want help with, even if you are unsure about BPD. An assessment can clarify what is happening and help you choose treatment. If care has not helped so far, discuss what is missing, whether the approach fits, and whether another condition needs attention.^[1][9]

If you are struggling or having thoughts of suicide, call or text 988 in the United States for the Suicide & Crisis Lifeline. In a life-threatening emergency, call 911. Tell a clinician about self-harm or suicidal thoughts so that your care plan addresses them directly.^[1]