Borderline Personality Disorder (BPD) Symptoms And Treatments

Content Warning: Please note that this article mentions trauma, self-harm, suicide, risky behavior, stigma, and other potentially triggering subjects. Read with discretion. 

You're not alone if you have been diagnosed with therapy for borderline personality disorder (BPD). Over five million Americans were living with BPD in 2022. Common symptoms of BPD can include emotional instability and difficulty maintaining healthy relationships. While therapy can be an effective treatment for BPD, results may not be immediate, and a robust support system can be beneficial. Learning more about the treatments available for BPD, such as dialectical therapy, may help you make an informed decision on your mental healthcare. 

What Is Borderline Personality Disorder (BPD)? 

If you are experiencing thoughts or urges of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support. If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

What Causes BPD? 

A 2018 study found that common factors believed to lead to BPD included neurobiological abnormalities, a combination of specific genetic factors, and a history of childhood trauma. 

How Is BPD Diagnosed? 

Borderline personality disorder is often diagnosed after age 18, as a person's personality evolves through childhood and adolescence. Many children or teens may be initially diagnosed with depression or anxiety, discovering their BPD diagnosis as adults. A licensed mental health professional can diagnose the condition through interviews, self-testing, and observations. 

Therapists or psychiatrists may look for the following symptoms when diagnosing BPD: 

• A fear of abandonment

• Emotional distress related to actual or imagined loss of significant relationships 

• Emotional instability or challenges controlling  emotions 

• Unstable self-image 

• Unstable relationships with friends and family

• Self-destructive relationship habits 

• Difficulty holding a job for an extended period

• Risky, impulsive behavior like unsafe sex or uncontrolled spending

• Self-harm 

• Suicidal thoughts

• Difficulty managing anger or irritability 

• Dissociation (feeling "out of your body") 

• Rapid mood swings 

• Stress-related paranoia 

• Persistent feelings of depression or anxiety 

• Feeling bored or empty 

• Challenges understanding one's identity or personality 

• Cycling patterns of recognizing and denying the value of one's relationships, often referred to as "splitting"  

BPD can also occur alongside other mental health conditions, including the following: 

• Anxiety disorders 

• Post-traumatic stress disorder (PTSD) 

• Sleep disorders 

• Complex post-traumatic stress disorder (C-PTSD) 

• Eating disorders

• Depression 

• Substance use disorders

• Bipolar disorder

• Narcissistic personality disorder (NPD) 

What Treatments Are Available For BPD? 

Psychotherapy, or talk therapy, is considered the cornerstone of BPD treatment, according to the National Alliance on Mental Illness (NAMI). A comprehensive treatment plan for borderline personality disorder may include a combination of psychotherapy and repairing social connections. Your mental health provider may also recommend medication to help manage your symptoms if appropriate. Do not start, stop, or change a medication without consulting a general practitioner or psychiatrist. 

Dialectical Behavior Therapy (DBT)

DBT is a form of cognitive-behavioral therapy (CBT) focused on the impact of your beliefs, thoughts, and behaviors, emphasizing mindful living and acceptance to manage symptoms. Dialectical behavior therapy is a structured program that involves a workbook, worksheets, and frequent sessions. It can be done in an individual or group format and was developed specifically to treat BPD, as its inventor, Dr. Marsha Linehan, was diagnosed with BPD as a young adult. It involves four modules, including: 

• Emotional control

• Distress tolerance 

• Mindfulness skills

• Interpersonal effectiveness

The authors of a journal publication on DBT for BPD state, "dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD. Randomized controlled trials have shown the efficacy of DBT not only in BPD but also in other psychiatric disorders, such as substance use disorders, mood disorders, post-traumatic stress disorder, and eating disorders." 

Family Therapy

BPD symptoms may lead to distress in a family dynamic. Family therapy can be a potential long-term therapeutic plan for Individuals such as mothers with borderline personality disorder often feel emotionally unstable and experience difficulty maintaining healthy relationships. Through family counseling, individuals with BPD and immediate family may meet with the therapist to discuss behavioral and emotional interventions and learn healthy coping skills and communication. 

Humanistic Therapy

Humanistic talk therapy centers on a person's nature and goals instead of treating every client equally. Sessions focus on positive behaviors and traits and developing the ability to use instincts to build positive patterns. The humanistic approach to therapy can foster a trusting relationship between a therapist and their client. 

Schema-Focused Therapy

Schema therapy can be effective for people with personality disorders that may not respond to other treatments by combining elements from multiple forms of therapy. In schema therapy, the therapists focus on targeting your schema, a pattern of unwanted thoughts and behaviors which may have developed during childhood. 

Cognitive-Behavioral Therapy (CBT)

Cognitive behavioral therapy is backed by significant research and has been demonstrated effective in treating various mental health conditions, including BPD. This therapy focuses on identifying unwanted or harmful thought patterns, behaviors, and perceptions of self and others and developing strategies to change them. 

Mentalization-Based Treatment (MBT)

MBT therapy centers on increasing your curiosity about and ability to accurately identify your emotions and thoughts and form a realistic expectation of others' thoughts. Researchers suspect difficulties in mentalization may result from challenges during the early attachment phase of development in childhood. While there are numerous therapies available, one of the most useful options for those with BPD is mentalization based therapy (MBT).

Transference-Focused Psychotherapy (TFP)

Researchers believe that TFP treatments can help those with BPD who experience a split optimistic and pessimistic view of themselves and their primary caregiver due to excessive childhood aggression. TFP aims to merge the positive and negative perspectives to form a realistic view of the self and others. 

Coping With Borderline Personality Disorder

In addition to working with your mental healthcare provider to develop a treatment plan, there are various coping skills and lifestyle changes you can use to manage your symptoms and adjust to living with BPD, including the following: 

• Journaling

• Building distress tolerance

• Practicing mindfulness

• Identifying accountability 

• Working self-focused time into your routine

• Practicing yoga or other forms of calming exercise 

• Distracting yourself with sensory stimulation

• Not assuming intentions

• Paying attention to your physical health

• Taking a walk in nature

Another skill developed through DBT, radical acceptance, may also be beneficial. With this skill, you can learn to accept situations and emotions that seem challenging or impossible to change. 

Tips For Supporting A Loved One With BPD

If you love someone who has been diagnosed with BPD, there are a few ways you can support them, including the following. 

Educate Yourself 

Educate yourself to learn everything you can about BPD, its symptoms, and effective treatments. If you're unsure where to start, ask your loved one for recommendations, or consider reaching out to a therapist for professional guidance. A wealth of stigma and misinformation exists, so finding proper resources can be essential. NAMI has published common myths and facts about BPD for those unsure to learn more about the condition. 

Consider Family Or Couples Therapy 

You can consider family or couples therapy to strengthen bonds and support your loved one through their symptoms. You may also learn helpful coping strategies for communication, bonding, and crisis response. 

Encourage Your Loved One To Attend Therapy 

A strong bond between a therapist and their client may benefit those living with BPD. It can take time to establish a safe bond, so encouraging your loved one to continue attending therapy and working through their treatments may help them feel motivated and on track. 

Establish And Maintain Boundaries 

Finding a balance between supporting your loved one and caring for yourself can be crucial. Set firm boundaries and hold to them. Boundaries can include rules for your space, belongings, body, and time. Note that you do not have to continue a relationship with someone who disrespects your boundaries, despite their diagnosis. Ending a relationship can be a form of a boundary. If you require support, speaking to a therapist may be beneficial.  

Attend Therapy 

Helping a loved one manage the symptoms of borderline personality disorder can be overwhelming. A therapist's support, guidance, and objective opinion may help you make decisions and defend your mental health.  

Counseling Options 

Deciding to reach out for help can be challenging. If you experience trouble maintaining healthy relationships, an intense fear of abandonment, poor impulse control, or any other symptoms of borderline personality disorder, consider reaching out to a therapist for guidance. If you face barriers to treatment like cost, distance, or lack of availability, there are forms of treatment for BPD available that can reduce these barriers, including online counseling.  

Establishing healthy thought and behavioral patterns can be challenging when living with BPD. With the ability to participate in therapy from home through live phone, video, or online sessions, you can receive the benefits of reduced cost and increased flexibility. A recent study shows that clients attending DBT treatments online had a higher attendance rate than those in a traditional in-person clinical environment. Overall, the study found that online DBT treatments are more reachable than and as effective as face-to-face options. 

If you're interested in trying DBT or another form of counseling online, consider signing up for a platform like BetterHelp for individuals or ReGain for couples. Both platforms offer a growing database of over 30,000 therapists specializing in many symptoms or concerns, including BPD, trauma, and personality disorders.