Managing borderline personality disorder

Around five million people with borderline personality disorder (BPD) are estimated to be living in the United States. Personality disorders are characterized by ways of seeing and reacting to others that can cause interpersonal and behavioral problems in life and relationships. Common signs of borderline personality disorder, in particular, include emotional instability and difficulty maintaining healthy connections with others. People with this condition may feel happy and positive and then sad and depressed a few hours later. Learning more about the treatments available for borderline personality disorder, such as dialectical therapy, may help you make an informed decision on your mental healthcare.

What is borderline personality disorder? 

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A 2018 study suggests there are common risk factors believed to lead to BPD. Neurobiological abnormalities, a combination of specific genetic factors, and a history of childhood trauma may put you at a higher risk.

What causes BPD? 

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

How is BPD diagnosed?

Borderline personality disorder is often diagnosed and treated after age 18. This is because an individual’s personality typically evolves so significantly throughout childhood and adolescence that providing an accurate diagnosis of a personality disorder in these phases of life can be difficult. Many children or teens who will go on to receive a borderline personality disorder diagnosis as adults may be initially diagnosed with depression or anxiety in their younger years. A licensed mental health professional can diagnose the condition through interviews and observations of both the individual and family history. 

Therapists and psychiatrists typically look for the following symptoms when considering a diagnosis of borderline personality disorder and other mental disorders:

• A fear of abandonment
• Emotional pain related to actual or imagined loss of significant relationships 
• Unstable emotions and/or challenges controlling intense emotions 
• Unstable self-image 
• Traumatic life events 
• Intense and unstable relationships with friends and family members
• 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 stress
• Intense anger and/or irritability 
• Dissociation (feeling "out of your body") 
• Rapid mood swings 
• Significant stress-related paranoia 
• Ongoing feelings of depression or anxiety 
• Feeling persistently 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"

Developing borderline personality disorder (BPD) may also occur alongside another mental health condition, including the following:  

• Anxiety disorders 
• Post-traumatic stress disorder (PTSD) 
• Complex post-traumatic stress disorder (C-PTSD) 
• Sleep disorders 
• Eating disorders, including binge eating
• Depression 
• Substance use disorders
• Suicidal behavior
• Bipolar disorder
• Narcissistic personality disorder (NPD) 

If you or a loved one is experiencing symptoms of any eating disorders, you can contact the National Eating Disorder Association Helpline for support and resources at 1-800-931-2237 (M–Th from 9 AM–9 PM EST and Fri 9 AM–5 PM EST).

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 health treatment plan for borderline personality disorder may include a combination of psychotherapy and specific work to repair social factors alongside a clinical social worker or other mental health professionals. A mental health provider may also recommend medication to help manage severe symptoms in some cases. Do not start, stop, or change any medication without consulting a psychiatrist or other healthcare provider who can manage your psychiatric management plan. Types of therapy that are commonly recommended for those who develop borderline personality disorder (BPD) are listed below.

Dialectical behavior therapy (DBT)

Borderline personality disorder is often treated through DBT, which 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. This type of therapy (DBT) is usually a structured program that involves a workbook, worksheets, and frequent sessions. It can be done in an individual or a group therapy format and was developed specifically to treat borderline personality disorder by Dr. Marsha Linehan. It involves four modules, including:

• Emotional control
• Distress tolerance 
• Mindfulness skills
• Interpersonal effectiveness

The authors of a journal publication on DBT for borderline personality disorder state that "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 borderline personality disorder but also in other disorders, such as substance use disorders, mood disorders, post-traumatic stress disorder, and eating disorders."

Family therapy

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

Humanistic therapy

Humanistic talk therapy centers on a person's individual nature and goals instead of approaching every client in the same way. Sessions focus on positive behaviors and traits and developing the person's 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 other personality disorders who may not respond to other treatments as it’s a combination of elements from multiple forms of therapy. In schema therapy, the therapists focus on targeting your schema, or a pattern of unwanted thoughts, to reduce self-destructive behaviors that may have developed during childhood. 

Cognitive-behavioral therapy (CBT)

Cognitive behavioral therapy is backed by significant research suggesting its effectiveness in treating various mental health conditions, including borderline personality disorder. This therapy focuses on identifying unwanted or harmful thought patterns, behaviors, and perceptions of self and others and developing strategies to shift them. 

Mentalization-based treatment (MBT)

Mentalization-based therapy (MBT) centers on increasing your curiosity and ability to accurately identify your emotions and thoughts and form a realistic expectation of others' thoughts. Researchers suspect that difficulties with mentalization may result from challenges during the early attachment phase of development in childhood. 

Transference-focused psychotherapy (TFP)

Researchers believe that TFP treatments may help those with borderline personality disorder (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 plan to treat specific symptoms, there are various coping skills and lifestyle changes you might use to manage your symptoms and adjust to living with borderline personality disorder, 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 movement 
• Distracting yourself with sensory stimulation
• Not assuming intentions
• Caring for your physical health
• Taking walks in nature

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

Tips for supporting a loved one with BPD

If someone you love has been diagnosed with borderline personality disorder, there are several ways you can support them, including the following:

Educate yourself on borderline personality disorder

First, you might educate yourself to learn everything you can about borderline personality disorder, its symptoms, and effective treatments. A wealth of stigma and misinformation exists, so finding credible resources is important. NAMI has published common myths and facts about borderline personality disorder if you’re looking for a place to start. 

Address unstable relationships with family or couples therapy 

If your family or partner has BPD, attending family or couples therapy together could help strengthen your bonds and teach you both helpful coping strategies for communication, connection, and crisis response. 

Encourage your loved one to participate in treatment

In the end, it’s the choice of the individual with borderline personality disorder whether or not to attend therapy or seek other treatments for their condition. However, it could be beneficial for you as their loved one to gently encourage them to seek or stick with treatment long-term. Knowing that they have your support through the process could help them start or stay the course.

Establish and maintain boundaries 

Finding a balance between supporting your loved one and caring for yourself can be crucial. This can look like setting and enforcing boundaries related to your space, belongings, body, and time. for one. If you feel you could benefit from support with this or another aspect of loving someone with borderline personality disorder, speaking to a therapist yourself may be beneficial.  

Counseling options 

If you experience trouble maintaining healthy relationships, feelings of emptiness, an intense fear of abandonment, poor impulse control, and/or other symptoms of borderline personality disorder, you might consider reaching out to a therapist for guidance. If you face barriers to treatment like cost, distance, or lack of availability, online counseling for BPD could represent a more convenient option.

A recent study suggests that clients attending DBT treatments online had a higher attendance rate than those in a traditional in-person clinical environment. Overall, the study also suggests thatonline DBT treatments can be as effective as in-person options for treating a variety of conditions, from BPD to depression to bipolar disorder. 

If you're interested in trying DBT or another form of counseling online, you might consider signing up for a platform like BetterHelp for individuals or Regain for couples. Both platforms offer a growing pool of over 35,000 licensed therapists specializing in various mental health challenges. You can get matched with one who suits your needs and preferences and then meet with them via phone, video call, and/or in-app messaging from the comfort of your home.