Diagnosed With BPD? Therapy Can Help You Manage

By: Mary Elizabeth Dean

Updated February 18, 2021

Affecting millions worldwide, Borderline Personality Disorder (BPD) is one of the most misjudged mental health conditions today. Characterized by the inability to regulate one's emotions, BPD can make a person feel unstable, uncertain, and insecure. Because these issues start in childhood, it can take many years for a person to be appropriately diagnosed with BPD. Therapy was once thought to be ineffective for treating this condition, but newer treatment methods like DBT are now helping people overcome their self-destructive relationship patterns and create lives that are much more manageable.

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Symptoms And Signs Of Borderline Personality Disorder

The National Institute of Mental Health (NIH) defines Borderline Personality Disorder as an illness marked by an ongoing pattern of varying moods, self-image, and behavior.

An individual with this disorder often suffers display uncertainty and mood swings on how they perceive themselves and others.

Specific signs and symptoms of BPD:

  1. Extreme efforts to avoid being abandoned (sometimes the abandonment is only imagined.)
  2. Unstable relationships and patterns with friends and family.
  3. Frequent mood swings when emotionally triggered that range from love (idealizing) to anger or hatred (devaluing).
  4. Disturbance of identity/unstable sense of self.
  5. Inappropriate bouts of anger that seem uncontrollable and are usually followed by other intense emotions.
  6. Impulsive behavior or actions that are self-destructive such as unsafe sex, reckless driving, binge eating, and spending sprees.
  7. Regular feelings of emptiness or boredom
  8. Threats, as well as the recurring thought of suicide and cutting.
  9. The feelings of dissociation, for instance, seeing oneself from the outside body as well as cutting off from oneself is another symptom found in the borderline disorder

The nine criteria listed above are used to diagnose BPD. Therapy takes place after an accurate mental health analysis and diagnosis, but no every person with a Borderline Personality Disorder experiences every single symptom. Some people struggle with only a few of these issues while another individual experiences all of the criteria at one point or another. To be diagnosed with this particular personality disorder, a person has to experience at least 5 out of 9 symptoms.

BPD Diagnosis

According to the Mayo Clinic, BPD is diagnosed through the following steps:

  • An interview with a doctor/mental health professional trained in diagnosing and treating personality disorders.
  • Discussing of symptoms, past experiences.
  • A psychological evaluation and medical exam.

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Many Borderline Personality symptoms often mirror other psychological diseases. Therefore, it is historically harder to diagnose and treat than many other mental health conditions. Children are rarely diagnosed with BPD since emotional instability is common and somewhat normal in people under the age of 18.

Lots of people self-diagnose, figuring out that they have BPD through online assessments or research, but it is important to get an official evaluation before pursuing the following treatment options.

Therapies And Treatment

BPD is considered hard to treat for two main reasons. First, many mental health officials stigmatize the disorder and believe the stereotype that "BPD can't be treated." Some therapists even decline to treat patients with BPD, assuming that they will be wasting their time.

The second treatment hurdle has to do with the most common cause of BPD. A personality disorder by definition is compromised by ingrained patterns of thinking-which are difficult to change. Most people with BPD experienced childhood trauma that caused them to develop unhealthy coping mechanisms early in childhood. It can be many years before they realize that their way of dealing with problems and other people isn't working. The reversal of these patterns can be difficult.

Still, people diagnosed with this disorder shouldn't give up hope. Treatment options are available for BPD. Therapy is the place to start.


Psychotherapy is a line of BPD therapy for individuals with this disorder. Also known as "talk therapy" this treatment option help people with emotional issues, depression, personality disorders, and other mental health issues improve symptoms and solve problems.

It's important to realize that psychotherapy isn't "one size fits all." There are many different types of psychotherapy. One of the most promising treatments for personality disorder being Dialectical Behavior Therapy, a kind of Cognitive Behavior Therapy.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is a type of talk-therapy used to treat various mental health issues including BPD. Benefits include:

  • Better management of symptoms
  • Help to cope with grief/loss
  • Healing of past trauma
  • Recovery from problems that medication can't assist with
  • Better regulation of emotions
  • Healthier relationships/resolution of conflicts

During CBT, a licensed counselor or other mental health professional encourage their patient to talk about his or her thoughts and feelings. Specific problems are often targeted, especially when goal-oriented therapy tactics are used. Generally, with someone with BPD, therapy sessions that are CBT in nature are structured like this:

  • A problem or issue is discussed
  • The client is made aware of his or her thoughts, feelings through this discussion
  • Any negative thinking, behaviors, beliefs or patterns are addressed
  • These negative patterns are 'reshaped,' and new ways of responding are pinpointed

Dialectical Behavior Therapy (DBT)

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DBT is a form of CBT (see above) that has proven beneficial for those struggling with BPD. The goal of Dialectical Behavior Therapy is to equip those with BPD with skills and coping mechanisms that allow BPD patients to better deal with overwhelming emotions and relationship conflict. One great thing about DBT is that it is structured and provides assistance in four specific areas:

  1. Mindfulness skill focuses on improving a person's ability to present in the current moment and accept things as they are.
  2. Distress Tolerance. This area helps you better tolerate and learn from suffering.
  3. Emotional Regulation. The focus of emotional regulation is helping patients change and manage intense emotion causing problems in an individual's life.
  4. Interpersonal Effectiveness. This section consists of techniques that allow an individual to communicate with other people assertively, strengthen relationships as well as maintain self-respect.

How Dialectical Behavior Therapy Works

With BPD, therapy sessions help the person discover ways of holding opposite perspectives at once, avoiding black and white, and promoting balance. Dialectical Behavior Therapy differs from traditional CBT in the fact that it works on changing long-term patterns and daily life, not just specific goals. One main focus of DBT is to encourage patients to 'build a life worth living.'

Specific things that are important to know about DBT:

  • With BPD, therapy sessions using DBT are personalized. No two treatment plans are alike, and this customization allows for better-targeted management of symptoms.
  • All about improvement, DBT focuses on securing a more robust sense of self and self-image.
  • It can also help people learn to be more confident and stand up for themselves, teaching those with BPD to say "no" when necessary.
  • DBT can help target addiction and addictive behaviors that often plague people with BPD.
  • Emotional intelligence is gained through DBT tools since they teach creating boundaries, protecting self-interest, and patience.

Common DBT skills recommended to patients include:

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  • DEAR MAN: People struggling to communicate effectively can use the "DEAR MAN" to better express themselves. The acronym stands for describe, express, assert, reinforce, mindful, appear, and negotiate.
  • Radical Acceptance: The act of accepting our reality instead of holding on to unrealistic expectations or wallowing in victimized statements like "this isn't fair" and "this shouldn't be happening."
  • Nonjudgmental Stance: Avoiding assigning value or "right" and "wrong" to situations. For example, one of your coworkers shows up late for work, causing you to have to stay 20 extra minutes. Instead of thinking negative thoughts like "she doesn't respect my time" and getting upset, someone practicing this skill will take a nonjudgmental stance and instead focus on facts "I don't like staying late, so this has made me a little upset."
  • Opposite to Emotional Action: Instead of stuffing down painful emotions or acting on them, this BPD therapy strategy helps people find opposite ways of acting that are not self-destructive.
  • The Wise Mind: This theory holds that we have three types of thoughts/emotional behaviors. The first is the 'reasonable mind' and the second the 'emotional mind.' The third is a balance of the two, known as 'wise mind.' This strategy helps those struggling with emotional regulation find a middle ground.

Finding The Right Therapist

You will want to find a therapist who is trained in DBT and knows how to use these tools to address the self-destructive and harmful aspects of Borderline Personality Disorder.

More than any other condition, it is vital that those struggling with BPD find someone who is comfortable with DBT and knows that when it comes to BPD, therapy is both necessary and beneficial.

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For this reason, calling a random therapist you find on Yelp or see in a local ad isn't recommended. Instead, you might consider using a therapy matching service such as Betterhelp and allowing them to match you with the perfect mental health counselor for you. Having therapy tailored to your needs will make recovery much more likely.

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