Borderline personality disorder

Hi Alice,

I think I might have borderline personality disorder. How is it diagnosed, how can it be treated, and what exactly is it?


Dear Reader,

Borderline personality disorder (BPD) is a serious mental disorder marked by a pattern of ongoing instability in behavior, moods, self-image, and functioning. These constant fluctuations may seriously hinder a person’s impression of their self-identity, work relationships, family life, and personal and professional growth. Some people with BPD also have high rates of co-occurring mental disorders, such as mood, anxiety, and eating disorders, along with substance abuse, self-harm, suicidal thinking and behaviors, and suicide. If you’re concerned you may have this or other mental health concerns, it’s recommended you speak with a professional. A mental health professional, such as a psychologist or clinical social worker, can provide a diagnosis for BPD after a thorough interview and a physical exam. Through psychotherapy, and potentially medication, relief for those living with BPD is possible.

The specific causes of BPD are not yet clear, but research suggests that genetic, brain, environmental, and social factors are all likely to be involved. Genetically speaking, those who have close family members with this disorder are about five times more likely to be diagnosed themselves. Moreover, many people with the disorder report experiencing traumatic life events, such as abuse or abandonment during childhood. However, some people with BPD have no history of trauma and many people with a history of traumatic life events don’t have this illness. Similarly, studies show that those who are diagnosed have structural and functional changes in the brain, especially in the areas that control impulses and emotional regulation. More research is needed to understand the relationship between brain structure and function as it relates to borderline personality disorder.  

What is it that makes you think you might have BPD? Perhaps you've read an article, or spoken with a friend who mentioned a diagnosis along with their own symptoms. You might try to identify the thoughts and behaviors that have you worried so you can describe them to a mental health professional or health care provider. A diagnosis of BPD is based on a thorough interview and a comprehensive medical exam, which can help rule out other potential causes of symptoms. It’s also possible that you’re experiencing some other mental health concern or a combination of conditions. Alternatively, it may be that you’re experiencing the normal ups and downs of daily life. Making an appointment with a professional can help identify what it is you’re experiencing and determine the most appropriate course of action.

The good news is that individuals with borderline personality disorder can undergo treatment and experience fewer or less severe symptoms and an improved quality of life. Psychotherapy (or “talk therapy”) is the main treatment for people with BPD, and both individual and group psychotherapy have been shown to help. A newer type of therapy, dialectical behavior therapy (DBT), has been specifically designed to address BPD and found to be even more effective. DBT consists of weekly sessions where the counselor and patient focus on a past event with which the patient struggled to cope and, consequently, behaved erratically and emotionally. DBT teaches coping skills, so that the person learns to deal with everyday situations that they normally have difficulty handling well. There are a number of factors that affect the length of time it takes for symptoms to improve once treatment begins, so patience is a virtue for people with BPD and their loved ones when it comes to receiving appropriate support during treatment.

The benefits of medication as BPD treatment remain unclear, and thus they aren’t recommended as a primary treatment. However, while there’s no FDA-approved medication for the treatment of BPD, many of those with the disorder are prescribed medication in addition to psychotherapy at the discretion of a medical professional. These medications are typically recommended by a mental health professional to treat specific symptoms, such as mood swings, depression, or other disorders that may co-occur with BPD.

With a provider's help, and perhaps with the combination of psychotherapy and medication, people can feel better, manage their feelings, and improve their personal and professional lives. Whether or not you have BPD, because you’re concerned, it’s wise to seek out some professional guidance. For additional information about borderline personality disorder, check out the National Institute of Mental Health.

Last updated May 05, 2017
Originally published Jun 03, 2005

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