Borderline Personality Disorder – Diagnosis and Treatment
Diagnosis
Diagnosing borderline personality disorder takes care and attention. Health professionals usually begin with a detailed interview, asking about mood swings, impulsive actions, unstable relationships, anger, and self-image issues.
They might use questionnaires to get a clearer picture of symptoms like impulsivity, intense emotions, and emptiness. Doctors also check medical history and look for other conditions, like anxiety, eating disorders, trauma, substance use, or major depression.
Most of the time, doctors diagnose BPD in adults, since symptoms in younger people often change as they grow up.
To meet the criteria for BPD, a person typically shows several ongoing symptoms that affect their relationships, self-control, and overall daily life.
The process may involve psychiatrists, psychologists, or clinical social workers. They’ll often use guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which outlines specific traits linked to BPD—like fear of abandonment, intense mood shifts, and unstable self-identity.
Because symptoms can overlap with other mental health conditions, getting an accurate diagnosis may take time, but it’s an important first step toward getting the right treatment and support.
Treatment
Meeting With a Therapist
Psychotherapy stands out as the main way to treat borderline personality disorder (BPD). People can try one-on-one counseling, join groups, or meet with family members.
Therapy teaches skills for handling stress, tough feelings, and relationship problems. It also helps people understand how BPD shapes their lives.
Several types of therapy have proven helpful for BPD. Each one focuses on specific skills or ways of thinking.
- Dialectical Behavior Therapy (DBT): DBT teaches skills for controlling emotions, dealing with distress, and improving social connections. Group and individual sessions both play a role.
- Cognitive Behavioral Therapy (CBT): CBT helps people notice negative thoughts or beliefs. It encourages changing these patterns and using better coping strategies. CBT can lower anxiety, cut down on harmful behaviors, and support emotional balance.
- Schema-Focused Therapy: This approach works on changing unhelpful patterns or beliefs that build up over time. It teaches healthier responses.
- Mentalization-Based Therapy: MBT helps people think about their own thoughts and feelings, as well as consider what others may be experiencing. This can lead to more thoughtful actions instead of quick reactions.
- Systems Training for Emotional Predictability and Problem-Solving (STEPPS): STEPPS is a group program that involves the person with BPD and their friends or family. It works alongside other therapy methods.
- Transference-Focused Psychotherapy (TFP): TFP, or psychodynamic therapy, explores emotions and relationship patterns by looking at how the patient and therapist interact. This can serve as a model for real-life situations.
Some people try both group and solo therapy. Group sessions give a chance to practice social skills and learn from others, while individual counseling focuses on personal struggles.
Benefits of therapy:
- Builds skills for managing intense emotions
- Reduces impulsive behavior
- Encourages healthy relationships
- Teaches problem-solving
- Improves understanding of BPD
Possible challenges:
- It takes time and effort
- Progress might be slow or uneven
- Some people feel uncomfortable at first
A clear, trusting relationship with a trained mental health professional really boosts the chances of success.
Using Prescription Medicine
No medications are approved just for borderline personality disorder, but some drugs can help manage symptoms like mood swings, depression, anxiety, or impulsivity.
Medicines may also help with other mental health problems that sometimes go along with BPD, such as substance use or post-traumatic stress disorder.
Medicine choices may include:
| Medication Type | How It May Help |
|---|---|
| Antidepressants | Lifts mood, eases anxiety or sadness |
| Mood Stabilizers | Balances highs and lows, lowers irritability |
| Antipsychotic Medications | Reduces feelings of anger, paranoia, or agitation |
| Omega-3 Fatty Acids | May help with mood and brain health |
Doctors talk through possible benefits and side effects. Medication can play an important role, especially for people with severe symptoms or when therapy alone doesn’t do enough.
A mental health provider checks for changes and adjusts the plan if needed. Medicine usually works best alongside therapy.
When Hospital Care Is Needed
Sometimes, people with borderline personality disorder need to stay in a hospital or mental health clinic—especially if they’re at risk of hurting themselves or others.
Hospital care offers a safe space and support during a crisis. Staff can help manage strong urges or thoughts of self-harm, support new coping skills, and guide people through tough emotions.
Stays usually last only a short time and focus on safety and moving back to regular outpatient treatment.
Ways to Cope and Find Support
Managing symptoms linked to borderline personality disorder takes effort, routine, and support from others.
It helps to know which situations or events trigger stronger emotions or self-destructive urges. Recognizing these triggers gives someone a chance to use healthy coping strategies before things spiral.
Having a crisis plan with a mental health professional is important. This plan lists steps to take during tough moments and includes who to contact for support.
Trusted friends, family, or support groups can offer understanding and guidance during setbacks.
Building a support network matters for stable relationships and emotional safety. Reaching out to others with similar experiences—like through the National Alliance on Mental Illness or local support groups—can bring comfort and practical tips for daily life.
Here are some effective coping ideas for daily life:
- Practice mindfulness and slow, deep breathing to sit with emotions without acting on them.
- Use safe alternatives if you feel the urge to self-harm, like squeezing a stress ball or drawing instead.
- Stay active with regular exercise, since physical movement can reduce stress and boost mood.
- Keep a journal or use a mood diary to track feelings, thoughts, and triggers.
| Coping Strategy | Example |
|---|---|
| Mindfulness | Guided meditation or deep breaths |
| Physical Activity | Walking, stretching, swimming |
| Crisis Plan | Emergency contacts list |
| Peer Support | Sharing with support groups |
Try not to blame yourself for having symptoms. Taking responsibility for treatment and keeping up a healthy lifestyle—eating well, staying social—can really help manage mental health.
How to Get Ready for Your Visit
Getting ready for a healthcare appointment can make it more useful and less stressful.
Here are some things you can do ahead of time:
- List Your Symptoms: Write down any changes in mood, thoughts, or behaviors. Note how long these have been happening and if anyone else has noticed them.
- Personal Background: Make a short summary of important events in your life. This can include past trauma or current stresses that might be important to share.
- Medical Information: Record any health conditions you have and any treatments you are getting for them.
- Medications and Supplements: Bring a list or photo of all medicines, vitamins, and supplements you are taking, with the dosages.
- Questions to Ask: Prepare a list of questions you want answered. This helps you remember what is most important during the visit.
It may help to bring a trusted family member or friend, especially someone who knows you well. They might offer helpful details about your health or behavior, with your agreement.
Possible questions to consider asking at your visit:
| Question | Why it’s helpful |
|---|---|
| What do you think explains my symptoms? | To understand the possible cause |
| What treatments are available? | To learn your options |
| Will therapy or medication be needed? | To know more about your care plan |
| How long might treatment last? | To set expectations |
| Are there risks or side effects with treatment? | To be aware of possible problems |
| Will this affect my other health issues? | To understand how care plans might overlap |
| How can my family or friends support me? | To include your support system in your care |
| Do you have reading material or website suggestions? | To help you learn more after the appointment |
Don’t hesitate to ask any other questions or bring up things that aren’t clear. Making the most of your time with the healthcare provider, family physician, or mental health professional helps you leave with the information you need.
What Your Doctor or Specialist Might Do
When you show up for your appointment, your provider—maybe a family doctor, psychologist, or psychiatrist—will probably start by asking you a bunch of questions to get a sense of what’s going on.
They’ll want to know about your symptoms. You might hear questions about when you first noticed things, what you’re dealing with right now, and how all of it affects your daily life.
They’ll likely dig into your emotional state too. Stuff like your mood, how you handle anger, whether you feel lonely, or how you see yourself might come up.
Expect them to ask about your behavior patterns. They might bring up risky actions, if you use substances, or how you cope when things get stressful.
Your personal and family history matters as well. The provider could ask about your childhood, any tough experiences, or whether anyone in your family has struggled with mental health.
They’ll also want to know if you’ve had mental health care before. What worked, what didn’t—those kinds of details help them understand your background.
Your answers give them a clearer picture of your health and what you might need. They might also ask if you have any physical health issues or if other doctors are treating you for something else.
Try to answer as honestly and openly as you can. Being upfront helps your doctor or mental health professional figure out what will actually help you.
If you can, bring some notes or have a trusted person come along. It’s easy to forget things in the moment, and a little backup never hurts.
