Borderline Personality Disorder - Diagnosis and Treatment (2023)


Personality disorders, including borderline personality disorder, are diagnosed based on:

  • Detailed interview with your doctor or healthcare provider
  • Psychological evaluation which may include completing questionnaires.
  • Medical history and exam
  • Discuss your signs and symptoms

Borderline personality disorder is usually diagnosed in adults, not children or adolescents. This is because what appear to be signs and symptoms of borderline personality disorder may disappear as children get older and more mature.


Borderline personality disorder is usually treated with talk therapy, but medication can be added. Your doctor may also recommend hospitalization if your safety is at risk.

Therapy can help you learn skills to manage and cope with your condition. You also need treatment for other mental health disorders that often go along with borderline personality disorder, such as depression or substance abuse. With treatment, you can feel better about yourself and live a more stable and fulfilling life.


Psychotherapy, also known as talk therapy, is a fundamental treatment method for borderline personality disorder. Your therapist can tailor the type of treatment to your needs. The goals of psychotherapy are to help you:

  • Focus on your current ability to function
  • Learn to control your uncomfortable emotions
  • Reduce your impulsiveness by helping you notice your feelings instead of acting on them.
  • Work on improving relationships by being aware of your own feelings and those of others.
  • Learn more about borderline personality disorder

Types of psychotherapy that have been found to be effective include:

  • Dialectical Behavioral Therapy (DBT).DBT includes group and individual therapy specifically designed to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, tolerate distress, and improve relationships.
  • Form-oriented therapy.Form-oriented therapy can be done individually or in a group. It can help you identify unmet needs that have led to negative life patterns that were once helpful for survival but are detrimental in many areas of your life as an adult. Therapy focuses on helping you meet your needs in a healthy way to promote positive life patterns.
  • Mindfulness-based therapy (MBT).MBT is a type of talk therapy that helps you identify your thoughts and feelings at a given moment and create an alternative perspective on the situation. MBT emphasizes thinking before reacting.
  • Emotional Predictability and Problem Solving Training Systems (STEPPS).STEPPS is a 20-week treatment where you work in groups with your family members, carers, friends or significant others in treatment. STEPPS is used alongside other forms of psychotherapy.
  • Transference-oriented psychotherapy (TFP).Also referred to as psychodynamic psychotherapy, TFP aims to help you understand your feelings and interpersonal issues by developing the relationship between you and your therapist. Then apply this information to actual situations.
  • Good psychiatric management.This treatment approach is based on case management, where treatment is based on the expectation of participation in work or school. Focuses on understanding emotionally difficult times by taking into account the interpersonal context of emotions. It may include medication, groups, family education, and individual therapy.


While the Food and Drug Administration has not approved medications specifically for the treatment of borderline personality disorder, some medications may help with symptoms or co-occurring problems, such as depression, impulsivity, aggression, or anxiety. Medications can be antidepressants, antipsychotics, or mood stabilizers.

Talk to your doctor about the benefits and side effects of medications.


Sometimes you need more intensive treatment in a hospital or psychiatric clinic. Hospitalization can also protect you from self-harm or address suicidal thoughts or behaviors.

recovery takes time

It takes time to learn to control your emotions, thoughts, and behavior. Most people improve significantly, but you may still experience some symptoms of borderline personality disorder. You may experience times when your symptoms get better or worse. But treatment can improve your ability to function and help you feel better about yourself.

You'll have the best chance of success if you go to a healthcare provider experienced in treating borderline personality disorder.

More information

  • psychotherapy

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Management and support

The symptoms associated with borderline personality disorder can be stressful and challenging for you and those around you. You may know that your feelings, thoughts, and behaviors are self-defeating or destructive, but you feel powerless to control them.

In addition to professional treatment, you can help manage and manage your condition by:

  • Learn more about the condition so you can understand its causes and treatments.
  • Learn to recognize what can trigger anger outbursts or impulsive behavior
  • Get professional help and stick to your treatment plan: attend all treatment sessions and take medications as prescribed.
  • Work with your healthcare provider to develop a plan for what to do in the next crisis.
  • Get treatment for related problems, such as substance abuse.
  • Consider involving people close to you in your treatment so that they can understand and support you.
  • Manage strong emotions by practicing coping skills, such as using mindfulness meditation and breathing techniques.
  • Set boundaries and limits for yourself and others by learning to express emotions correctly in a way that doesn't alienate others or cause abandonment or instability.
  • Don't make assumptions about what people feel or think about you.
  • Reach out to other people with the disorder to share ideas and experiences.
  • Build a support system of people who can understand and respect you
  • Continue a healthy lifestyle, such as eating healthy, being physically active, and participating in social activities.
  • Don't blame yourself for the disorder, but acknowledge your responsibility to treat it.

Preparing for your date

You can start with a visit to your GP. After an initial appointment, your doctor may refer you to a healthcare provider, such as a psychologist or psychiatrist. Here you will find information to help you prepare for your appointment.

What can you do

Before your appointment, make a list of:

  • Symptoms you or your loved ones have noticedand for how long
  • basic personal information,including traumatic events in your past and any major stressors
  • Your medical data,including other physical or mental health problems
  • Any medications you are takingincluding prescription and over-the-counter medications, vitamins, and other supplements and dosages
  • Questions to ask your doctorso you can get the most out of your appointment

Bring a family member or friend with you if possible. Someone you've known for a long time can share important information with your doctor or healthcare provider with your permission.

Important questions to ask your doctor or healthcare provider include:

  • What is likely the cause of my symptoms or condition?
  • Are there other possible causes?
  • Which treatments are most likely to work for me?
  • How long can I expect my symptoms to improve with treatment?
  • How often do I need treatment sessions and for how long?
  • Are there any medications that can help?
  • What are the possible side effects of the medications you may be prescribed?
  • Should I take precautions or observe restrictions?
  • I have these other health problems. How can I better manage them together?
  • How can my family or close friends help me with my treatment?
  • Do you have printed materials I can get? Which sites do you recommend?

Don't hesitate to ask questions during your appointment.

What to expect from your doctor

A doctor or health care professional will likely ask you a number of questions. Be prepared to answer them to save time for the topics you want to focus on. Possible questions include:

  • What are your symptoms? When did you first notice them?
  • How do these symptoms affect your life, including your personal relationships and work?
  • How often do you experience mood swings in a normal day?
  • How often have you felt betrayed, victimized or abandoned? Why do you think it happened?
  • How well do you control anger?
  • How well do you manage to be alone?
  • How would you describe your self-esteem?
  • Have you ever felt that you are bad or even evil?
  • Have you had problems with self-destructive or dangerous behaviors?
  • Have you ever thought or tried to harm yourself or tried to kill yourself?
  • Do you use alcohol or recreational drugs or abuse prescription drugs? If so, how often?
  • How would you describe your childhood, including your relationship with your parents or guardians?
  • Were you physically or sexually abused or neglected as a child?
  • Has anyone in your immediate family or caregivers been diagnosed with a mental health problem, such as a personality disorder?
  • Have you been treated for other mental health problems? If so, what diagnoses were made and what treatments were most effective?
  • Are you currently being treated for other conditions?

By Mayo Clinic staff

13 december 2022


How valid is borderline personality disorder diagnosis? ›

Results. Of the respondents, 82% accepted the overall validity of borderline personality disorder for adult populations. The subquestions that separated conceptual (87% agreed) and empirical (67% agreed) considerations of validity showed similar profiles.

What is the most promising treatment for borderline personality disorder? ›

Dialectical behavior therapy (DBT).

DBT uses a skills-based approach to teach you how to manage your emotions, tolerate distress and improve relationships.

What happens if you are diagnosed with borderline personality disorder? ›

With borderline personality disorder, you have an intense fear of abandonment or instability, and you may have difficulty tolerating being alone. Yet inappropriate anger, impulsiveness and frequent mood swings may push others away, even though you want to have loving and lasting relationships.

Should I try to get a BPD diagnosis? ›

If you think that you (or a loved one) may have borderline personality disorder (BPD), it's important to get an accurate diagnosis, which requires a BPD assessment. Did you know that BPD symptoms often overlap those of other mental health disorders, such as anxiety and major depression?

Is BPD a controversial diagnosis? ›

The diagnosis of borderline personality disorder has a long and controversial past that continues to spark debates in psychology today.

What is BPD often misdiagnosed as? ›

Challenges with getting a BPD diagnosis

The symptoms of BPD are very broad, and some can be similar to or overlap with other mental health problems, such as: Bipolar disorder. Complex post-traumatic stress disorder (C-PTSD) Depression.

What is the gold standard treatment for borderline personality disorder? ›

The most popular and most effective form of therapy for BPD is dialectical behavioral therapy (DBT). This form of therapy was created for people with borderline personality disorder in mind. If you've been diagnosed with BPD, know that you're not alone.

What mood stabilizer is best for BPD? ›

Common anticonvulsants and mood stabilizers for BPD include:
  • Depakote (valproate)
  • Lamictal (lamotrigine)
  • Lithobid (lithium)
  • Tegretol or Carbatrol (carbamazepine)
Apr 10, 2023

Can someone with BPD get better without treatment? ›

However, despite dedication or the desire to recover, it is unlikely that a person with Borderline Personality Disorder will overcome BPD on their own without the guidance and insight that the therapeutic process can offer.

Is it worth being with someone with BPD? ›

Anyone living with BPD can still lead satisfying lives and take pleasure in long-term relationships and even life partnerships. With the proper treatment and support, people with BPD can and do have healthy and happy relationships.

Can someone with BPD be trusted? ›

Recent Findings. In trust appraisal paradigms, people with BPD have a bias to rate others as untrustworthy. In behavioral exchange games, they report lower trust in partners and are more likely to rupture cooperation.

What kind of trauma causes BPD? ›

Stressful or traumatic life events

Often having felt afraid, upset, unsupported or invalidated. Family difficulties or instability, such as living with a parent or carer who experienced an addiction. Sexual, physical or emotional abuse or neglect. Losing a parent.

Why are therapists hesitant to diagnose BPD? ›

A diagnosis of personality disorder can be stigmatizing to people. This is especially true for Borderline, Narcissistic and Antisocial Personality Disorders. This is probably largely due to the portrayal of these disorders by the media as being caustic or dangerous to the general population.

Why do therapists avoid BPD? ›

Individuals with symptoms of BPD are particularly sensitive to perceived criticism. This increases the likelihood that they will feel attacked when a therapist attempts to offer suggestions or insights. This often leads to lashing out.

What do doctors look for when diagnosing BPD? ›

Recurring thoughts of suicidal behaviors or threats. Intense and highly variable moods, with episodes lasting from a few hours to a few days. Chronic feelings of emptiness. Inappropriate, intense anger or problems controlling anger.

What is the hardest mental illness to treat? ›

Symptoms of personality disorder are: Moody, Criticizing everyone, Overreacting, Intimidating others, and Dominance over another person. A borderline personality disorder is the hardest to treat.

What are the disadvantages of BPD diagnosis? ›

Borderline personality disorder is known to cause many negative outcomes, including the loss of interpersonal relationships, divorce, an inability to maintain steady employment, self-harm, addiction, legal trouble, unplanned pregnancy, health complications, and more.

Why does BPD have a bad reputation? ›

Why does BPD have such a bad reputation? A sufferer of BPD may act out in upsetting and unsettling ways that when observed by others can lead them to be fearful of the sufferer, but compassion for the underlying causes of the person's behavior is what is often desperately needed to move them toward healing.

Why is BPD so hard to diagnose? ›

Borderline personality disorder (BPD) can be hard to diagnose because the symptoms of this disorder overlap with many other conditions, such as bipolar disorder, depression, anxiety, and even eating disorders.

What are the 3 overlooked signs of a personality disorder? ›

The Three Key Signs. Perhaps more importantly, and even more telling than specific symptoms associated with particular disorders, are matters of duration, rigidity, and globalism of the vexing behaviors.

Is BPD overdiagnosed? ›

BPD is one of the most commonly misdiagnosed mental health conditions.

What is the success rate of treatment for borderline? ›

Follow up studies of people with BPD receiving treatment found a borderline personality disorder treatment success rate of about 50% over a 10-year period. BPD takes time to improve, but treatment does work.

Can you fully treat BPD? ›

While BPD can't be cured and won't go away, Gatlin said the prognosis can be good for those who are going to therapy and taking medication, if needed, to manage their symptoms. She noted that a key milestone is when a young adult reaches their mid to late 20s, as that's when the brain finishes developing.

What are the recovery rates for borderline? ›

All told, 50% of the borderline patients studied achieved a recovery from borderline personality disorder—an outcome that required being symptomatically remitted and having good social and vocational functioning during the past two years.

What is the best antidepressant for BPD? ›

Antidepressants for BPD

Celexa or Zoloft for borderline personality disorder have been found to help with mood instability and impulsivity. By reducing the person's mood symptoms, they can improve their overall well-being.

What vitamins help with BPD? ›

Magnesium. Lower levels of magnesium have been observed in individuals with BPD (20). Further, supplementation of magnesium, in conjunction with vitamin B6, has been indicated to be supportive for reducing symptoms in individuals with BPD (20).

What calms BPD? ›

Many experts believe that weekly therapy involving education about the disorder, family support, and social and emotional skills training can treat most BPD cases. It's important to take the time to find a therapist you feel safe with—someone who seems to get you and makes you feel accepted and understood.

What foods should people with borderline personality disorder avoid? ›

Consider cutting out all processed food and sugar for a few weeks and observe your energy level and your emotions. Avoid misusing alcohol or caffeine, as these also can intensify mood instability. BPD sometimes includes symptoms of self-harm or substance abuse.

What is the life expectancy of a person with BPD? ›

People with Borderline Personality Disorder have a reduced life expectancy of some 20 years, attributable largely to physical health maladies, notably cardiovascular. Risk factors include obesity, sedentary lifestyle, poor diet and smoking.

Why is BPD the hardest to treat? ›

Borderline personality disorder often occurs with other mental illnesses, such as post-traumatic stress disorder (PTSD). These co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with symptoms of the disorder.

Why not to date someone with BPD? ›

Dating someone with borderline personality disorder can be challenging. Your partner may have major difficulties with strong emotions, drastic mood swings, chronic fear of abandonment, and impulsive behaviors that can strain your relationship with chaos and instability.

Why is it hard to love someone with BPD? ›

Loving someone with borderline personality disorder isn't easy. Watching your loved one struggle with deep inner turmoil, negotiating a fluctuating sense of identity, and experiencing such profound rawness of emotion can be painful. Often, even everyday interactions can be laden with potential hazards.

Do BPD people care about others? ›

For instance, a person with BPD is not trying to be manipulative; they are scared of being left or abandoned. They are also not uncaring people. They do care about family and friends but find it difficult not to act selfishly when experiencing their own heightened emotions.

Do borderlines ever regret? ›

Do Those Suffering from BPD's Regret Breaking Up? Although BPD personalities initiate a break-up as a way of seeking validation, because of the intense anxiety at play, they'll often express intense regret because of their abandonment wounding, especially if they're not met with the response they desire.

Do borderlines feel remorse? ›

It is often the case that a person with borderline personality disorder displays intense emotions, sometimes "flying off the handle." After such a display, they have difficulty regulating themselves. Once they have regained their equilibrium, they do often feel guilt or remorse about their behavior.

Can someone with BPD ever be happy? ›

This person says it exactly right — people with BPD have very intense emotions that can last from a few hours to even a few days, and can change very quickly. For example, we can go from feeling very happy to suddenly feeling very low and sad.

Is BPD inherited from mother or father? ›

Conclusions: Parental externalizing psychopathology and father's BPD traits contribute genetic risk for offspring BPD traits, but mothers' BPD traits and parents' poor parenting constitute environmental risks for the development of these offspring traits.

What is the root cause of borderline personality disorder? ›

Environmental factors

being exposed to long-term fear or distress as a child. being neglected by 1 or both parents. growing up with another family member who had a serious mental health condition, such as bipolar disorder or a drink or drug misuse problem.

Are people with BPD abusive? ›

Those diagnosed with Borderline Personality Disorder (BPD) or those with BPD who may not even know they have it, are more likely than the general population to be verbally, emotionally/psychologically, physically abusive.

How do I get my BPD to tell the truth? ›

How to Approach a Compulsive Liar
  1. Nip the lie in the bud. If your friend starts to say something outrageous, speculative, or clearly wrong, question them immediately. ...
  2. Make it clear that compulsive lying is not enough to end your respect or esteem for them. ...
  3. Clarify your intentions. ...
  4. Maintain respect. ...
  5. Accept the outcome.

How often is borderline personality disorder misdiagnosed? ›

One study cited that almost 40% of people who were diagnosed with BPD were provided with a misdiagnosis of BD at some point in their lifetime in comparison to only 10% of people in the general population receiving a misdiagnosis of BD. The exact reasoning for this high rate of misdiagnosis is debated among researchers.

How do therapists know if you have BPD? ›

Personality disorders, including borderline personality disorder, are diagnosed based on a: Detailed interview with your doctor or mental health provider. Psychological evaluation that may include completing questionnaires. Medical history and exam.

What is a difficult patient with borderline personality disorder? ›

The very symptoms and behaviors associated with BPD are linked with how providers define the “difficult patient.” Kelly & May (1982) found that behaviors such as mutilation, chronic illness, rule-breaking behavior, aggressive, uncooperative or won't accept care, or need too much care, and are destructive, willful, ...

Why is BPD the hardest mental illness to live with? ›

People with BPD are chronically unsure about their lives, whether it is with their family, personal relationships, work, or future aspirations. They also experience persistent uncertain and insecure thoughts and feelings about their self-image, long-term goals, friendships, and values.

What is the best job for someone with BPD? ›

Many people with BPD feel emotions deeply and find working in a caring role fulfilling. If you are an empathetic person, consider jobs such as teaching, childcare, nursing and animal care.

What is the best test to diagnose BPD? ›

There's no specific test for BPD, but a healthcare provider can determine a diagnosis with a comprehensive psychiatric interview and medical exam. After that, you can get appropriate treatment and begin to manage your symptoms better and move forward in your life.

How accurate is BPD diagnosis? ›

Interpersonal symptoms

A pattern of unstable relationships, marked by extremes of idealization and devaluation, is one of the most important symptoms in making an accurate diagnosis of borderline personality disorder, with studies reporting a sensitivity of 74% and a specificity of 87%.

Is borderline personality disorder actually real? ›

Borderline personality disorder (BPD) is a disorder of mood and how a person interacts with others. It's the most commonly recognised personality disorder.

Is BPD being removed from the DSM? ›

BPD and other personality disorders were diagnosed as Axis II disorders in the last Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). These axes are no longer used in the current edition of the DSM.

Is BPD Recognised? ›

Borderline Personality Disorder | Ausmed

The term 'borderline' was first used in the era of psychoanalysis when the condition was thought to exist on the border of psychosis and neurosis. However, BPD is now understood to be a disorder in its own right.

Do people get misdiagnosed with BPD? ›

Unfortunately, it's not uncommon for individuals with BPD to be misdiagnosed. In fact, studies show that 40% of people with this condition have received a wrong diagnosis at some point in their lifetime.

Why don t therapists like treating BPD? ›

Individuals with symptoms of BPD are particularly sensitive to perceived criticism. This increases the likelihood that they will feel attacked when a therapist attempts to offer suggestions or insights. This often leads to lashing out.

Why won't my therapist diagnose me with BPD? ›

Mental health providers can be reluctant to diagnose BPD and other personality disorders due to diagnosis criteria, insurance, and stigma. Not diagnosing BPD, where appropriate, can adversely affect treatment. Traits of BPD can be communicated without formally diagnosing the full personality disorder.

What is an example of a BPD delusion? ›

For example, an adolescent with BPD might see two of his friends talking in the hallway and develop the paranoid belief that his friends all secretly hate him and are planning to humiliate him.

What are the 9 criteria for BPD? ›

The 9 symptoms of BPD
  • Fear of abandonment. People with BPD are often terrified of being abandoned or left alone. ...
  • Unstable relationships. ...
  • Unclear or shifting self-image. ...
  • Impulsive, self-destructive behaviors. ...
  • Self-harm. ...
  • Extreme emotional swings. ...
  • Chronic feelings of emptiness. ...
  • Explosive anger.
Feb 24, 2023

What does a BPD episode look like? ›

Things that can indicate an episode is occurring: Intense angry outbursts. Suicidal thoughts and self-harm behavior. Going to great lengths to feel something, then becoming increasingly avoidant and withdrawn.

What is the hardest mental illness to live with? ›

Individuals with Borderline Personality Disorder (BPDs) become overwhelmed and incapacitated by the intensity of their emotions, whether it is joy and elation or depression, anxiety, and rage. They are unable to manage these intense emotions.

How much disability do you get for BPD? ›

The average disability check for borderline personality disorder and similar mental health conditions is $1,232.97 per month. Your monthly benefit won't vary based on your condition, but your work history, income history, and the benefits program you qualify for can all impact your actual check size.

Do people with BPD think differently? ›

People with BPD are often affected by several types of distorted thinking. Some ways that a person with BPD thinks include having paranoid ideation, dichotomous thinking, and dissociation. If you believe that you might be experiencing thinking associated with BPD, talk to your doctor.

Do people with BPD have empathy? ›

People with BPD score low on cognitive empathy but high on emotional empathy. This suggests that they do not easily understand other peoples' perspectives, but their own emotions are very sensitive. This is important because it could align BPD with other neurodiverse conditions.


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