Borderline Personality Disorder (BPD) is one of the most misunderstood mental health conditions—and one of the most stigmatized. But behind the label is a real person who often feels emotions more deeply than others and struggles with identity, relationships, and regulation. With the right support, treatment, and understanding, people with BPD can lead meaningful and connected lives.
In this post, we’ll break down what BPD actually is, common signs and symptoms, how it’s diagnosed, and the most effective treatment options available today.
What Is Borderline Personality Disorder?
Borderline Personality Disorder is a mental health condition that affects how a person experiences emotions, relationships, and self-image. People with BPD may feel emotions intensely and for long periods of time, which can make it difficult to return to a baseline after something upsetting happens.
Some of the core features include:
- A strong fear of abandonment, even when it’s not based in reality
- A shifting or unclear sense of self
- Intense mood swings or emotional responses
- Difficulty maintaining stable relationships
- Impulsive or self-destructive behaviors, sometimes including suicide attempts
For many, BPD is rooted in early experiences, such as trauma, consistently invalidating caregivers, or major attachment disruptions (like adoption, an incarcerated parent, or time spent in foster care), but not always. Like many mental health diagnoses, it’s not about blame. It’s about the patterns that interfere with daily life and relationships and learning how to navigate them.
Common Symptoms of BPD
BPD shows up differently from person to person, but here are some hallmark symptoms clinicians look for:
- Emotional dysregulation: Sudden, intense emotional shifts. These can often be in response to seemingly small triggers, but feel like a big deal.
- Fear of abandonment: This can lead to frantic efforts to avoid real or imagined rejection.
- Unstable relationships: Relationships may swing between idealization (“You’re perfect”) and devaluation (“You never cared about me”).
- Impulsivity: Risky behaviors like binge eating, unsafe sex, or reckless driving can serve as a coping mechanism.
- Chronic emptiness: A deep, persistent feeling of emptiness or “not existing” can be hard to describe and even harder to live with.
- Distorted self-image: People with BPD may struggle to maintain a consistent sense of who they are, what they value, or where they’re headed.
Diagnosing Borderline Personality Disorder: What Makes It Tricky?
BPD often overlaps with—or is mistaken for—other diagnoses, which is why a thorough clinical evaluation is essential. Some conditions that share features with BPD include:
- Complex PTSD (C-PTSD): Both often involve the client having trauma histories, but C-PTSD tends to focus more on fear-based symptoms and long-term trauma responses, whereas BPD includes specific interpersonal and identity-related patterns. Some therapists argue that these should be the same diagnosis, just different symptom groups.
- Bipolar Disorder: Bipolar mood shifts are more episodic and can last days to weeks, unlike the rapid and often reactive shifts in BPD. Learn more about bipolar disorder at this blog post.
- Depression and anxiety disorders: These often co-occur with BPD and can sometimes mask or mimic its symptoms.
Accurate diagnosis matters because it guides treatment. A misdiagnosis can delay access to the most effective therapies, and the client feels more frustrated (“Nothing can help me, it’s hopeless”).
For some, the diagnosis of BPD can feel really heavy, but for others it can feel more enlightening or like they finally have a roadmap. Too often, people with BPD feel like something is wrong with them—they don’t understand why they can’t keep relationships like others or why they feel like they are “too much.” The reality is that our past experiences have a major impact on our current relationships, and that’s true for many people who have BPD.
Evidence-Based Treatments for BPD
The good news: BPD is very treatable. With the right therapeutic approach, many people see real and lasting improvement. Here’s what research shows works best:
- Dialectical Behavior Therapy (DBT): This is the most evidence-based treatment for BPD. DBT teaches core skills like mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. It’s structured, skills-focused, designed specifically for individuals with high emotional sensitivity, and it was created by someone with BPD.
- Talk Therapy (Psychotherapy): Beyond DBT, therapies like Schema Therapy, Mentalization-Based Therapy (MBT), and Transference-Focused Psychotherapy (TFP) help individuals understand the root of their patterns and shift how they relate to themselves and others.
- Medication: While no medication “cures” BPD, certain prescriptions may be used to manage co-occurring symptoms like depression, anxiety, or insomnia.
- Skill-building: Many people with BPD missed opportunities to learn healthy coping skills early in life. Therapy often includes emotional literacy, boundary setting, and communication tools. These are a core part of DBT, but can also be found in other modalities.
BPD Deserves Understanding, Not Judgment
Borderline Personality Disorder is not a character flaw. It’s not attention-seeking. It’s not untreatable. It’s a real mental health condition rooted in real pain—and it responds to real support.
Reducing the stigma around BPD starts with education. When we replace judgment with curiosity, and fear with empathy, we make room for growth. If you or someone you love is living with BPD, know that you aren’t alone.
Frequently Asked Questions
How is Borderline Personality Disorder diagnosed?
BPD is diagnosed by a licensed mental health professional through a clinical interview, psychological assessments, and careful evaluation of symptoms and personal history. It often involves ruling out other disorders like bipolar disorder or complex PTSD. With the stigma (and often heaviness) associated with this diagnosis, it is common for therapists to refer clients for thorough psychological testing with a psychologist to confirm this diagnosis.
What Causes Borderline Personality Disorder?
There is no single cause of BPD. It often develops from a combination of genetic vulnerability, early attachment disruptions, childhood trauma, and childhood instability. In the podcast episode, Dr. Janssen highlights, ‘People that are diagnosed with borderline personality disorder often have an insecure attachment,’ and stresses the importance of teaching clients about stable relationships and trust.
What is The Best Treatment for Borderline Personality Disorder?
Dialectical Behavior Therapy (DBT) is the most evidence-based and widely recommended treatment for BPD. Other therapies like Schema Therapy, Mentalization-Based Therapy (MBT), and Transference-Focused Psychotherapy (TFP) can also be effective.
Is Borderline Personality Disorder the Same as bipolar disorder?
No. While both involve mood instability, BPD mood shifts are typically rapid and triggered by interpersonal stress, whereas bipolar disorder includes longer episodes of depression and mania or hypomania, often unrelated to external events. For a deeper dive on the differences, check out our blog post about the common misdiagnosis of bipolar disorder.
