Borderline Personality Disorder Treatment Guide

Borderline personality disorder treatment primarily involves evidence-based psychotherapy approaches, with dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) proving most effective for managing symptoms, emotional regulation, and relationship stability when delivered by licensed mental health professionals.

Feeling like your emotions are a constant rollercoaster with relationships that swing between intense love and overwhelming fear? Borderline personality disorder treatment offers real hope through proven therapies like DBT and CBT that can help you find stability and build healthier connections.

Content warning: Please be advised, the below article on treatment for borderline personality disorder might mention substance use disorder and treatment-related topics that could be triggering to the reader. If you or someone you love is struggling with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Support is available 24/7.

Borderline personality disorder (BPD) typically involves symptoms such as risky behavior, intense fear of abandonment, periods of paranoia, extreme mood swings, and a pattern of unstable relationships. Risk factors for borderline personality disorder may include family history, the structure and function of the brain, and various environmental, cultural, and social factors.

Borderline personality disorder treatment usually consists of a combination of therapy, medication, and hospitalization, although therapy in the form of cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) tends to be the most common.

Understanding borderline personality disorder

Borderline personality disorder (BPD) is a mental health condition that can affect the way a person thinks or feels about themselves and others. People with borderline personality disorder generally experience symptoms beginning in adolescence or early adulthood. It is typically characterized by a long-term pattern of strong emotional responses, unstable relationships, a distorted self-image, and impulsive behaviors that may affect how individuals with borderline personality disorder feel about themselves and how they relate with others.

Recognizing the symptoms of BPD

Symptoms of borderline personality disorder can vary among individuals, and it tends to manifest mostly in adults, as it is a personality disorder. Some people may experience several symptoms, but others may only experience limited signs. The severity and duration of symptoms can also vary among individuals.

The symptoms of borderline personality disorder may be incited by what some consider simple events. For example, an individual with borderline personality disorder may become distressed when separated from people with whom they feel close, such as when traveling to work or school.

Common symptoms can include:

Risky or impulsive behaviors

People with borderline personality disorder may be likely to engage in risky or dangerous behaviors, such as unprotected sex, reckless driving, alcohol or substance use, and binge eating. They may also show impulsive behaviors, such as gambling, going on spending sprees, or suddenly ending positive relationships for no apparent reason. Some people with borderline personality disorder might exhibit self-harming behavior and, in severe cases, suicidal behavior.

If you are experiencing suicidal thoughts or urges, call or text the National Suicide Prevention Lifeline at 988. Support is available 24/7.

Intense fear of abandonment

A fear of abandonment is another common symptom experienced by people with BPD. This fear can be so severe that a person may engage in extreme measures, such as faking illness, to avoid perceived separation or rejection from others.

Periods of paranoia

Stress-related paranoia or loss of contact with reality can be common for those with BPD. Episodes of paranoia may be as brief as a few minutes but can last for much longer periods in some cases.

Extreme mood swings

Individuals living with borderline personality disorder may also experience intense, inappropriate anger. Such anger may present as suddenly losing their temper or acting bitter or sarcastic, and some people may engage in physical fights or self-harm, even attempting suicide in severe cases.

A pattern of intense, unstable relationships

People living with borderline personality disorder often experience intense and unstable relationships involving extreme emotional shifts. There may be emotional patterns ranging from extreme idealization (being madly in love) and closeness to anger and intense dislike.

Potential substance use

People who live with borderline personality disorder or bipolar disorder may resort to substance misuse to cope with the symptoms they’re experiencing. The combination of a mental health condition and substance use can greatly disrupt a person’s life and well-being. As a result, such an individual may need concurrent treatment for substance abuse and their mental health condition.

Borderline personality disorder vs. bipolar disorder

The symptoms of BPD can be similar to those of bipolar disorder. The primary difference may be that people living with bipolar symptoms typically experience longer periods of mood stability. A trained mental health provider, such as a licensed clinical social worker, can be helpful in determining the proper diagnosis.

What causes borderline personality disorder?

The exact cause of borderline personality disorder is currently unknown, and researchers and clinicians often vary in their hypotheses. According to the National Institute of Mental Health, three risk factors may primarily contribute to BPD: family history, the structure and function of the brain, and environmental, cultural, and social factors such as childhood abuse.

Some research suggests that the structure and function of the brains of people with BPD may differ from those without it, particularly in the areas that affect the control of emotions and impulses, primarily the prefrontal cortex. Additionally, genetics and social, cultural, and environmental factors are believed to increase a person’s risk of developing BPD.

People who have experienced neglect or abuse, post-traumatic stress disorder (PTSD), or an unstable environment, especially during the developmental stages of early childhood, may also be at increased risk of developing this disorder. Having a first-degree relative, such as a sibling or parent, with BPD has also been associated with the occurrence of BPD, as well as living with certain mental health conditions, such as eating disorders.

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Another hypothesis regarding the cause of BPD involves brain chemistry. A hormone compound in blood called serotonin, which is usually responsible for mood control, typically transmits signals from one area of the brain to another. Abnormalities in serotonin production and absorption may make some people more susceptible to developing BPD and other mental health problems.

The path to diagnosis

Borderline personality disorder is generally believed to have first been diagnosed in the early 20th century. Because BPD may not be as commonly known as other disorders, misdiagnoses can be common. As research advances, the process of getting borderline personality disorder diagnosed accurately is improving. As a result, mental health professionals may be better prepared with the knowledge to treat these disorders effectively.

The process of diagnosing borderline personality disorder is often multilayered. A medical exam, which can help rule out underlying medical conditions that may be the cause of symptoms, is usually the first step. Diagnosis can also involve completing a clinical interview, gathering a family history (including family medical history), and administering assessments or tests.

Because temperament is believed to continue developing through adolescence, diagnosing children or a person younger than 18 with borderline personality disorder is an issue of debate among some mental health professionals. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) sets standards for diagnosing behavioral, personality, and mood disorders as well as other mental illnesses, and it suggests caution when evaluating and diagnosing children with any personality disorder. This is because some conditions present symptoms that mirror typical adolescent behavior.

Overall, an official diagnosis of BPD generally requires that at least five primary symptoms be present in an individual. The primary symptoms of BPD may include:

• Intense or unstable interpersonal relationships
• Impulsive behavior
• Self-destructive behavior
• Fear of abandonment
• Poor self-image
• Emotional instability
• Difficulty controlling intense anger
• Feelings of emptiness or worthlessness
• Extreme suspiciousness or feelings of being “disconnected”

Treatment approaches for borderline personality disorder

The treatment approach for borderline personality disorder may include a combination of medication, psychotherapy, and hospitalization. Treatment plans to treat BPD are generally determined by the severity of a person’s symptoms and willingness to comply with a recommended care plan. For example, those with severe symptoms or co-occurring disorders may require a more intensive plan.

The role of psychotherapy in BPD treatment

The most common treatment for BPD is generally psychotherapy, often referred to as talk therapy. Psychotherapy may help individuals cope with mental health challenges, reduce self-destructive behaviors, and treat specific symptoms, such as intense emotions and an unstable self-image. It usually focuses on managing or controlling psychological symptoms so that the affected person can function more effectively. Mental health professionals may recommend individual and group therapy sessions.

Commonly used types of therapy include cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), and schema-focused therapy. Dialectical behavior therapy (DBT) is often the most effective method to treat borderline personality disorder, as it was developed specifically as an offshoot of CBT for the condition. The founder of DBT, Marsha Linehan, Ph.D., was also diagnosed with BPD and used her experience with this condition to develop treatment for mental health professionals and clients worldwide.

Cognitive behavioral therapy for borderline personality disorder

Cognitive-behavioral therapy is a form of talk therapy that typically helps identify and change unhealthy beliefs and inaccurate perceptions that an individual experiences regarding themselves or others. These changed perceptions and beliefs can then positively affect a person’s emotions and behaviors. CBT can teach a person healthy ways to react to feelings of anxiety, anger, and insecurity. In addition to BPD, CBT is also commonly used for eating disorders, depression, anxiety, or other disorders.

Dialectical behavior therapy: A specialized approach

Dialectical behavior therapy is generally considered to be designed specifically for people with borderline personality disorder. Developed by Dr. Marsha Linehan, it can be thought of as a special type of cognitive-behavioral treatment for BPD.

DBT generally takes participants through several stages and builds core skills like mindfulness, interpersonal effectiveness, emotional control, and distress tolerance.

Dialectical behavioral therapy (DBT) usually involves focusing on individual psychotherapy and group skills training. DBT often teaches participants how to apply the skills learned in real-life situations by structuring their environment and continuing to work with a treatment team. Dialectical behavior therapy typically requires weekly appointments so that mental health professionals can monitor progress effectively.

Individual psychotherapy usually focuses on helping a person grasp an understanding of borderline personality, what symptoms may occur, and how to manage symptoms when they arise.

Group skills training often includes the following four modules:

• Practicing mindfulness or awareness in the present moment
• Tolerating distress and pain in challenging situations
• Being more effective in interpersonal relationships by asking for what you want and saying no in appropriate ways
• Controlling emotions by increasing understanding of the function of emotions as well as the associated actions

Medication as part of treatment for borderline personality disorder

Although medication may not cure borderline personality, some medications may be useful in relieving symptoms associated with it. Each individual may respond to medication differently. Therefore, patients are encouraged to follow directions for medications, keep follow-up appointments, and report any changes in mood or behavior or any unpleasant side effects to their medical provider. Individuals with BPD should also avoid starting or stopping medication without the guidance of a medical professional.

Important note: Licensed clinical social workers, such as those at ReachLink, do not prescribe medications. If medication is recommended as part of your treatment plan, your ReachLink therapist can provide appropriate referrals to psychiatrists or other medical professionals authorized to prescribe medications.

While both medical and psychological treatment for BPD can be effective independent of each other, many people find that a combination of medication and psychotherapy offers the best treatment results.

Telehealth therapy: Accessible treatment for BPD

Dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) are common forms of treatment for borderline personality disorder, but it may not always be convenient to attend sessions in person. Telehealth therapy may be a more available alternative for those with borderline personality disorder who would prefer to get help from home or anywhere they have a stable internet connection.

According to a study in the International Journal of Mental Health Nursing, online DBT proved to be as effective as traditional in-office therapy.

With a telehealth therapy platform like ReachLink, you can speak with a licensed clinical social worker via secure video sessions at a time that works for you. ReachLink’s licensed clinical social workers are trained in evidence-based therapeutic approaches including CBT and DBT techniques that can be effectively delivered through telehealth modalities.

Telehealth therapy offers several advantages for individuals with BPD:

• Reduced barriers to access: No need to arrange transportation or take extended time off work
• Comfort and safety: Engage in therapy from a familiar, comfortable environment
• Consistency: Easier to maintain regular appointments, which is crucial for BPD treatment
• Flexibility: Schedule sessions around your life rather than rearranging your life around therapy

Why early intervention matters

Without treatment, BPD may influence your moods to keep swinging, and everyday life might become really challenging. Relationships can suffer, and it might feel like you’re stuck in a cycle of intense emotions. On the other hand, borderline personality disorder diagnosed and managed promptly can reduce self-destructive behaviors, help the individual learn to control intense emotions, improve relationships, manage substance abuse, reduce suicidal behavior, and generally improve borderline personality symptoms overall. Therapy can also address co-occurring conditions such as post-traumatic stress disorder and anxiety. Therefore it can be essential to seek treatment from a professional for borderline personality disorder.

Moving forward with treatment

Periods of paranoia, unstable relationships, risky behavior, mood swings, and an intense fear of abandonment can all be symptoms of borderline personality disorder (BPD). Risk factors for developing this disorder may include the brain’s structure and function, family history, and cultural, social, and environmental factors. Treatment for BPD most often involves cognitive behavioral therapy or dialectical behavioral therapy, but it may also include medication and hospitalization in some cases.

Many people improve with therapy to manage borderline personality disorder. Support like DBT or CBT can teach you new ways to handle your feelings and improve your relationships over time. Family therapy can also be a helpful way to learn healthy communication and improve relationships. Borderline personality disorder managed by a licensed mental health professional has come a long way in recent years, with evidence-based treatment approaches like dialectical behavior therapy leading to fewer symptoms, improved function, and better overall quality of life.

Telehealth therapy can be convenient for those with BPD to get the professional help they deserve. ReachLink’s licensed clinical social workers specialize in providing therapeutic counseling services through secure, HIPAA-compliant video sessions that make quality mental health care accessible regardless of your location or schedule. Take the first step toward improving your symptoms of BPD by exploring your telehealth therapy options today.

Frequently asked questions

Read more below for answers to questions commonly asked about borderline personality disorder treatment.

What is the most effective treatment for borderline personality disorder?

According to the American Psychiatric Association, treatment for borderline personality disorder usually consists of a combination of therapy, medication, and hospitalization, although talk therapy in the form of cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) tends to be the most common and most effective approach.

What happens if you don’t receive BPD treatment?

Without treatment, BPD may influence your moods to keep swinging, and everyday life might become really challenging. Relationships can suffer, and it might feel like you’re stuck in a cycle of intense emotions. Untreated BPD can lead to ongoing difficulties in work, relationships, and overall quality of life. Early intervention with evidence-based therapy approaches can significantly improve outcomes.

Can people with BPD symptoms get better through therapy?

Yes, many people improve with therapy to manage borderline personality disorder. Support like DBT or CBT can teach you new ways to handle your feelings and improve your relationships over time. Family therapy can also be a helpful way to learn healthy communication and improve relationships. Research consistently shows that with appropriate therapeutic support, individuals with BPD can experience significant symptom reduction and improved functioning.

Do BPD symptoms get worse with age if you don’t receive treatment?

Without help, your symptoms might stick around or even worsen. Getting treatment early can really change things for the better as you move forward. When you don’t manage borderline personality disorder, lack of control over intense emotions and intense relationships can lead to dangerous situations including self-harm. However, with appropriate treatment, many individuals experience significant improvement over time.

Can licensed clinical social workers treat borderline personality disorder?

Yes, licensed clinical social workers (LCSWs) are qualified mental health professionals who can provide effective therapy for borderline personality disorder. LCSWs are trained in evidence-based therapeutic approaches including CBT and DBT techniques. At ReachLink, all therapists are licensed clinical social workers with experience in treating a wide range of mental health conditions, including BPD, through telehealth therapy sessions.

Is telehealth therapy effective for treating BPD?

Research has shown that telehealth therapy, including online DBT, can be as effective as traditional in-office therapy for treating borderline personality disorder. Telehealth offers the added benefits of increased accessibility, convenience, and the ability to receive treatment in a comfortable, familiar environment, which can be particularly beneficial for individuals managing BPD symptoms.

The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional.

FAQ

• What types of therapy are most effective for treating borderline personality disorder?

  Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) are considered the most effective therapeutic approaches for BPD. DBT specifically focuses on teaching emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness skills. CBT helps identify and change negative thought patterns and behaviors that contribute to BPD symptoms.

• How long does therapy for borderline personality disorder typically take?

  BPD therapy is typically a long-term commitment, often lasting 1-2 years or more depending on individual needs and progress. DBT programs usually run for 6-12 months, while other therapeutic approaches may require ongoing sessions. The duration depends on symptom severity, personal goals, and how quickly new coping skills are developed and integrated.

• What should I expect during my first therapy session for BPD?

  Your first session will typically involve a comprehensive assessment where your therapist gathers information about your symptoms, personal history, and treatment goals. They'll explain their therapeutic approach, discuss what BPD treatment involves, and begin building a therapeutic relationship. You may also discuss safety planning and coping strategies for crisis situations.

• Can borderline personality disorder be effectively treated through online therapy?

  Yes, online therapy can be effective for BPD treatment when conducted by licensed therapists trained in evidence-based approaches like DBT and CBT. Telehealth platforms provide convenient access to specialized care, regular sessions, and crisis support. However, some individuals may benefit from in-person sessions initially, especially if they have severe symptoms or safety concerns.

• What's the difference between DBT and CBT for borderline personality disorder treatment?

  While both are effective, they have different focuses. DBT was specifically developed for BPD and emphasizes accepting difficult emotions while learning skills to manage them. It includes mindfulness, distress tolerance, and interpersonal effectiveness training. CBT focuses more on identifying and changing negative thought patterns and behaviors. Many therapists integrate elements from both approaches for comprehensive BPD treatment.