Diagnosis

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
  • Review of your signs and symptoms

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often used by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment.

A diagnosis of borderline personality disorder is usually made in adults, not in children or teenagers. That's because what appear to be signs and symptoms of borderline personality disorder may go away as children get older and become more mature.

Treatment

Borderline personality disorder is mainly treated using psychotherapy, but medication may be added. Your doctor also may recommend hospitalization if your safety is at risk.

Treatment can help you learn skills to manage and cope with your condition. With treatment, you can feel better about yourself and live a more stable, rewarding life.

Psychotherapy

Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline personality disorder. Your therapist may adapt the type of therapy to best meet your needs. The goals of psychotherapy are to help you:

  • Focus on you current ability to function
  • Learn to manage emotions that feel uncomfortable
  • Reduce your impulsiveness by helping you observe feelings rather than acting on them
  • Work on improving relationships by being aware of your feelings and those of others
  • Learn about borderline personality disorder

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

  • Dialectical behavior therapy (DBT). DBT can include group or individual therapy designed specifically to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, tolerate distress and improve relationships.
  • Schema-focused therapy. Schema-focused therapy can be done individually or in a group. It can help you identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival, but as an adult are hurtful in many areas of your life. Therapy focuses on helping you get your needs met in a healthy manner to promote positive life patterns.
  • Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you identify your own thoughts and feelings at any given moment and create an alternate perspective on the situation. MBT emphasizes thinking before reacting.
  • Systems training for emotional predictability and problem-solving (STEPPS). STEPPS is a 20-week treatment which involves working in groups that incorporate your family members, caregivers, friends or significant others into treatment. STEPPS is used in addition to other types of psychotherapy.
  • Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations.
  • General psychiatric management. This treatment approach relies on case management and focuses on making sense of emotionally difficult moments by considering the interpersonal context for feelings. It may integrate medications, groups, family education and individual therapy.

Medications

Although no drugs have been approved by the Food and Drug Administration specifically for the treatment of borderline personality disorder, certain medications may help with symptoms or co-occurring problems such as depression, impulsiveness, aggression or anxiety. Medications may include antidepressants, antipsychotics or mood-stabilizing drugs.

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

Hospitalization

At times, you may need more-intense treatment in a psychiatric hospital or clinic. Hospitalization may also keep you safe from self-injury or address suicidal thoughts or behaviors.

Recovery takes time

Learning to manage your emotions, thoughts and behaviors takes time. You may need many months or years of treatment, and you may always struggle with some symptoms of borderline personality disorder. You may experience times when your symptoms are better or worse. But treatment can improve your ability to function and help you feel better about yourself.

Because treatment can be intense and long term, you have the best chance for success when you consult mental health providers who have experience treating borderline personality disorder.

Coping and support

Symptoms associated with borderline personality disorder can be stressful and challenging for you and those around you. You may be aware that your emotions, thoughts and behaviors are self-destructive or damaging, yet you feel unable to manage them.

In addition to getting professional treatment, you can help manage and cope with your condition if you:

  • Learn about the disorder so that you understand its causes and treatments
  • Learn to recognize what may trigger angry outbursts or impulsive behavior
  • Seek professional help and stick to your treatment plan — attend all therapy sessions and take medications as directed
  • Work with your mental health provider to develop a plan for what to do the next time a crisis occurs
  • Get treatment for related problems, such as substance misuse
  • Consider involving people close to you in your treatment to help them understand and support you
  • Manage intense emotions by practicing coping skills, such as the use of breathing techniques and mindfulness meditation
  • Set limits and boundaries for yourself and others by learning how to appropriately express emotions in a manner that doesn't push others away or trigger abandonment or instability
  • Don't make assumptions about what people are feeling or thinking about you
  • Reach out to others with the disorder to share insights and experiences
  • Build a support system of people who can understand and respect you
  • Keep up a healthy lifestyle, such as eating a healthy diet, being physically active and engaging in social activities
  • Don't blame yourself for the disorder, but recognize your responsibility to get it treated

Preparing for your appointment

You may start by seeing your primary care doctor. After an initial appointment, your doctor may refer you to a mental health provider, such as a psychologist or psychiatrist. Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

  • Any symptoms you or people close to you have noticed, and for how long
  • Key personal information, including traumatic events in your past and any current major stressors
  • Your medical information, including other physical or mental health conditions
  • All medications you take, including prescription and over-the-counter medications, vitamins and other supplements, and the doses
  • Questions you want to ask your doctor so that you can make the most of your appointment

Take a family member or friend along, if possible. Someone who has known you for a long time may be able to share important information with the doctor or mental health provider, with your permission.

Basic questions to ask your doctor or a mental health provider include:

  • What's likely causing my symptoms or condition?
  • Are there any other possible causes?
  • What treatments are most likely to be effective for me?
  • How much can I expect my symptoms to improve with treatment?
  • How often will I need therapy sessions and for how long?
  • Are there medications that can help?
  • What are the possible side effects of the medication you may prescribe?
  • Do I need to take any precautions or follow any restrictions?
  • I have these other health conditions. How can I best manage them together?
  • How can my family or close friends help me in my treatment?
  • Do you have any printed material that I can take? What websites do you recommend?

Don't hesitate to ask questions during your appointment.

What to expect from your doctor

A doctor or mental health provider is likely to ask you a number of questions. Be ready to answer them to save time for topics you want to focus on. Possible questions include:

  • What are your symptoms? When did you first notice them?
  • How are these symptoms affecting your life, including your personal relationships and work?
  • How often during the course of a normal day do you experience a mood swing?
  • How often have you felt betrayed, victimized or abandoned? Why do you think that happened?
  • How well do you manage anger?
  • How well do you manage being alone?
  • How would you describe your sense of self-worth?
  • Have you ever felt you were bad, or even evil?
  • Have you had any problems with self-destructive or risky behavior?
  • Have you ever thought of or tried to harm yourself or attempted suicide?
  • Do you use alcohol or recreational drugs or abuse prescription drugs? How often?
  • How would you describe your childhood, including your relationship with your parents or caregivers?
  • Were you physically or sexually abused or were you neglected as a child?
  • Have any of your close relatives or caregivers been diagnosed with a mental health problem, such as a personality disorder?
  • Have you been treated for any other mental health problems? If yes, what diagnoses were made, and what treatments were most effective?
  • Are you currently being treated for any other medical conditions?

If you have suicidal thoughts

If you have fantasies or mental images about hurting yourself or have other suicidal thoughts, get help right away by taking one of these actions:

  • Call 911 or your local emergency number immediately.
  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor.
  • Call your mental health provider, doctor or other health care provider.
  • Reach out to a loved one, close friend, trusted peer or co-worker.
  • Contact someone from your faith community.
July 30, 2015
References
  1. Personality disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed July 1, 2015.
  2. Borderline personality disorder. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/borderline-personality-disorder/index.shtml. Accessed July 1, 2015.
  3. Silk KR. Borderline personality disorder: Epidemiology, clinical features, course, assessment, diagnosis, and differential diagnosis. http://www.uptodate.com/home. Accessed July 1, 2015.
  4. Silk KR. Treatment of borderline personality disorder. http://www.uptodate.com/home. Accessed July 1, 2015.
  5. Newlin E, et al. Personality disorders. Continuum: Lifelong Learning in Neurology. 2015;21:806.
  6. Gonzalez CA (expert opinion). Mayo Clinic, Rochester, Minn. July 16, 2015.
  7. Palmer BA (expert opinion). Mayo Clinic, Rochester, Minn. July 12, 2015.

Borderline personality disorder