Borderline Personality Disorder (BPD): Signs, Skills, and Treatment
Borderline Personality Disorder is a mental health condition that affects emotions, thinking, and relationships. Feelings may shift quickly, relationships can feel intense, and fear of abandonment is common. This guide explains BPD, from diagnosis to treament.
Our website is for information only. We help you understand your options and prepare for conversations with licensed providers, but we do not diagnose, treat, or guarantee outcomes.
Understanding Borderline Personality Disorder
BPD involves strong emotional responses, difficulty managing stress, and changes in self-image. Many people with BPD feel deeply and value connection. With the right support, including therapy, skills training, and sometimes medication, life can become more stable and manageable.
Common Signs and Symptoms
Emotions and Thoughts
- Intense emotions that rise quickly and take time to settle
- Feeling empty or numb between emotional shifts
- Black-and-white thinking about self or others
- Brief episodes of feeling disconnected or unreal
Relationships and Behaviors
- Strong fear of abandonment or rejection
- Rapid shifts between closeness and conflict
- High sensitivity to tone, silence, or perceived changes
- Impulsivity, e.g. spending, substance use, or risky choices
- Urges toward self-harm or thoughts of suicide
Not everyone experiences BPD in the same way. A licensed clinician is needed to assess symptoms and determine what is happening.
Safety First
If you have thoughts of self-harm, or someone is in immediate danger, call your local emergency number now. For mental health emergencies, use your country’s suicide and crisis line.
BPD and Substance Use
Some people use alcohol or drugs to numb emotional pain or feel steadier. This often increases mood instability and safety risks. Integrated care treats BPD and substance use together by combining emotion and relationship skills with substance use support. If opioids may be involved, ask about naloxone for overdose emergencies.
How Diagnosis Works
A licensed clinician will:
Ask about emotions, relationships, stress, and safety
Review personal history, including trauma if you choose to share
Rule out other mental health conditions or medical causes
Use screening tools and, with consent, input from loved ones
Assessment helps guide a care plan that you help shape.
Treatment Options
Treatment for BPD is individualized and collaborative. Many people benefit from a coordinated plan that includes therapy and structured skills support.
DBT (Dialectical Behavior Therapy) Skills
- Mindfulness to notice emotions without acting on them
- Distress tolerance tools for crisis moments
- Emotion regulation skills to reduce emotional intensity
- Interpersonal effectiveness skills for boundaries and needs
Other Evidence-Based Therapies
- Mentalization-based therapy to understand emotions and intentions
- Schema therapy to change long-standing patterns
- Transference-focused psychotherapy to explore relationship dynamics
- Family or skills programs, with consent, to support loved ones
Medication Support
There is no single medication for BPD. A prescriber may recommend medication for specific symptoms such as mood swings, anxiety, or sleep problems. Medication is voluntary, used carefully, and reviewed regularly. Benzodiazepines are often avoided or used with caution due to safety risks.
Levels of Care
- Outpatient and telehealth with weekly therapy and skills groups
- Intensive Outpatient Programs with multiple sessions per week
- Partial Hospitalization Programs for more structured daytime support
- Inpatient or residential care with 24/7 support during safety crises
Skills You Can Practice Now
These strategies support treatment but do not replace care.
- STOP skill to pause and choose a safer response
- Paced breathing with slow, steady exhales
- Cold water or ice to briefly reset the body’s stress response
- Pros and cons lists to slow impulsive urges
- PLEASE skills to support physical health and emotional balance
A Simple Safety Plan
Warning signs I notice: ______
People I can contact: ______
My most helpful coping skills: ______
Reasons to choose safety today: ______
Crisis numbers: ______
Guidance for Loved Ones
Support starts with validation and calm communication. Loved ones can help by learning early warning signs, setting clear and respectful boundaries, and staying consistent. With consent, education or family sessions can help everyone plan how to respond if symptoms increase. If safety becomes urgent, use emergency services.
Preparing for Your First Appointment
Use this checklist to ensure you’re well-prepared for your first consultation or appointment. Bring the following:
FAQs
Is BPD untreatable?
No. Many people improve with skills-based therapy, structure, and ongoing support. Progress may take time and is still meaningful.
Do I have to take medication?
Not always. Medication is optional and used for specific symptoms alongside therapy.
Is BPD the same as bipolar disorder?
No. Both involve mood changes, but patterns and treatments differ. A clinician can help clarify.
Can I work or attend school during treatment?
Often yes. Outpatient and IOP options are designed to fit daily responsibilities.
What if I recently self-harmed?
Focus on safety and wound care first. Contact your clinician or program to update your plan and adjust care if needed.
Helpful Resources
In Crisis? Get Immediate Help
If you are in danger or thinking of self-harm, call 911 (or your local emergency number). In the US, dial or text 988 for the Suicide & Crisis Lifeline.