Borderline personality disorder (BPD) is a mental health condition. Sometimes, healthcare professionals can miss or misdiagnose BPD because its symptoms can overlap with those of other conditions. Therefore, knowing what characteristics to look out for can be helpful.
Having BPD can mean that a person is unable to regulate their emotions properly. For example, BPD can lead to a person acting impulsively, experiencing intense emotions, or struggling with their self-image.
There are certain characteristics that a person with BPD may have that can help a psychotherapist diagnose their condition. This article will cover a series of questions that a psychotherapist might ask a person to determine whether or not they have BPD.
This article is a guideline only. Only a healthcare professional can make an official diagnosis of BPD.
Some of the criteria that healthcare professionals may use to diagnose BPD are available in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) from the American Psychiatric Association.
Based on the criteria in the DSM-5, a person may have BPD if they experience five or more of the following:
Criteria for a BPD diagnosis
- They engage in panicked attempts to prevent real or imaginary abandonment.
- They experience an unstable sense of self, who they are, or what they believe in.
- They have intense relationships with other people that change from idolizing them to disliking them.
- They engage in at least two damaging acts of impulsivity, such as overspending, binge eating, having unsafe sex, or engaging in excessive substance use.
- They engage or have engaged in repeated self-harm behaviors, suicidal behaviors, threats, or gestures.
- They experience intense mood shifts that are difficult to control.
- They feel chronic loneliness or emptiness.
- They feel intense anger and have a hard time controlling their temper.
- They often feel suspicious, paranoid, or that their reality seems unreal during times of stress.
It is important to remember that these questions are not a substitute for an official diagnosis of BPD. If a person thinks that they may have BPD, they should speak with a healthcare professional.
If a person feels that they may have BPD, they can take the following steps.
Contact a family doctor
Before the appointment or conversation, a person can keep a journal to record their feelings and symptoms. They might wish to note down things such as:
- their level of distress
- anything they may have done to try to reduce this distress
- risks they might pose to other people or themselves
The healthcare professional may then refer the person to a psychiatrist or psychologist.
Speak with a psychiatrist or psychologist
Psychiatrists and psychologists may use the diagnostic criteria above as guidelines.
They may also ask a person about other symptoms that they have been having. They
They will also use this time to focus on:
- the person’s everyday management of life, relationships, and work
- their coping strategies
- their strengths
- areas in their life they may struggle with
- any other mental health problems they may have
- any other social issues they may experience
- any social support needs they may require
- any support they may need in their workplace or with finding a job
- any psychological treatment they may require
- the needs of any dependent children they may have
If a person meets five or more of the criteria in the previous section, they may wish to contact a healthcare professional about BPD.
According to the National Alliance on Mental Illness (NAMI), around 1.4% of adults in the United States experience BPD. However, NAMI also notes that BPD is one of the most commonly misdiagnosed mental health conditions.
BPD misdiagnosis may occur due to the similarity of the symptoms it shares with other mental health conditions. These include:
- bipolar disorder
- complex post-traumatic stress disorder
- antisocial personality disorder
However, each of these conditions requires specific treatments, so it is important that a person receives the correct diagnosis. If the person feels that they have received the wrong diagnosis or has any concerns regarding their diagnosis, they should contact a healthcare professional.
Living with BPD can be challenging for many people. The lack of information and potential difficulty associated with diagnosing BPD can lead to a person experiencing stigma regarding their condition. Additionally, certain characteristics of BPD can cause issues in personal relationships.
According to the National Education Alliance for Borderline Personality Disorder (NEABPD), around 85% of people with BPD will also have another mental health condition. Some additional conditions that a person with BPD may experience include:
- major depressive disorder
- chronic depression
- substance use issues
- eating disorders
- bipolar disorder
- antisocial personality disorder
- narcissistic personality disorder
However, the NEABPD states that the outcome for people with BPD can be quite positive. It notes that with specialized treatment, many people with BPD have reduced symptoms and improved lives.
The NEABPD also says that people with BPD may find that their impulsive behaviors decrease after the age of 40 years.
Having a good support network from friends and family can help when treating BPD. There are also online and phone services that a person with BPD can use if they need help with their condition.
The National Institute of Mental Health (NIMH) has an
There are various treatments that a person with BPD can try to reduce their symptoms. These include the following.
The NIMH notes that psychotherapy, or talking therapy, is the
This can involve a person speaking with a therapist one-on-one or having therapy in a group setting. Group therapy for people with BPD can help them learn how to interact with other people and how to express themselves. It can also be comforting to share experiences with people who can relate to them firsthand.
CBT helps people with BPD identify unhealthy thoughts and beliefs about themselves and others. A therapist can work with a person to change these beliefs and adjust any behaviors that cause them issues.
DBT is a form of therapy designed specifically for people with BPD. DBT uses mindfulness to help a person become aware of and accept their current emotional state. DBT can also help a person control intense emotions, improve relationships, and reduce self-destructive behaviors.
A therapist may recommend that a friend or relative joins the therapy sessions to help them understand and support the person with BPD. This form of therapy can also help the friend or relative understand the obstacles that someone caring for a person with BPD may encounter.
According to the NIMH, medications are
- mood shifts
- any additional mental health condition
A person with BPD should speak with a healthcare professional about the medication that may be best for them.
When testing for BPD, a healthcare professional may ask a person certain questions to use as a diagnostic guideline. If a person meets five or more of the criteria in this article, they may benefit from speaking with a psychotherapist or psychologist.
Before their appointment, a person may wish to keep a journal of their experiences and feelings to aid the diagnostic process.
BPD is a mental health condition that can cause a person to have difficulty regulating their emotions. BPD can result in a person acting impulsively, having mood shifts, or self-harming.
BPD can be difficult for a person to live with. However, there are many support options and treatments available. A person with BPD should speak with a healthcare professional about what treatment method is right for them.