Borderline personality disorder

Diagnosis

Personality disorders, including borderline personality disorder, are diagnosed based on a:

• Detailed interview with your doctor or a mental health professional.
• Mental health evaluation that may include completing a series of questions.
• Medical history and exam.
• Discussion of your symptoms.

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

Treatment

Borderline personality disorder is mainly treated using psychotherapy, which also is known as talk therapy. But medicine may be added. Your doctor also may recommend that you stay in the hospital if your safety is at risk.

Treatment can help you learn skills to manage and cope with your condition. You also should be treated for any other mental health conditions that often occur along with borderline personality disorder, such as depression or substance misuse. With treatment, you can feel better about yourself and have a stabler, more fulfilling life.

Talk therapy

Talk therapy is a basic treatment approach for borderline personality disorder. Your mental health professional may adjust the type of therapy to best meet your needs.

Talk therapy seeks to help you:

• Focus on your ability to function.
• Learn to manage emotions that feel uncomfortable.
• Reduce your impulsiveness by helping you note feelings rather than act on them.
• Work on making relationships better by being aware of your feelings and those of others.
• Learn about borderline personality disorder.

Management of borderline personality disorder mainly focuses on making sense of moments that are emotionally hard by thinking about what happened in your relationships that led to those moments. Good mental health management tends to include a combination of individual therapy, group therapy, family education and medicines for related conditions.

Types of talk therapy that have been found to be effective include:

• Dialectical behavior therapy (DBT). DBT includes group and individual therapy designed to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, handle distress and understand relationships better.
• Cognitive behavioral therapy (CBT). CBT helps you change your beliefs that come from distorted ways of seeing things. It also can help with relationship issues. The goal is to learn to pinpoint negative thoughts and cope with those thoughts. This treatment can reduce mood swings and make you less anxious. It also can make it less likely that you'll harm yourself or attempt suicide.
• Schema-focused therapy. Schema-focused therapy focuses on changing negative thought patterns.
• Mentalization-based therapy (MBT). MBT helps you note your thoughts and feelings and see things differently. MBT stresses thinking before reacting.
• Systems Training for Emotional Predictability and Problem-Solving (STEPPS). STEPPS is a 20-week treatment program where you work in groups that include your family members, caregivers, friends or significant others. STEPPS is used in addition to other types of talk therapy.
• Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you learn about your emotions and issues relating to others by creating a relationship between you and your therapist. You then apply what you learn to other situations.

Medicines

The Food and Drug Administration hasn't approved any drugs specifically to treat borderline personality disorder. But some medicines may help with symptoms. And some medicines can help with conditions that occur with borderline personality disorder, such as depression, impulsiveness, aggression or anxiety. Medicines used to treat these conditions may include antidepressants, antipsychotics or mood-stabilizing drugs.

Talk to your doctor or mental health professional about the benefits and side effects of medicines.

Hospitalization

At times, you may need to be treated in a psychiatric hospital or clinic. Staying in the hospital also may keep you safe from harming yourself or help you talk about thoughts or behaviors related to suicide.

Recovery takes time

Learning to manage your emotions, thoughts and behaviors takes time. Most people improve greatly, but some people always struggle with some symptoms of borderline personality disorder. You may have times when your symptoms are better or worse. But treatment can make it easier to function and help you feel better about yourself.

You have the best chance for success when you work with a mental health professional who has experience treating borderline personality disorder.

Coping and support

Symptoms related to 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 harmful to yourself. But you may feel that you don't know how to manage them.

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

• Learn about the condition so that you understand its causes and treatments.
• Know what may make you angry or impulsive.
• Seek professional help and stick to your treatment plan. Attend all therapy sessions and take medicines as directed.
• Work with your mental health professional to create a plan for what to do the next time a crisis occurs.
• Stay away from drugs and alcohol.
• Consider involving people close to you in your treatment to help them understand and support you.
• Manage strong emotions by practicing coping skills, such as the use of breathing techniques and mindfulness meditation.
• Set limits for yourself and others by learning how to express emotions in a manner that doesn't push others away or make you feel abandoned or unstable.
• Don't assume what people are feeling or thinking about you.
• Reach out to others with borderline personality disorder to share your experiences and what you've learned.
• 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 taking part in social activities.
• Don't blame yourself for the condition. But take responsibility for treating it.

Preparing for your appointment

You may start by seeing your primary care doctor or other healthcare professional. After the first appointment, your doctor may refer you to a mental health professional, 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 medicines you take, including prescription medicines, medicines available without a prescription, vitamins and other supplements — and the doses.
• Questions you want to ask 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 professional, with your permission.

Basic questions to ask at the appointment include:

• What's causing my symptoms or condition?
• What treatments are most likely to be effective?
• Will my symptoms get better with treatment?
• How often will I need therapy sessions and for how long?
• Are there medicines that can help?
• What are the possible side effects of the medicines you may prescribe?
• Do I need to take any precautions or follow any restrictions?
• I have 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 professional is likely to ask you some questions, such as:

• 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 do you experience a mood swing each day?
• 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 do you see your value as a human being?
• Have you ever felt you were bad or evil?
• Have you had any issues with behavior that is risky or harmful to yourself?
• Have you ever thought of or tried to harm yourself or attempt suicide?
• Do you use alcohol or recreational drugs or misuse prescription drugs? If so, how often?
• How would you describe your childhood, including your relationship with your parents or caregivers?
• Were you physically or sexually abused, or neglected, as a child?
• Have any of your blood relatives or caregivers been diagnosed with a mental health issue, such as a personality disorder?
• Have you been treated for other mental health issues? If yes, what diagnoses were made, and what treatments were most effective?
• Are you being treated for any other medical conditions?

Be ready to answer questions to make sure there's time to go over any points you want to focus on.