Borderline personality disorder

Borderline personality disorder (BPD) is treatable. Here’s what the diagnosis describes, what tends to happen over time, and what helps.

What the diagnosis describes

BPD describes a pattern of very intense emotions that are hard to manage. Relationships can feel unstable, with a strong fear of being abandoned, and your sense of who you are can shift or feel empty. It can also involve acting on impulse, and self-harm or suicidal thoughts and actions. Around 1 in 100 people have it.

Only a proper assessment can say whether it fits, and a diagnosis describes a pattern you’re living with, not who you are.

If self-harm or suicidal thoughts are part of things for you right now, the numbers near the end of this page are there any time.

How the diagnosis is changing

The newest edition of the World Health Organization’s International Classification of Diseases lists one personality disorder, rated by how severe it is, instead of separate types. Clinicians can add a “borderline pattern” description where it fits. The Diagnostic and Statistical Manual of Mental Disorders still lists BPD as its own diagnosis. The name is still widely used in Australia, and it’s the name most treatment research uses.

BPD and complex post-traumatic stress disorder can overlap. Clinicians debate where the line between them sits, and some people have both. Only an assessment can tell, and complex PTSD covers that diagnosis.

What happens over time

One study followed 290 people with BPD for 16 years. All of them had first been assessed during a stay in hospital (Zanarini and colleagues, 2012). By the end, most no longer met the criteria for the diagnosis, often for years at a time.

For some, difficulties came back after a period of being well. The researchers also used a stricter measure of recovery, which added working well and having good relationships, and about half the group reached that as well.

What helps

A review of 75 trials compared therapy designed for BPD with usual treatment (Storebø and colleagues, 2020). Therapy designed for BPD made people’s difficulties less severe, and the reviewers rated that change as big enough to make a real difference. It may also reduce self-harm and suicidal thoughts and actions, and help with daily life.

The two most studied therapies were dialectical behaviour therapy (DBT) and mentalisation-based treatment (MBT). MBT helps you make sense of what’s going on in your own mind and in other people’s, especially when feelings run high. DBTDialectical behaviour therapy (DBT) A structured therapy for people whose emotions come on hard and fast, and who find it hard to settle again. It teaches practical skills, in a set order, for staying present, getting through a crisis, managing strong emotions and handling other people. More in the jargon decoder Close helped with overall severity, self-harm and daily life. MBT helped with self-harm, suicidal thoughts and actions, and depression. The evidence for these findings was rated low certainty, and the review found no clear sign that one of these therapies works better than another.

One large trial tested schema therapy for BPD. Schema therapySchema therapy A longer-term talking therapy that works on deep, long-standing patterns. A schema is a deep belief about yourself and other people, formed early, that shapes how you read situations. More in the jargon decoder Close delivered as group and individual sessions together did better than the best usual care available, and better than schema therapy delivered mostly in a group.

Recent guidelines from Germany and the American Psychiatric Association say structured therapy designed for BPD is the main treatment, and medication isn’t. Therapy and medication covers what’s known about medication alongside therapy. Guidelines also support recognising and treating BPD in teenagers, rather than waiting until adulthood.

Finding it, and what it involves

Therapy designed for BPD often runs for a year or more, and full programs can be hard to find, with waits. Some public mental health services run programs. Ask your GPGP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder Close whether there’s a public program for BPD where you live. In New South Wales, the Project Air Strategy also publishes Australian treatment guidance for personality disorders. The DBT page describes what a full program involves.

How you pay shapes what’s available. Paying the full fee has no session limit, and that includes seeing a counsellorCounsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder Close or psychotherapistPsychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder Close, whom MedicareMedicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder Close doesn’t cover. Workplace programs and community services usually offer a set number of sessions, and headspaceheadspace A national youth mental health service for anyone aged 12 to 25, with centres around Australia and support online and by phone. It's free or close to it, you don't need a referral or a parent, and you can book it yourself. More in the jargon decoder Close offers free or low-cost support for people aged 12 to 25. A group usually costs less per session.

A Mental Health Treatment PlanMental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder Close from your GP gives a Medicare rebateRebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder Close on ten individual sessions a calendar year, and up to ten group sessions on top. Ten sessions a calendar year is a funding limit, not a judgement about how much therapy anyone needs. Free and low-cost options covers other ways to keep costs down.

For family and friends

Guidelines recommend offering support to family members. If someone close to you is in treatment, it’s reasonable to ask their treating team what support is available for you.

Safety

If you’re thinking about suicide or about hurting yourself right now, please contact one of the numbers below. You don’t need to be in crisis to call.

Kids Helpline is on 1800 55 1800, any time, for anyone aged 5 to 25. Lifeline is on 13 11 14 and, if you’re 15 or over, the Suicide Call Back Service is on 1300 659 467. In an emergency, call 000. Crisis and emergency support has the full list.

Where next

However good the method, how well you and your therapist work together matters a great deal. Why who you see matters more than what they do explains why.