Understanding and Treatment for Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a Cluster B personality disorder characterized by impulsivity and instability in interpersonal relationships, self-image, and affects. The estimated prevalence in the general population is between 0.7% and 2.7%. Common features of BPD include impulsivity, an intense fear of abandonment, and chronic feelings of emptiness. One hallmark defense mechanism is “splitting”: a tendency to view others as entirely good or entirely bad, which often leads to unstable relationships. Neurological studies have shown that individuals with BPD may also experience impaired cognitive flexibility and increased impulsivity. Impulsivity may appear as reckless driving, self-harming and suicidal behavior, impulsive purchases, or binge eating, to name a few (Chapman, 2025 and Kulacaoglu, 2018).

Risk Factors

While the cause is generally unknown, BPD is currently believed to be a result of the interaction of adverse childhood experiences and genetic components, with a heritability of approximately 40%. The four dimensions of temperament that make up personality are identified as: (1) Harm avoidance, (2) Novelty Seeking, (3) Reward Dependence, and (4) Persistence.  Individuals with BPD tend to have a high amount of novelty seeking and may have higher harm avoidance as well. Childhood trauma, specifically physical abuse and neglect, is the most significant risk factor, although it is important to note that individuals that have experienced trauma in childhood will not always develop BPD. (Chapman, 2025 and Kulacaoglu, 2018).

Treatment Approaches

Psychotherapy is the primary treatment for BPD and has been shown to significantly reduce symptom severity. Educating patients and their support systems on the disorder, signs and symptoms is another important aspect of treatment (Kulacaoglu, 2018). Three evidence-based approaches include:

• Dialectical Behavioral Therapy (DBT): Focuses on building emotional regulation, mindfulness, and distress tolerance skills. A study that followed women with BPD that engaged in self-injurious behaviors, found that those who received DBT over a 2 year period had fewer suicide attempts (23%) and hospitalizations than the control group (46%) results (Kulacaoglu, 2018).

• Mentalization-Based Treatment (MBT): Helps individuals better understand their own and others’ mental states

• Transference-Focused Psychotherapy (TFP): Explores and resolves distorted interpersonal dynamics rooted in early relationships

There are currently no FDA-approved medications specifically for BPD, though medications may be prescribed to manage co-occurring conditions such as depression, anxiety, or mood disorders (Chapman, 2025).

Important Considerations

Comorbidity is common in individuals with BPD, with especially high rates of diagnosis with depression and anxiety disorder. Individuals with BPD may be mistakenly diagnosed with bipolar disorder, due to the similarity in symptomology. Persistent substance abuse can mimic symptoms of BPD, complicating diagnosis (Kulacaoglu, 2018).

Individuals with BPD have a higher suicide rate than those with other personality disorders. Retrospective studies have identified a rate of suicide for individual with BPD to be between 8-12%. Suicidality and self-harm should always be taken seriously and addressed through regular assessments and detailed safety planning (Chapman, 2025 and Kulacaoglu, 2018).

How to Support

For families, friends and supports, you can support an individual with BPD by:

1. Supporting them in getting proper treatment, from a therapist with experience working with individuals with BPD, especially those trained in DBT.

2. Taking suicide threats seriously. Reach out to the suicide hotline at 988 if further support is needed.

3. Continue your education in learning about BPD, signs and symptoms.

References:

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.

Chapman J, Jamil RT, Fleisher C, et al. Borderline Personality Disorder. [Updated 2024 Apr 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

Kulacaoglu F, Kose S. Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe. Brain Sci. 2018 Nov 18;8(11):201. doi: 10.3390/brainsci8110201. PMID: 30453675; PMCID: PMC6266914.

Amanda Deering, Behavior Specialist, Miren Behavior