Borderline personality disorder (BPD) is a mental health condition marked by intense, fast-shifting emotions, an unstable sense of self, and relationships that can swing between closeness and conflict. It is also treatable. Many people with BPD get substantially better, and therapies designed for it, including dialectical behavior therapy (DBT), have helped people build steadier, more satisfying lives.
BPD carries more stigma than most diagnoses, and that stigma keeps people from asking for help. This guide covers the common signs, the myths worth dropping, and what treatment looks like, for adults and for parents of teens in Brooklyn and beyond.
If you or someone you love is thinking about suicide or self-harm, call or text 988 (Suicide & Crisis Lifeline) or go to the nearest emergency room. Mind Body Seven is an outpatient practice.
Common signs of BPD
BPD looks different from person to person. Clinicians look for a long-standing pattern, not a single bad week. Signs can include:
- Intense emotions that shift quickly: moving from calm to overwhelmed, angry or despairing within hours, often in response to relationship events
- Fear of abandonment: strong distress at the idea of being left, sometimes leading to frantic efforts to keep people close
- Unstable relationships: seeing someone as wonderful one day and hurtful the next
- A shifting sense of identity: uncertainty about who you are, what you value, or what you want
- Impulsive behavior: spending, substance use, reckless driving, binge eating or other risky choices when upset
- Self-harm or suicidal thoughts and behavior
- Chronic feelings of emptiness
- Intense anger that is hard to control, often followed by shame
- Stress-related paranoia or feeling detached from yourself or your surroundings
Having one or two of these does not mean someone has BPD. Many people feel abandonment fears or act impulsively at times. The diagnosis describes a pattern that shows up across many situations and has lasted a long time.
Many of these experiences overlap with other conditions, such as depression, bipolar disorder, PTSD, ADHD or anxiety, and they can occur together. Reading a list cannot tell you whether you have BPD. A clinician can help sort out what is going on through a careful evaluation.
Myths that get in the way
"People with BPD are manipulative."
Behavior that looks manipulative from the outside is usually a person in intense pain trying to get a need met with the only tools they have. DBT was built on the view that these behaviors make sense given the person's history and emotional sensitivity, and that better tools can be learned.
"BPD is untreatable."
This myth has done real harm. Several therapies have been developed and studied specifically for BPD, and improvement over time is common. The outlook is far more hopeful than its reputation suggests.
"It's just a label for difficult women."
BPD affects people of all genders. In men it can be missed, or seen only as an anger or substance problem. An accurate diagnosis helps anyone get the right treatment.
"BPD means you'll always have unstable relationships."
Interpersonal skills can be learned. Many people in treatment find their relationships become steadier and more trusting, both with others and with themselves.
What causes BPD
There is no single cause. BPD is generally understood to develop from a combination of factors: a temperament that feels emotions quickly and intensely, and an environment that did not help the person learn to understand and manage those feelings. That environment may have included trauma or invalidation, though not everyone with BPD has a trauma history. Blame, whether of the person or their family, does not help anyone recover. Understanding does.
Treatments that help
Psychotherapy is the main treatment for BPD. Several approaches have been developed specifically for it:
- Dialectical behavior therapy (DBT): the best known, built around balancing acceptance and change and teaching skills in mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Read our introduction to DBT for the background.
- Mentalization-based treatment: helps people understand their own and others' mental states, especially during emotional moments in relationships.
- Schema therapy and transference-focused psychotherapy: work on deep-rooted patterns in how people see themselves and others.
- Good psychiatric management: a practical, structured approach that many clinicians can provide, focused on education, problem-solving and stable care.
What these therapies share is a clear structure, a strong working relationship with the therapist, attention to safety, and a focus on emotions in relationships. Treatment usually takes time, and progress tends to come in steps: fewer crises first, then more stable relationships and a clearer sense of self. A clinician can talk with you about which approach fits your situation and what is available.
For people whose emotional intensity is tied to past trauma, trauma therapy can be part of the plan, often after stabilization skills are in place.
Where medication fits
Medication is not the core treatment for BPD itself. A psychiatric prescriber can discuss whether medication may help with conditions that often occur alongside BPD, such as depression, anxiety or sleep problems, and how it fits with therapy. Our medication management page explains how prescribers and therapists coordinate care.
For parents, partners and families
Adolescence is a time of big emotions for everyone, which is why clinicians are thoughtful about using the BPD label with teens. When a teen shows persistent patterns of self-harm, intense emotional swings and unstable relationships, getting help early matters, whatever the label. DBT was adapted for adolescents with parents involved, and our post on DBT for teens with self-harming behavior explains how that version works.
Family members and partners often feel worn out, confused or walking on eggshells. It helps to learn about the condition, to validate the feeling behind a reaction even when you do not agree with the behavior, and to set clear, kind limits you can keep. Your own support matters too. Many families find it useful to learn DBT skills themselves so everyone shares the same language.
Getting support at Mind Body Seven
At Mind Body Seven in Brooklyn, dialectical behavior therapy is offered as a compassionate, collaborative approach that can be combined with other therapies and psychiatric care. Clinicians who can help include:
- Dr. Beth Wecksell, PsyD, is a supervising psychologist with intensive DBT training who treats borderline personality disorder, emotional dysregulation and suicidal ideation in adolescents and adults, in English or Spanish.
- Kathleen Fentress Tripp, NP, is a board-certified psychiatric nurse practitioner who combines medication management with DBT-informed treatment for emotional regulation and mood concerns.
Reaching out can feel hard, especially when emotions already feel overwhelming. You do not need a diagnosis to start. And if you are in crisis, call or text 988 or go to the nearest emergency room first.
FAQs
Can borderline personality disorder get better?
Yes. BPD is treatable, and many people see their symptoms ease a great deal over time, especially with therapy designed for it. Recovery is often gradual, and people commonly describe their relationships, work and sense of self becoming more stable.
Can teenagers be diagnosed with BPD?
Clinicians can diagnose BPD before age 18 when the patterns are persistent, though many are careful with the label because teens are still developing. Either way, skills-based treatment such as DBT can begin without a formal diagnosis.
Is there a medication for BPD?
Medication is not the main treatment for BPD itself. A psychiatric prescriber can discuss whether medication may help with conditions that often occur alongside it, such as depression, anxiety or sleep problems, as part of a broader plan that centers on therapy.
How do I support someone I love who has BPD?
Learning about the condition, validating their feelings without endorsing harmful behavior, and setting clear, kind limits all help. Family members often benefit from their own support or from learning DBT skills too. If your loved one is in danger, call or text 988 or go to the nearest emergency room.
Is BPD caused by bad parenting or trauma?
BPD is generally understood to come from a mix of factors, including an emotionally sensitive temperament and experiences in the environment, which can include invalidation or trauma. Not everyone with BPD has a trauma history, and blame does not help anyone get better.
