How is BPD diagnosed?

People living with BPD may not always receive a correct diagnosis.

For example, there’s a large discrepancy between the number of women who are living with BPD and the number of men who are living with it. An estimated 75 percent of diagnosed cases involve women, which leads some to believe that doctors may misdiagnose BPD in men.

A primary care doctor typically can’t diagnose BPD, but they may be able to refer you or a loved one to a licensed mental health professional. Some professionals who can diagnose the condition include:

  • psychiatrist

  • psychologist

  • clinical social worker

In order to diagnose BPD, a mental health professional will typically need to:

  • interview you about your symptoms and other topics pertinent to your mental and emotional health

  • ask about your family’s medical history and history of mental health issues

Diagnosing BPD can be challenging because it can often occur along with other mental health conditions, such as anxiety or depression.

That is, you may be dealing with symptoms of depression that may mask or overshadow symptoms of BPD, which can lead to a misdiagnosis of BPD.

If you or someone you know needs help, you can contact a suicide and crisis hotline. Resources from the National Institute of Mental Health (NIMH), Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Alliance on Mental Illness (NAMI) can provide more information and local support. 


Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental illness characterized by significant instability in moods, relationships, self-image, and behavior, impacting daily functioning. Those with BPD often struggle with intense emotions and can exhibit impulsive actions and unstable interpersonal relationships. 

Signs and Symptoms

A BPD diagnosis requires meeting at least five of nine specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These include frantic efforts to avoid abandonment, unstable and intense relationships, unstable self-image, impulsivity in potentially self-damaging areas, recurrent suicidal or self-harming behavior, mood reactivity, chronic feelings of emptiness, intense anger, and stress-related paranoid thoughts or dissociative symptoms. 

Causes and Risk Factors

While the exact cause is not fully understood, factors like genetics, changes in brain structure and function, and environmental factors such as childhood trauma (abuse, neglect, abandonment) are believed to increase the risk of developing BPD. 

Diagnosis and Treatment

Diagnosis is made by a mental health professional based on a review of symptoms and history. BPD frequently occurs alongside other mental health conditions, complicating diagnosis and treatment. 

Psychotherapy is the primary treatment. Therapies specifically developed for BPD include Dialectical behavior therapy (DBT), Cognitive behavioral therapy (CBT), Mentalization-based therapy (MBT), and Transference-focused psychotherapy (TFP). Medication may be used to treat co-occurring symptoms, but not the core symptoms of BPD. With treatment, individuals can experience significant improvement in symptoms and quality of life.

About 1.4 percent of the population in the United States is living with BPD. Around 75 percent of diagnosed cases involve women, according to the National Alliance of Mental Illness (NAMI). But some experts believe BPD may be just as common in men. It’s often misdiagnosed as post-traumatic stress disorder (PTSD) or depression.  

How is BPD treated?

Psychotherapy

Psychotherapy is typically the main treatment  for BPD. Your mental health professional may recommend one of the following types:

Cognitive behavioral therapy (CBT)

CBT helps you to identify and change unhealthy beliefs, behaviors, and inaccurate perceptions you may have about yourself or others. It teaches you better ways to react when you feel angry, insecure, anxious, or have suicidal thoughts.

Dialectical behavior therapy (DBT)

DBT teaches you how to recognize, be aware of, and accept your beliefs and behaviors. You can also learn more balanced responses to the behaviors of others.

Schema-focused therapy

Schema-focused therapy helps you to view yourself and the world in a more positive way.

Medication

Medication doesn’t cure BPD, but it can relieve symptoms. Your doctor may prescribe medication in addition to psychotherapy treatment to help with changes in mood or depression. For example, they may prescribe:

  • antidepressants to treat depression

  • antipsychotics to treat aggressive symptoms

  • antianxiety medications to treat anxiety

If you experience side effects from your medication, you should talk with your doctor. They may be able to recommend different medication or treatment options.

Hospitalization

If your symptoms are severe, your doctor may recommend that you temporarily stay in a hospital for treatment.

It’s important to remember not to feel shame or embarrassment regarding a hospital stay. Getting the treatment you or a loved one needs is an important part of self-care.