DSM-5 defines BPD as a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

ICD-10 lists F60.3 (emotionally unstable personality disorder) with emphasis on impulsivity and affective instability. 

Use whichever system your clinic or payer requires and document the specific criteria met.

For a detailed explanation of symptoms, click here.

When BPD is present, standard treatments for other conditions are often less effective unless emotion dysregulation is directly addressed.

You don’t need to resolve every overlap immediately. Focus on identifying whether chronic, severe emotion dysregulation is central—and ensure treatment matches that pattern.

Use clear, compassionate language. Explain the diagnosis as a pattern that explains their struggles, review objective criteria that were met, emphasize that effective treatments exist, and collaborate on next steps. Offer written materials and follow-up appointments for questions. Frame the conversation around hope and concrete options for care.

Use descriptive, non-pejorative language that emphasizes underlying processes—such as emotion dysregulation, rejection sensitivity, and invalidation histories—rather than moralizing terms.

BPD arises from an interaction of biological vulnerabilities (emotional sensitivity, genetics), neurobiological differences, and life experiences including early attachment stress or trauma. Family, social, and cultural environments can shape how emotion regulation develops, which may influence symptom expression. No single cause explains every case.

Yes. Recovery means improved symptom control, more stable relationships, better daily functioning, and reduced crises, not an erasure of emotion. Evidence shows substantial clinical improvement is achievable with structured, skills-based treatments and ongoing support systems.

First-line psychosocial treatments include Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy (MBT), and Schema Therapy. Evidence about the effectiveness on Transference-Focused Psychotherapy (TFP) for BPD is mixed. Group skills training, suicide-focused interventions, and team consultation improve outcomes and clinician sustainability. Integrate case formulation, skills practice, and safety planning into treatment. Fore more information, click here.

No medication is FDA-approved specifically for BPD. Medications may be used to target co-occurring conditions (depression, anxiety, PTSD) or specific symptom domains (e.g., impulsivity, severe affective lability) as part of a comprehensive plan. Document rationale, expected targets, and monitoring.

Emerging evidence is limited and preliminary. Small controlled and observational studies report rapid reductions in depressive symptoms and suicidality among some people with BPD, yet robust, replicated trials are lacking. If considering ketamine, evaluate co-occurring conditions, suicidality, substance-use risk, and local regulations, and provide it within a monitored medical setting integrated with psychotherapy.

Offer families education and structured support. The Family Connections program from BPD Alliance teaches skills in validation, boundaries, and self-care, and helps families understand emotion dysregulation and recovery.

When suicidality or trauma are present, connect families with specialized crisis resources, trauma-informed support groups like BPD Alliance’s program Managing Suicidality and Trauma Recovery program, and psychoeducation about safety planning and stabilization. Encourage participation in therapy for their own wellbeing and provide national crisis contacts or local behavioral health hotlines.

Self-harm and suicidal behavior are common and carry elevated risk. Systematic assessment, safety planning, lethal means counseling, frequent follow-up, and crisis resources are essential. Evidence shows DBT reduces self-injury and suicidal behaviors; include these interventions early when risk is present.

Plan endings collaboratively. Consider discharge when the client has met agreed goals, uses skills consistently, maintains safety, and has a relapse plan with a support system in place. Offer booster sessions, maintenance groups, or stepped care options. Document progress and provide referrals if needed.

Refer when there is unmanageable suicide risk, medical instability, severe substance use, or psychosis. Options include intensive outpatient (IOP), partial hospitalization (PHP), inpatient, or residential programs, depending on acuity. Coordinate transitions, provide a clear clinical summary, and support continuity of care.

If needs exceed your training or resources, share that with the client and do what you can to help them find a provider who is a better fit.

Validate experiences, set clear treatment goals, use structured sessions and skills practice, maintain predictable scheduling, involve family support with consent, and use consultation teams to reduce therapist burnout. DBT programs emphasize commitment strategies, behavioral contingencies, and skills coaching to improve retention.