Borderline personality disorder (BPD) is a mental health diagnosis characterized by a pervasive pattern of instability of interpersonal relationships, self-image, emotions, and impulsivity. When DBT was initially developed, it was initially used to treat clients diagnosed with BPD, hence the title of the DBT manual for therapists: Cognitive-Behavioral Treatment of Borderline Personality Disorder. Today, DBT has accrued evidence for its effectiveness in a wide range of clinical populations, which you can read more about here. At the same time, DBT is still known as a gold-standard treatment for BPD, and we, as well as most DBT clinics, regularly see clients diagnosed with BPD.

So, what is BPD?

Let’s begin with the criteria, as described in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5-TR (APA, 2022).

The diagnostic criteria for borderline personality disorder include 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.
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 area that are potentially self-damaging (e.g. spending, sex, substance use, reckless driving, binge eating).
5. Recurrent suicidal behavior or non-suicidal self injury
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.

Altogether, BPD is characterized by difficulties with managing intense emotions, which often lead to problems in interpersonal relationships and impulsive or out-of-control behaviors.

There is a common misconception that personality disorders, including BPD, are untreatable or incurable. In reality, people who meet criteria for BPD and for other personality disorders, can achieve symptom reduction such that they no longer meet criteria for the disorder. If you have been diagnosed with, or suspect you meet criteria for BPD, comprehensive treatment, such as DBT, can help you to recover. Read more about DBT here.