How Is BPD Diagnosed?
Borderline personality disorder is diagnosed through a comprehensive evaluation, as there’s no single test for this complex mental health condition. The diagnostic process includes meeting specific criteria in the DSM-5 and undergoing a psychiatric evaluation. This multifaceted approach ensures a thorough understanding of the individual’s symptoms and experiences.
Understanding this process of diagnosing BPD is crucial for those seeking clarity and treatment for BPD. We’ll dive into the DSM-5 criteria for BPD, outlining the key symptoms and behaviors considered for diagnosis, followed by an overview of what to expect during a psychiatric evaluation.
DSM-5 BPD diagnosis criteria
There’s no specific test that can be done, and the process of getting a BPD diagnosis is multifaceted. It can involve a thorough assessment, interviews, psychological exams, personal screenings — and most importantly, meeting the BPD diagnosis criteria set forth by the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
The current DSM-5 criteria for a borderline personality disorder diagnosis states that someone must routinely experience at least 5 of the following symptoms:
- Consistent feelings of emptiness
- Persistent and unstable self-image
- Intensely unstable relationships
- Repetitive suicidal thoughts, threats, gestures, or behaviors
- Energetic effort to avoid abandonment (imaginary or real)
- Inappropriate, intense anger or difficulty controlling temperament
- Sudden mood swings and emotional instability that can last hours or days
- Severe dissociative symptoms and paranoid delusions related to temporary stressors
- At least 2 impulsive behaviors (for example: reckless driving, overeating, overspending, substance abuse, or sex)
It’s also important to be aware of the less obvious manifestation known as quiet BPD, where individuals internalize their struggles, often leading to misdiagnosis or delayed diagnosis. In quiet BPD, symptoms like intense emotional pain are turned inward, which can be just as debilitating but less visible to others.
Getting a borderline personality disorder diagnosis also includes getting a general psych evaluation from your mental health provider and going through the BDP assessment process as described below.
Psychiatric evaluation
A crucial step in diagnosing BPD is undergoing a comprehensive psychiatric evaluation. It’s vital to seek a mental health professional, such as a psychiatrist or therapist, who is well-versed in the complexities of BPD. Their expertise in recognizing and treating this disorder is key to an accurate diagnosis.
In the psychiatric evaluation for BPD, a mental health professional will conduct a thorough assessment, which goes beyond basic questionnaires and interviews. This evaluation delves into your personal history, emotional patterns, and behavioral responses, offering a nuanced understanding of your experiences. The clinician will also consider any past treatments or diagnoses to differentiate BPD from similar conditions.
This comprehensive approach not only aids in accurately diagnosing BPD but also in crafting a personalized treatment plan, making your active participation and honest communication vital to the process.
BPD Assessment Process
Need guidance through the process of diagnosing BPD? You can start with your primary physician to find a mental health professional you trust and would like to work with. Then, you’ll schedule an assessment and begin the process as follows:
- Attend your initial consultation.
- Schedule any follow-up sessions needed for a full assessment.
- Provide detailed information about your symptoms, family life, living situation, and work history.
- You may need to complete a short questionnaire or a lengthier psychological assessment.
- A therapist may refer you to a specialist for a more thorough assessment.
Once your full BPD assessment is complete, you’ll receive a diagnosis. It may be for BPD, another mental health condition, multiple conditions, or no discernible condition whatsoever.
Let us reassure you: it’s normal to feel a little nervous at your first session, especially if you’ve never been in therapy before. Good therapists realize it’s not easy to open up about the details of your life. Even though it can be a difficult process, in order to get a borderline personality disorder diagnosis, try to be as honest and direct as possible during the assessment.
For those seeking convenience or facing barriers to in-person consultations, Talkspace offers online access to licensed therapists and psychiatric providers. Through Talkspace, you can connect with professionals to get a diagnosis for BPD from the comfort of your home, so you can start managing your mental health.
Remember how important it is to get help, collaborate with an experienced mental health professional, and find a therapist who uses evidence-based treatment options. BPD may not be entirely curable, but it is very treatable.
“Written assessments are used to assist with the diagnosis of personality disorders, but the primary tool is having sessions with a therapist who can ask questions and understand patterns that are consistent with the diagnosis.”
— Karmen Smith, Licensed Clinical Social Worker (LCSW), DD
How to Receive a Borderline Personality Disorder Diagnosis through Talkspace
If you have reason to think you might have Borderline Personality Disorder (BPD), you can get answers without delay. With Talkspace it’s fast and convenient to connect with a mental health provider for an evaluation of your symptoms and, if appropriate, a diagnosis.
Talkspace makes it affordable to receive diagnosis and treatment for mental health conditions including BPD, with online therapy and psychiatry plans that take insurance. Your insurer and health plan will determine the specifics of your coverage and copays, but covered members only pay a copay (the average copay is $15). Separately, many employers cover the cost of Talkspace so employees can receive our care for free. You may also choose to pay with pre-tax dollars using your FSA/HSA card or simply pay out-of-pocket at costs lower than those of most in-person mental health providers.
Here’s how it works:
- Get started any time by answering a few questions on the Talkspace website or app. You don’t need a referral for either therapy or psychiatric care.
- You’ll be connected with a therapist within about two days or a psychiatric provider within about a week.
- If you choose to start with therapy you can message with your therapist as much as you like and also schedule live sessions. If you choose psychiatry you’ll schedule a live video session with your psychiatric provider.
In some cases BPD is most effectively treated with a combination of medication and talk therapy. Online therapy helps you manage symptoms and develop coping skills, while online psychiatry addresses the physiological basis or your symptoms, usually with a prescription for medication and ongoing medication management.
What to Do if You Get Diagnosed with BPD
If you do receive a BPD diagnosis after your assessment, your therapist or other mental health provider will explain in detail the symptoms you’re experiencing and offer effective treatment options you should consider.
Learning about effective BPD treatment is a critical step in working toward a happier, healthier, stable life in the future.
Seek therapy for BPD
Some highly effective types of talk therapy for BPD you can turn to after receiving a borderline personality disorder diagnosis include:
- Cognitive-behavioral therapy (CBT)
- Dialectical behavioral therapy (DBT)
- Mentalization-based therapy (MBT)
- Schema-focused therapy
- Systems training for emotional predictability and problem-solving (STEPPS)
- Transference-focused psychotherapy (TFP)
In some cases, BPD medication might also be recommended for short-term symptom management.
Discuss medication for symptoms with a doctor
There are no known medications that work (or that are FDA-approved) specifically to treat personality disorders like BPD. However, some mood stabilizers or antipsychotic medications might be recommended to relieve or address some of the symptoms you experience.
Borderline personality disorder medication can be useful in treating some of the severe symptoms of BPD and some comorbid mental health conditions.
“Borderline personality disorder symptoms include emotional dysregulation and erratic interpersonal relationships. This could be the reason people seek treatment. Therapy and medication management can help effectively treat symptoms of BPD.”
— Karmen Smith, Licensed Clinical Social Worker (LCSW), DD
Do your research and ask relevant questions before beginning a new prescription. Doing deep, intense work in therapy can be necessary to diminish your BPD symptoms, and it will most often be more helpful than relying on medication alone.
The process of getting an accurate BPD diagnosis might seem daunting, but it’s worth it. Once you’re diagnosed, you can get the tools you need to live a rewarding and full life. BPD treatment will release you from the tumultuous instability this condition often causes. You can learn to live with BPD, and having a diagnosis in hand is the first step.
If you believe you are showing signs of BPD, consider starting with our BPD test to learn more.
How to Treat Borderline Personality Disorder
There are several ways to treat borderline personality disorder (BPD) effectively. The chronic mental health condition known as BPD affects an estimated 1.6% of the population. It’s marked by dramatic mood swings, anger, feelings of abandonment, and difficulty managing emotions or maintaining relationships.
Treatment for BPD can include:
- Psychotherapy
- Dialectical behavior therapy (DBT)
- Schema-focused therapy
- Mentalization-based therapy (MBT)
- Systems training for emotional predictability and problem-solving (STEPPS)
- Transference-focused psychotherapy (TFP)
- Medication
- Holistic/natural treatment options
Borderline personality disorder treatment — including therapy, some types of medication, and family and peer support — often results in long periods of remission or significant improvement of BPD symptoms.
Therapy for BPD
Therapies for BPD include:
- Dialectical behavior therapy (DBT)
- Schema therapy (ST)
- Transference-focused therapy (TFP)
- Mentalization-based therapy (MBT)
- Systems training for emotional predictability and problem solving (STEPPS)
Note that, as of today, no medications are FDA-approved to treat borderline personality disorder. However, combining therapy with some types of medication might be effective in minimizing certain symptoms and related conditions, such as depression and anxiety.
“Most types of treatment for borderline personality disorder involve learning to become aware of one’s behavior and reactions to others, learning to manage relationships, and understanding the situations that may trigger an episode of decompensation (to name a few). Treatment also involves learning the coping skills that will help an individual work through a particularly hard episode.”
— Minkyung Chung, Licensed Mental Health Counselor (LMHC), MS
Dialectical behavior therapy (DBT)
Dialectical behavior therapy (DBT) is a form of cognitive behavioral therapy (CBT) that was developed specifically for the treatment of BPD. It uses individual and group talk therapy to teach people the skills they can use to manage difficult emotions. DBT for BPD has proven extremely successful. In fact, one study showed that 77% of people no longer met diagnostic criteria after just a single year of treatment.
This type of therapy focuses on mindfulness, emotion regulation, and building strong, healthy relationships. Several studies, including one done by researchers in 2014, found that DBT also helps people with BPD avoid self-harm and hospitalization.
Schema therapy (ST)
Schema therapy (ST) is a borderline personality disorder therapy that seeks to reshape someone’s schemas (ingrained patterns of thinking).
Schemas are generally formed in childhood and become set patterns. The goal of schema therapy is to replace negative schemas with positive and healthy thought patterns.
A 2016 pilot study by the Department of Psychiatry, University of Lübeck in Germany, found that ST can result in a striking reduction of symptom severity, reduced time of hospitalization, and several other positive impacts. (However, it’s important to note that the sample size of this study was small, just 10 patients, and more research is needed).
Transference-focused therapy (TFP)
Another promising BPD therapy is transference-focused therapy (TFP). TFP seeks to break the pattern of transferring emotions onto someone else, which causes reactions that have little basis in reality.
In TFP, a therapist helps people recognize that their reactions are based on their own experiences, not reality, and helps them begin to develop better coping strategies.
Mentalization-based therapy (MBT)
Mentalization-based therapy (MBT) is a type of therapy for borderline personality disorder that helps people with BPD better understand their own mental state and the mental states of the people around them. It’s been found effective in treating depression and anxiety while also improving social functioning.
This therapy is based on the theory that people with BPD have difficulty in relationships because they have trouble understanding the emotions, thoughts, and feelings of others. Thus, MBT seeks to teach people better ways to interpret the words and actions of others.
Systems training for emotional predictability and problem solving (STEPPS)
STEPPS is another frequently-used borderline personality disorder therapy. It’s a skills-based, group method that’s typically used in conjunction with another form of BPD therapy.
STEPPS teaches people skills that help them with emotion regulation. It also touches on self-care strategies like healthy eating, getting enough sleep, and avoiding self-harm.
Effectiveness of Therapy for BPD
The effectiveness of therapy depends on each individual person. Everyone’s symptoms are unique, so people can react to therapy somewhat differently. To achieve the best results possible, there needs to be a full commitment to BPD therapy. People who hope to get better must be dedicated to keeping their appointments and “doing the work.”
What therapy type is best for BPD?
What works well for one person may not be effective for another. A good therapist can help you find the treatment plan that works for you and your symptoms.
“There is no ‘best type’ of treatment for borderline personality disorder, or any disorder, as it’s based on what’s best for the individual. It’s important for people to be aware of their own feelings on the effectiveness of a particular treatment. Advocating for oneself is important in finding the right treatment.”
— Minkyung Chung, Licensed Mental Health Counselor (LMHC), MS
BPD therapy in conjunction with BPD medication
BPD medication is sometimes used in conjunction with therapy to help people with BPD. While it’s true that the FDA hasn’t approved any medication specifically to treat BPD, some antipsychotic, antidepressant, and mood-stabilizing medications can help symptoms and co-morbid conditions like depression, hostility, and anxiety.
Coupling medication with therapy can help people learn to cope with day-to-day life without anxiety and depression so they can concentrate on developing new ways to process their own feelings and interpret the feelings of others.
Medications for Borderline Personality Disorder
While generally not the first line of treatment, medications are sometimes prescribed for people with BPD. There’s no FDA-approved medication to treat borderline personality disorder, but some types can be effective in treating major common symptoms that are typical to BPD, like anxiety and depression.
It’s important to point out that no single BPD medication will be effective for everyone. Each individual, and each case of BPD, is unique since there are different types of BPD, and medication is rarely, if ever, used without therapy.
How does medication treat BPD?
Medication that’s used to treat BPD works by easing some of the debilitating and distracting symptoms common to the disorder. It might help some people get to a calm place by controlling their anxiety or impulses, for example, so they can begin to focus on deeper issues.
Types of medication for BPD
Several medications are used to treat BPD symptoms like mood swings, depression, and anxiety.
Some types of medications frequently used for people living with BPD include:
- Antidepressants: Antidepressants can help treat low mood, sadness, and anxiety that’s related to BPD, but they’re typically not effective on symptoms like impulsive behavior and anger. Selective serotonin reuptake inhibitors (SSRIs), tricyclic and tetracyclic antidepressants, and monoamine oxidase inhibitors (MAOIs) all might be prescribed to treat BPD. Some common ones include:
- Effexor (venlafaxine)
- Nardil (phenelzine)
- Prozac (fluoxetine)
- Wellbutrin (bupropion)
- Zoloft (sertraline)
- Antipsychotics: These medications are used to treat dramatic mood swings, delusions, paranoia, anxiety, hostility, anger, and impulsivity. Some of the common antipsychotics used to treat BPD can include:
- Abilify (aripiprazole)
- Geodon (ziprasidone)
- Risperdal (risperidone)
- Seroquel (quetiapine)
- Zyprexa (olanzapine)
- Anti-anxiety medication: Commonly used to treat the anxiety that often accompanies BPD, some of the types of anti-anxiety medications might include:
- Ativan (lorazepam)
- Buspar (buspirone)
- Klonopin (clonazepam)
- Valium (diazepam)
- Xanax (alprazolam)
- Mood stabilizers: Certain mood stabilizers or anticonvulsants have been found effective in treating impulsivity and emotional instability in people with BPD. Some medications that might be prescribed are:
- Depakote (valproate)
- Lamictal (lamotrigine)
- Lithobid (lithium)
- Tegretol or Carbatrol (carbamazepine)
“Using medication for borderline personality disorder (BPD) can depend on the individual treatment plan with the provider, as there’s no one-size-fits-all approach. Antidepressants and mood stabilizers have been shown to impact positive outcomes and should be advised by a professional clinician who also has a positive grasp on your psychosocial history, challenges, and symptoms.” — Elizabeth Keohan, Licensed Certified Social Worker-Clinical, (LCSW-C), LICSW, MSW
Holistic Treatment for Borderline Personality Disorder
In addition to psychotherapy and medication, some people dealing with BPD find help through the use of holistic and natural treatments. There are several natural options to consider in addition to other forms of BPD treatment. They might include:
- Vitamin C supplements: Those looking to learn how to treat BPD naturally might turn to vitamin C. This common supplement may be helpful for people with BPD with anxiety and nervous tension. According to a 2015 study, taking 500 mg of vitamin C a day reduced anxiety in the study’s subjects.
- Foods containing omega-3 fatty acids: Foods with omega-3 fatty acids may also be a good choice for people who want to learn how to treat BPD holistically. Foods like salmon, walnuts, sardines, and mackerel have been cited as effective treatments for BPD by several studies, including a 2003 research study by McLean Hospital in Belmont, MA.
- Magnesium: Another natural treatment for BPD symptoms is magnesium. This supplement can be particularly effective for people who suffer from migraines or who have depression or high anxiety associated with BPD. One 2015 study found that people dealing with BPD had very low levels of magnesium. It was discovered that some subjects who took drugs based on organic salts of magnesium for one year had improved enough to reduce the need for other medication.
Benefits of a holistic approach
When it comes to how to treat BPD naturally, holistic and natural treatments can be a great way to supplement some of the more traditional ways of treating BPD (like therapy and medication). Certain holistic options have been found very effective at managing some common BPD symptoms. They might be a great tool for anyone wanting to know how to treat borderline personality disorder without as much (or possibly any) medication.
One of the key assets of holistic remedies is that they can offer a sense of control over treatment.
“BPD presents a range of diverse symptoms, moods, and episodes, and at times, it can be unpredictable with regard to their occurrence, frequency, and severity. If these are coupled with a dual diagnosis, there’s a layer of complexity added to the overall picture. If you can control your daily health routines and nutrition, and you have a healthy sleep schedule, it can be easier to notice when you’re feeling out of sorts and stressed by other negative triggers.”
— Elizabeth Keohan, Licensed Certified Social Worker-Clinical, (LCSW-C), LICSW, MSW
Find Treatment for BPD
The most important takeaway here is that if you or a loved one is living with BPD, you don’t have to suffer or just deal with the symptoms of this condition. Many effective treatments can help you enhance your quality of life, improve your unstable relationships, and feel less angry, anxious, or out of control.
For best results, you should look for a therapist with experience in treating people with BPD. Start by consulting your primary care physician or using online resources.
Online therapy platforms, like Talkspace, offer a flexible approach to therapy. You can find a skilled, trained therapist to help you treat borderline personality disorder when and where it’s convenient for you.
Reach out today to learn more about how Talkspace can give you your life back. There is treatment for BPD, and you can take control of your future.
