Quick answer
Borderline personality disorder (BPD) is a pattern of intense, fast-changing emotions, an unstable sense of self and relationships that feel unstable. It's one of the most misunderstood diagnoses, and it's treatable. Therapy is the main treatment, and DBT was developed specifically for BPD. No medication is FDA-approved for BPD, and medication isn't the main treatment. It may help with specific symptoms or conditions that come with it.
Key takeaways
- BPD is a real, treatable condition, not a character flaw.
- Emotions feel very intense, and moods can shift within hours.
- Therapy is the main treatment, and DBT was developed specifically for BPD. We teach DBT skills in visits and help you find DBT therapy.
- Medication can help with specific symptoms or co-occurring conditions.
What BPD is
Borderline personality disorder is a pattern of intense emotions, rapid emotional shifts, difficulty keeping relationships steady, and an unstable sense of who you are. It often involves difficulty regulating emotions, and many people with BPD report having been through traumatic life events.
It's also one of the most stigmatized diagnoses. People with BPD are sometimes called manipulative, but that stereotype is wrong: what drives the behavior is difficulty regulating emotions, and real emotional pain. Symptoms that overlap with other conditions can make BPD harder to diagnose. We approach it with respect and without judgment.
Common signs, in plain language
- Emotions that feel very intense
- Moods that can shift within hours, with episodes lasting from a few hours to a few days
- Strong fear of being left or rejected
- Relationships that swing between closeness and conflict, sometimes called splitting: Seeing people or situations as all good or all bad, sometimes switching quickly between the two.
- A shifting sense of who you are
- Feeling empty
- Intense anger that's hard to control
- Acting on impulse when emotions are high
These are common experiences, not a checklist for diagnosis. BPD looks different from person to person, which is one reason it's often missed. Source: NIMH
How it's diagnosed
A careful evaluation looks at long-standing patterns in emotions, relationships and self-image, not one difficult period. BPD often occurs alongside depression, anxiety, PTSD, bipolar disorder or substance use, and the symptoms can overlap, so we take time to sort out what's what.
BPD is often confused with bipolar disorder, but they're different conditions, and they can also occur together. Getting the diagnosis right opens the door to treatment that actually fits.
How it's treated
Therapy is the main treatment for BPD, especially dialectical behavior therapy (DBT): A therapy developed for borderline personality disorder that teaches skills for handling intense emotions, distress and relationships., which was developed specifically for it. We don't offer standalone weekly therapy, but our visits include DBT skills such as distress tolerance and emotion regulation, and we can help you find a DBT therapist and coordinate with them.
No medication is FDA-approved for BPD, and medication isn't the main treatment. It may help with specific symptoms or conditions that come with it, such as depression or mood swings. We're careful and conservative, and we explain every choice.
What progress looks like
- Emotions that feel more manageable
- Fewer crises
- Steadier relationships
- A clearer sense of who you are
BPD can improve: with treatment, many people have fewer and less severe symptoms.
Is it this or that?
Borderline personality disorder, or bipolar disorder?
| Borderline personality disorder | Bipolar disorder | |
|---|---|---|
| How moods change | Moods can shift within hours to a few days, often set off by stress, especially in relationships. | Distinct episodes of mania or hypomania and depression, usually lasting days to weeks. |
| Energy and activity | Mood swings without the sustained high mood and big changes in energy and activity seen in bipolar disorder. | Big changes in energy, activity and sleep during high periods. |
| Main treatment | Therapy, especially DBT. Medication for specific symptoms or co-occurring conditions. | Medication, usually a mood stabilizer, plus routines. |
| Both | Real, treatable conditions. They can also occur together. | Real, treatable conditions. They can also occur together. |
Borderline personality disorder
- How moods change
- Moods can shift within hours to a few days, often set off by stress, especially in relationships.
- Energy and activity
- Mood swings without the sustained high mood and big changes in energy and activity seen in bipolar disorder.
- Main treatment
- Therapy, especially DBT. Medication for specific symptoms or co-occurring conditions.
- Both
- Real, treatable conditions. They can also occur together.
Bipolar disorder
- How moods change
- Distinct episodes of mania or hypomania and depression, usually lasting days to weeks.
- Energy and activity
- Big changes in energy, activity and sleep during high periods.
- Main treatment
- Medication, usually a mood stabilizer, plus routines.
- Both
- Real, treatable conditions. They can also occur together.
The two are often confused. A careful evaluation looks at the pattern over time. Sources: NIMH: BPD · Merck Manual: BPD · NIMH: Bipolar disorder · NHS: Bipolar disorder
Medication quick facts
Medication and BPD
No medication is FDA-approved for BPD, and medication isn't the main treatment. It may help with specific symptoms or conditions that come with it.
Medication for BPD
No FDA-approved medication for BPD
- The evidence
- The benefits of medication for BPD itself are unclear, and it isn't a first-line treatment.
- When it helps
- As an add-on to therapy, for specific symptoms or co-occurring conditions such as mood swings or depression.
- How we use it
- Carefully and conservatively, explained clearly, and reviewed over time.
- Alongside
- Therapy, especially DBT.
Source: NIMH: Borderline personality disorder
General information, not medical advice; talk with your provider.
Treating depression that comes with BPD
For example an SSRI antidepressant
- Why
- Depression often occurs alongside BPD, and medication may be added to therapy to treat it.
- Important
- In short-term studies, antidepressants increased suicidal thoughts and behaviors in people up to age 24. Anyone taking one should be watched closely for worsening, especially during the first few months and at times of dosage changes. Don't stop suddenly; talk with your provider first.
Source: NIMH: Borderline personality disorder · MedlinePlus: Sertraline · FDA label (DailyMed): Zoloft (sertraline), an example antidepressant label
General information, not medical advice; talk with your provider.
What to expect
What to expect with treatment
1Start your intake packet
Fill out our secure intake packet. Once it's submitted, we'll verify your insurance and call you to schedule your appointment.
2A careful evaluation
A longer video visit about what you're experiencing, your history, your health and your goals.
3Your diagnosis, explained
We explain what we think is going on, and why.
4A plan you understand
If medication could help, we talk through the options, side effects and what to expect, and decide together. If you'd benefit from therapy or another kind of care, we help you find it.
5Follow-up and adjustment
We check how you're doing and adjust carefully over time.
Bring this to your visit
Questions to ask your provider
Tick the ones you want to ask, then copy your list. Nothing is saved or sent.
Before your first visit
Information your provider will want to know
Tick what you have ready, then copy the list to fill in your notes. Nothing is saved or sent.
Frequently asked questions
Is BPD treatable?
Yes. With treatment, many people with BPD have fewer and less severe symptoms.
Do you offer DBT?
We teach DBT skills such as distress tolerance and emotion regulation within our visits. We don't offer standalone weekly DBT, but we can help you find a DBT program and coordinate with your therapist.
Is there a medication for BPD?
No medication treats BPD as a whole. Medication can help with specific symptoms or co-occurring conditions, alongside therapy.
What if I'm thinking about hurting myself?
If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.
Is a psychiatric nurse practitioner the same as a psychiatrist?
Both diagnose psychiatric conditions and prescribe psychiatric medication. Ours are board-certified psychiatric nurse practitioners (PMHNP-BC), focused on careful evaluation and medication management.
Check your understanding
Three quick questions
1What is the main treatment for BPD?
DBT was developed specifically for BPD. Medication can help alongside it.
2How quickly can moods shift in BPD?
Moods in BPD are intense and can change quickly, often in response to stress or relationships.
3What can medication do in BPD?
Medication isn't the main treatment for BPD, but it may help with specific symptoms or conditions that come with it.
Myth or fact? Borderline personality disorder
Choose an answer for each to see the explanation. Nothing is saved.
1People with BPD are manipulative.
Myth. Difficulty regulating emotions and real emotional pain are not manipulation. This stereotype keeps people from getting help.
2BPD can improve with treatment.
Fact. With treatment, many people have fewer and less severe symptoms.
3BPD and bipolar disorder are the same thing.
Myth. They're different conditions, though they're often confused and can occur together.
The science: how we checked this
Sources
- NIMH: Borderline personality disorder
- Merck Manual (professional): Borderline personality disorder
- NIMH: Bipolar disorder
- NHS: Bipolar disorder symptoms
- MedlinePlus: Sertraline
- FDA label (DailyMed): Zoloft (sertraline), an example antidepressant warning
How we checked this
- Summarized in our own words from Alyssa Killion's articles on BPD and the source above.
- Clinically reviewed by Alyssa Killion, MSN, APN, PMHNP-BC. Last reviewed October 25, 2026.
