mind by design



Assessing & Treating
Borderline Personality Disorder (BPD)

Recently, I’ve noticed more talk about Borderline Personality Disorder (BPD), specifically about the potential for misdiagnosis. As a therapist, I have some mixed feelings about the diagnostic process of BPD due to the verbiage in our diagnostic manual. As with many diagnostic tools, there is a disparity in diverse research, leaving too much room for error. With any assessment, it’s important that the provider is taking into consideration the age, gender, socio-economic status, race, ethnicity and culture when gauging the client’s baseline.

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pendulum to show mood swings in borderline personality disorder

Borderline Personality Disorder

In addition to using a whole-person lens, assessment tools and diagnostic criteria should only be used by trained providers who can interpret and understand the results. So, how is BPD assessed? Assessing BPD typically involves a comprehensive evaluation conducted by mental health professionals. They employ various diagnostic tools, such as interviews, questionnaires, and clinical assessments, to assess the presence and severity of BPD symptoms. Through a thorough examination of one’s emotional patterns, relationship dynamics, and overall psychological well-being, professionals can make an informed determination regarding BPD.

Features, Traits & Characteristics
Reflective of Borderline Personality Disorder

Individuals with BPD often display emotional intensity, experiencing mood swings that can quickly escalate from sadness to anger or anxiety. They may struggle with a fear of abandonment, leading to efforts to avoid real or imagined rejection. Impulsive behaviors, such as reckless spending, substance abuse, or self-harming tendencies, are also commonly observed. Difficulties with self-image, identity instability, and turbulent relationships are typical aspects of their lives.

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symptoms commonly seen with BPD

The main characteristics of BPD include emotional instability, marked by intense and rapidly shifting emotions, as well as a chronic sense of emptiness. Individuals with BPD often exhibit impulsive behaviors, have difficulties maintaining stable relationships due to fears of abandonment, and frequently experience self-destructive thoughts or actions. Additionally, identity disturbances, a distorted self-image, and a tendency towards black-and-white thinking are key features of the disorder.
Borderline Personality Disorder is characterized by a range of symptoms that may include:

  • unstable relationships
  • intense emotional experiences
  • impulsive behaviors
  • fear of abandonment
  • chronic feelings of emptiness
  • self-destructive tendencies
  • identity disturbances
  • and recurrent self-harming or suicidal thoughts.

Positive traits of people with BPD

creative art for positive mental health



Detail Oriented

Bold & Outspoken

Deeply Empathetic

Strong Self-Awareness

celebrating mental health


While BPD and bipolar disorder share some overlapping symptoms, they are distinct conditions. BPD primarily involves difficulties with emotional regulation, unstable relationships, and a shaky sense of self. Bipolar disorder, on the other hand, is characterized by significant mood swings between manic and depressive episodes. BPD tends to affect interpersonal functioning and self-identity more prominently, whereas bipolar disorder centers around extreme shifts in mood and energy levels.

What Causes Borderline Personality Disorder?

The exact cause of Borderline Personality Disorder (BPD) is not fully understood. However, research suggests that there are multiple factors that contribute to its development. It is believed that a combination of genetic, environmental, and neurobiological factors play a role in the onset of BPD.

Evnironmental Factors

Early life experiences and the environment in which a person grows up can significantly influence the development of BPD. Childhood trauma, such as physical or sexual abuse, neglect, or unstable family environments, has been linked to an increased risk of developing the disorder. Other factors like early parental loss, inconsistent or invalidating parenting, and chronic invalidation of emotions can also contribute to the development of BPD.

Neurobiological Factors

Studies have shown that there are abnormalities in brain structure and functioning in individuals with BPD. Areas of the brain involved in emotional regulation, impulse control, and interpersonal processing, such as the amygdala, prefrontal cortex, and hippocampus, may be affected. Neurotransmitter imbalances, particularly involving serotonin and dopamine, have also been implicated in the development of BPD.

Genetic Factors

There is evidence to suggest that there is a genetic component to BPD. Individuals with a family history of the disorder are more likely to develop BPD themselves. However, specific genes or genetic markers related to BPD have not yet been identified.

Understanding the potential causes of BPD can help mental health professionals and individuals affected by the disorder to develop more effective treatment approaches. It’s important to note that these factors do not guarantee the development of BPD, but rather increase the vulnerability to the disorder. Each individual’s experience with BPD is unique, and the specific combination of these factors can vary from person to person.

Treatment for BPD:
Online Therapy in NJ

A comprehensive treatment plan for BPD typically involves therapy, medication if necessary, and support from a healthcare team to address the underlying factors contributing to the disorder and promote emotional regulation, healthy coping mechanisms, and improved overall well-being. Treating BPD usually involves a multifaceted approach tailored to the individual’s specific needs. Psychotherapy approaches common used to treat BPD include:

  • Dialectical Behavior Therapy (DBT)
  • Cognitive-Behavioral Therapy (CBT)
  • Acceptance & Commitment Therapy (ACT)
  • Schema Therapy

These modalities address emotional dysregulation, develop healthy coping mechanisms, improve interpersonal skills, and enhance self-awareness. Additionally, medication may be prescribed to manage accompanying symptoms, such as depression or anxiety, and support overall well-being.

online therapy session for young woman
hopeful image for optimistic therapy in NJ

In a Nutshell.....

In conclusion, Borderline Personality Disorder (BPD) is a complex condition that requires careful assessment and understanding. While the diagnostic process may have limitations and room for error, it is crucial for mental health professionals to consider various factors such as age, gender, socio-economic status, race, ethnicity, and culture when evaluating a client’s baseline. BPD is characterized by emotional intensity, fear of abandonment, impulsive behaviors, identity disturbances, and turbulent relationships, significantly impacting one’s daily functioning and quality of life. However, with appropriate treatment approaches like psychotherapy and medication, individuals with BPD can experience improvements in emotional regulation, interpersonal skills, and overall well-being. By continuing to research and enhance our understanding of BPD, we can strive to provide better support and care for those affected by this disorder.

If you are looking for help with BPD or other mental health challenges, reach out! Our team of online therapists in New Jersey are here to help! Call or text 609-300-6481 or email info@mindbydesignllc.com

Rebecca Sidoti, LCSW

Rebecca Sidoti, LCSW

Rebecca is the founder of Mind by Design Counseling. She is an expert in the treatment of anxiety disorders, and has a knack for working with high-intensity, driven individuals who are seeking the ever-elusive balance of professional and personal wellness.