Condition guide
Borderline Personality Disorder
Borderline personality disorder (BPD) involves a pattern of difficulty regulating emotions, a strong fear of abandonment, and instability in relationships and self-image. It’s one of the most misunderstood and stigmatised mental health conditions, often unfairly, and it’s also one of the most treatable — many people with BPD experience significant, lasting improvement with the right support.
This page is written to reflect current, non-stigmatising understanding of BPD as a genuine mental health condition rooted in difficulty with emotional regulation, not a character flaw or a label to be feared.
Recognising it
What are the signs of BPD?
Emotions & sense of self
- Intense fear of real or perceived abandonment, and significant efforts to avoid it
- An unstable sense of self or identity
- Intense mood reactivity, with emotional shifts that can happen quickly
- Chronic feelings of emptiness
- Difficulty managing intense anger
Relationships & behaviour
- A pattern of intense, unstable relationships, often shifting between idealising and being disappointed in someone
- Impulsivity in areas that could be risky, such as spending, substance use, or driving
- Recurring thoughts of self-harm or suicide, or self-harming behaviour, in some people with BPD
- In some cases, brief episodes of stress-related paranoia or dissociation
Not everyone with BPD experiences every one of these, and the way BPD shows up varies significantly between individuals. What underlies most of these experiences is a genuine difficulty regulating intense emotions — not a deliberate choice or a manipulative intent, which is a common and harmful misconception about BPD.
Understanding why
What contributes to BPD?
- Biological factors
- Genetics and individual differences in emotional sensitivity and regulation appear to play a role.
- Early experiences
- Invalidating, unstable, or difficult early environments are commonly associated with BPD, though not everyone with BPD has this history, and not everyone with this history develops BPD.
- Sensitivity meeting environment
- A widely supported model suggests BPD often develops from the combination of an emotionally sensitive temperament and an environment that didn’t adequately support learning to manage that sensitivity.
Understanding these contributing factors is about building a fuller picture, not about assigning blame — either to the person with BPD or to their family.
Getting better
How is BPD treated?
BPD is genuinely treatable, and outcomes for many people are good, particularly with structured, BPD-specific therapy:
Dialectical behaviour therapy (DBT)
Specifically developed for BPD, with strong evidence for effectiveness; DBT builds skills in emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
Mentalisation-based therapy (MBT)
Helps build the capacity to understand your own and others’ mental states, which is often affected in BPD.
Schema therapy
Addresses long-standing patterns and beliefs that developed from earlier experiences.
Structured, longer-term treatment
BPD treatment is often longer-term than treatment for some other conditions, and this is a normal and expected part of the process, not a sign that treatment isn’t working.
With appropriate treatment, many people with BPD see substantial improvement, and a significant proportion no longer meet diagnostic criteria for BPD after a number of years of treatment.
Next step
When should I see a psychologist about BPD?
It’s worth reaching out if you recognise a pattern of intense emotional reactivity, unstable relationships, and fear of abandonment that’s affected multiple areas of your life over time, or if you’ve previously been told you might have BPD traits. A comprehensive assessment by a psychologist experienced in personality presentations is the appropriate way to understand your situation rather than self-diagnosing from this page.
If thoughts of self-harm or suicide are part of your experience, please reach out to Lifeline (13 11 14) or a psychologist as soon as you can — this is a common part of BPD for some people, and it’s a genuine reason to seek support, not something to feel ashamed of.
A GP can help you access a Mental Health Care Plan under Medicare’s Better Access initiative, and specific BPD treatment programs (including DBT) may be available through public mental health services as well as private practice.
A GP can help you access a Mental Health Care Plan under Medicare's Better Access initiative, which provides rebates for a set number of psychology sessions per year.
How Pair helps
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Common questions
Frequently asked questions
Is BPD a life sentence, or can people recover?
People with BPD can and do experience significant, lasting improvement, particularly with structured treatment like DBT. Research shows a meaningful proportion of people no longer meet diagnostic criteria for BPD after a number of years of appropriate treatment.
Is BPD the person’s fault, or their parents’ fault?
Neither. BPD is best understood as developing from a combination of biological sensitivity and environmental factors, and framing it in terms of blame — of the person or their family — isn’t accurate or helpful.
Are people with BPD manipulative?
No. This is a persistent but inaccurate stereotype. What can look like manipulation is usually intense fear of abandonment and difficulty regulating overwhelming emotions, not a deliberate strategy to control others.
What’s the difference between BPD and just having intense emotions?
Everyone experiences strong emotions sometimes. BPD specifically involves a persistent pattern — across relationships, self-image, and behaviour — that causes significant distress or difficulty functioning, not an occasional intense reaction to a difficult situation.
Is DBT only for people with BPD?
DBT was originally developed for BPD and has the strongest evidence base there, but it’s also used effectively for other conditions involving emotional regulation difficulties, including some presentations of depression, anxiety, and eating disorders.
Do I need a GP referral to see a psychologist about BPD?
No — you can see a psychologist directly. A GP referral is only required if you want to access a Medicare rebate through a Mental Health Care Plan.
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