A message is slow to arrive and your mind has already decided you are about to be left. Within an hour you go from rage to despair and then to an emptiness you cannot fill. Afterwards you feel ashamed of what you said or did, and promise it will not happen again.

If this has been happening for years, it may be borderline personality disorder, also known as BPD. It can be treated, and long-term studies give real grounds for hope. If you are thinking about seeing a psychologist and looking for therapy for borderline personality disorder, this guide explains when to seek help, which therapies work, what they involve, how long they take, whether they work online and how to choose a professional.

When to see a psychologist for BPD

The NHS groups the symptoms of BPD into four areas:

  • Emotional instability: intense emotions such as rage, sorrow, shame, panic or terror, and long-term feelings of emptiness and loneliness. Your mood can change dramatically within a few hours.
  • Disturbed patterns of thinking: upsetting thoughts about yourself, such as believing you are a terrible person, and sometimes brief episodes of strange experiences.
  • Impulsive behaviour: the urge to self-harm and other impulses that are very hard to control, such as binge drinking, drug misuse, going on a spending or gambling spree, or unprotected sex.
  • Intense but unstable relationships: fear of being abandoned, frantic efforts to prevent it and a black-and-white view in which someone goes from wonderful to terrible.

According to the NHS, the symptoms usually emerge in adolescence and persist into adulthood. The causes are unclear and seem to involve a mix of genetic and environmental factors, but most people with BPD will have experienced some kind of trauma or neglect as children, as we discuss in Childhood trauma in adults: how it shows up and what can be done. The NHS advises starting with your GP, who will rule out other more common conditions, such as depression, and check whether there is any immediate risk.

MyPsicoTest does not have a BPD test. If fear of abandonment weighs heavily on your relationships, the Emotional Dependency Test includes statements such as "When I am in a relationship, the idea of my partner leaving me terrifies me, even at times when things are going well". And if you are unsure whether it is BPD or bipolar disorder, Sudden mood swings: why they happen and when they are something more explains the most useful clue: how long each change lasts.

Do not wait if there is self-harm or suicidal thinking. The NHS points out that many people with BPD self-harm and attempt suicide. Call the 024 line in Spain (free, confidential, around the clock), 112, or your local emergency number.

Which treatment works for BPD

The main treatment is psychotherapy. The NHS explains that it should be delivered by a trained professional and may last a year or longer. NICE, the body that issues clinical guidance in England, calls for a structured approach with a clear theoretical model, advises against brief interventions of less than three months and recommends considering a comprehensive dialectical behaviour therapy (DBT) programme for women with BPD for whom reducing recurrent self-harm is a priority.

There are good reasons for optimism. The Cochrane review by Storebø and colleagues, covering 75 trials and 4,507 participants, found that psychotherapy reduced the severity of BPD symptoms compared with treatment as usual, a clinically relevant improvement based on moderate-quality evidence. It may also reduce self-harm and suicide-related outcomes, although the evidence there was of lower quality. The most studied therapies were DBT and mentalisation-based treatment (MBT).

What therapy for BPD involves

Each approach has its own style, but those with evidence behind them work on similar things:

  1. Validation before change. In DBT, according to the NHS, the therapist accepts that your emotions are real and understandable while challenging the idea that self-harm is the only way to cope with them.
  2. Learning skills for intense emotions. DBT combines individual sessions with weekly skills groups; building those skills is what we cover in Emotional regulation: what it is, why it sometimes fails and how it is learned.
  3. Curbing impulses and self-harm, with concrete alternatives for the moments of greatest tension.
  4. Mentalising. MBT helps you step back from an urge, examine your own thoughts and recognise that other people have their own mental states, which are not always what you imagine.
  5. Looking after relationships, moving away from all-or-nothing thinking and the constant fear of abandonment.
  6. Having a crisis plan. The NHS explains that DBT usually includes an out-of-hours number to call if your symptoms get worse, and that talking to someone who understands the condition can help bring you out of a crisis.
Psychologist holding the hand of a client who is crying during a session, as in the emotional validation of dialectical behaviour therapy

What about medication?

No medicine is licensed to treat BPD, the NHS notes. NICE advises against using medication specifically for the disorder or for its individual symptoms, such as self-harm, emotional instability or risk-taking, and against using antipsychotics in the medium or long term. Medication may be considered for associated problems, such as depression or anxiety. That decision is always made by a doctor.

How long therapy for BPD takes

It is not a short therapy. The NHS talks about a year or longer, and explains that a course of MBT usually lasts around 18 months. In return, the long-term results give cause for hope. In a follow-up by Zanarini and colleagues, which assessed 290 people who had been in hospital for BPD over ten years, 93% achieved a remission of symptoms lasting at least two years. Full recovery, with good social and work functioning, was harder: half of them reached it, but those who did usually kept it. NICE asks for treatment to be discussed in an atmosphere of hope and optimism, explaining that recovery is possible.

Does online therapy work for BPD?

Here research is lagging behind. A 2022 review of internet-delivered interventions for personality disorders found eleven studies and only two randomised trials; most were apps added to face-to-face therapy such as DBT, with promising early results. During the pandemic, many DBT programmes moved to video calls while keeping their structure, and in a study of 168 French-speaking relatives of people with BPD, the Family Connections programme worked similarly online and in person.

Video sessions can help keep treatment going, always with a clear crisis plan and local resources for emergencies. In the case of serious self-harm or immediate risk, what is needed is urgent, in-person care.

How to choose a psychologist for BPD

These checks help you get it right:

  • Registration as a health professional. This comes first.
  • Specific training in DBT, MBT or another structured approach. The NHS encourages you not to be afraid to ask about the professional's experience.
  • A crisis plan and clarity about what to do between sessions.
  • Treatment without stigma. NICE points out that many people with BPD have experienced rejection, abuse or trauma, and that nobody should be excluded from a service because of their diagnosis or because they have self-harmed.
  • Coordination with psychiatry if there is medication or associated problems.
  • Care with endings. NICE asks for any change or ending of treatment to be prepared well in advance, because it can stir up very strong emotions.
  • The option of involving your family, if you want to.

A psychologist for BPD

At MyPsicoTest we recommend Xènia Capel Salcedo, a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. She sees clients in Igualada and Sant Sadurní d'Anoia and also through online therapy, and on her blog she has written an article about borderline personality disorder. In it she explains that she works with BPD by combining techniques from dialectical behaviour therapy, schema therapy and EMDR, tailored to each case, and that it is a long process, often one to three years, although changes start to show within a few months. She also warns that not every psychologist is trained in these approaches and that it is worth looking for experience with this condition. She works from an integrative, evidence-based approach: on her website she explains that she uses tools from cognitive behavioural therapy, EMDR, systemic therapy and person-centred therapy. Sessions are available in English, Spanish or Catalan, and the first contact is a free, no-commitment information consultation. She herself points out that in a serious crisis or psychiatric emergency, immediate in-person care is what is needed.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: