Borderline personality disorder: how it differs from bipolar disorder, its course and what helps

Borderline personality disorder (BPD) is a personality disorder in which emotions, self-image and relationships are markedly unstable and impulsive actions come easily, and this pattern lasts a long time. The US National Institute of Mental Health describes it as “a serious mental illness that affects how a person feels about themselves and others and makes it hard to function in everyday life”, which often involves difficulty regulating emotions, leading to impulsivity, an unstable or often changing sense of self, and troubled relationships (NIMH, 2025). The diagnosis entered the DSM-III in 1980 and its defining criteria have not changed much up to the DSM-5; the core is instability of self-image, interpersonal relationships and affects (Leichsenring et al., 2024). The word “borderline” tells you little on its own: it is this pattern of instability, not the name, that defines the diagnosis.

The World Health Organization’s ICD-11 has no separate category called “borderline personality disorder”. ICD-11 uses a single diagnosis of personality disorder, rated mild, moderate or severe, with prominent trait domains added, and an optional “borderline pattern” specifier (6D11.5) can be applied. The CDDR says the specifier “has been included to enhance the clinical utility of the classification of personality disorder” and “may facilitate the identification of individuals who may respond to certain psychotherapeutic treatments”. The essential requirements for personality disorder itself are problems in functioning of aspects of the self, such as identity, self-worth and accuracy of self-view, or in interpersonal functioning, persisting over an extended period, “e.g. lasting 2 years or more”, showing across a range of situations, and associated with substantial distress or significant impairment. It is not diagnosed when the pattern is developmentally appropriate, such as problems establishing an identity during adolescence, or can be explained primarily by social or cultural factors (WHO, 2024).

mind.io does not offer a borderline personality disorder test. The diagnosis is made by a licensed mental health professional after a thorough discussion of symptoms and personal and family history, and it is usually made in late adolescence or early adulthood (NIMH, 2025). There is evidence that it can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews (Leichsenring et al., 2024). So this guide prints no criteria list, scale items or cut-offs, and does not judge any particular person to be “borderline”. It covers what the disorder is, how its core features show, how it differs from mood swings, bipolar disorder, ADHD and complex PTSD, how common it is and what happens over time, why it is stigmatised and why that is unfair, which treatments have evidence, what those close to someone can do, and when to get help.

The ICD-11 borderline pattern comes down to pervasive instability of relationships, self-image and affects, with marked impulsivity. Relationships tend to swing between idealising and devaluing the other person, with both a strong desire for closeness and a fear of it. There are frantic efforts to avoid real or imagined abandonment, and self-image or sense of self is markedly and persistently unstable. Mood reacts strongly to internal triggers such as one’s own thoughts or to outside events, bringing intense dysphoric states that typically last a few hours but may last up to several days. Chronic feelings of emptiness, inappropriate intense anger or difficulty controlling it, and transient dissociative or psychotic-like experiences in situations of high emotional arousal are also described (WHO, 2024). NIMH adds that people with the disorder tend to view things in extremes, such as all good or all bad, which shows in relationships that swing from extreme closeness to extreme dislike (NIMH, 2025). This guide does not print these features as a checklist. Not everyone has all of them, and their severity, frequency and duration vary from person to person (NIMH, 2025).

Impulsivity can show as acting rashly in states of high negative affect in ways that may harm oneself, such as risky sex, reckless driving, excessive alcohol or substance use or binge eating, and recurrent self-harm is part of the pattern (WHO, 2024). People with borderline personality disorder have a significantly higher rate of self-harm and suicidal thoughts and behaviour than the general population, and anyone thinking of harming themselves or attempting suicide needs help right away (NIMH, 2025). If you have thoughts of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you have injured yourself or are in immediate danger, contact your local emergency services.

Other manifestations can include seeing oneself as inadequate, bad, guilty or contemptible, feeling profoundly different and isolated from other people with a painful loneliness, and being hypersensitive to rejection and prone to misreading social signals (WHO, 2024). There is no single cause. NIMH says the exact cause is unknown but genetic, physical, environmental and social factors may raise the risk; many people report traumatic events such as abuse, neglect, abandonment or hardship in childhood, or unstable and invalidating relationships, yet having these experiences does not mean a person will develop the disorder and people without them can have it too (NIMH, 2025). ICD-11 likewise treats early adversity as a risk factor and states that it is not determinative, and says that manifestations of personality disturbance tend to appear first in childhood and increase during adolescence; because self-harm and moodiness are more common in adolescence than in adulthood, the thresholds applied to adolescents should be correspondingly higher (WHO, 2024). A coherent syndrome typically begins in adolescence, after age 12, and is often preceded by or co-develops with depression and anxiety, conduct problems, hyperactivity or substance use (Bohus et al., 2021).

Intense emotions and relationships that run hot and cold do not by themselves make a personality disorder. In ICD-11, personality disorder is diagnosed only when problems in self or interpersonal functioning have lasted a long time, “e.g. 2 years or more”, show across a range of situations rather than in one relationship or role, and come with substantial distress or impairment. Developmentally appropriate problems, such as identity confusion in adolescence, or patterns explained primarily by social or cultural factors are excluded. There is also a separate notion of “personality difficulty”: pronounced personality characteristics that do not reach the level of personality disorder, shown only intermittently, for example under stress, or at low intensity, with problems in functioning not severe enough to cause notable disruption. And reactions evoked by social exclusion of marginal groups may be confounded with manifestations of the borderline pattern, such as impulsivity, instability, affective lability or explosive behaviour, so a diagnosis should be assigned only when the symptoms exceed what is normative for the sociocultural context (WHO, 2024).

The difference from bipolar disorder is the episode. ICD-11 says that people with a personality disorder may show impulsivity or mood instability, but personality disorder does not include depressive, hypomanic, manic or mixed episodes; since the two diagnoses co-occur relatively often, symptoms of personality disorder should be assessed outside a mood episode (WHO, 2024). NIMH likewise explains that the symptoms of borderline personality disorder occur in the absence of the significantly elevated mood seen in manic or hypomanic episodes, and that if impulsive behaviours such as spending sprees, unsafe sex or substance use happen mostly during times of elevated mood or energy, they may be symptoms of a mood disorder instead (NIMH, 2025). The timescale differs too: the dysphoric states of the borderline pattern typically last a few hours and at most several days (WHO, 2024). A review of how the two diagnoses overlap found that across studies approximately 10% of people with borderline personality disorder had bipolar I disorder and another 10% had bipolar II, while approximately 20% of people with bipolar II and 10% with bipolar I were diagnosed with borderline personality disorder. The overlap is substantial, but in the vast majority of cases (80% to 90%) each disorder is diagnosed without the other, and the authors concluded that this challenges the idea that borderline personality disorder is part of a bipolar spectrum (Zimmerman & Morgan, 2013). A meta-analysis of 42 papers put the share of people with bipolar disorder who also had borderline personality disorder at 21.6% among 5,273 people (37.7% in bipolar II, 6 studies), and its authors read the evidence as pointing to differences rather than similarities between the two (Fornaro et al., 2016). Bipolar disorder itself is covered in the bipolar disorder guide.

Adult ADHD overlaps as well. ICD-11 notes that when ADHD persists into adolescence and adulthood it may be difficult to distinguish from personality disorder with prominent disinhibition, which includes irresponsibility, impulsivity, distractibility and recklessness, or prominent negative affectivity, which includes anxiety, anger, self-loathing and irritability (WHO, 2024). According to a review, impulsivity is a feature of both disorders, but in borderline personality disorder it is stress-dependent and people have more trouble using context cues to inhibit responses, whereas in ADHD motor impulsivity is greater, so stopping an ongoing response is harder; emotion regulation difficulties run from ADHD to borderline personality disorder to the combination, which is most affected (Ditrich et al., 2021). Another review draws the same picture: adult ADHD shows more severe trait impulsivity, borderline personality disorder more severe trait emotion dysregulation, and people with both are severe on both dimensions (Weiner et al., 2019). Complex PTSD differs in these ways. ICD-11 says that many people with personality disorder have a history of trauma, particularly in childhood, and that affect dysregulation can be a feature of both, but avoidance of trauma reminders and a heightened sense of current threat are not diagnostic features of personality disorder; relationships in complex PTSD are marked by avoidance and a general sense of disconnection rather than fear of abandonment and instability; and people with complex PTSD tend to have a stable but persistently negative self-view, whereas in personality disorder an unstable sense of self is more common (WHO, 2024). An analysis of symptom patterns among 280 women with histories of childhood abuse found distinct groups matching PTSD, complex PTSD and borderline personality disorder, and four features greatly raised the odds of being in the borderline rather than the complex PTSD group: frantic efforts to avoid abandonment, an unstable sense of self, unstable and intense relationships, and impulsiveness (Cloitre et al., 2014). A review concluded that although the two overlap substantially, it is unwarranted to treat complex PTSD either as a replacement for borderline personality disorder or as a subtype of it (Ford & Courtois, 2014). Trauma is covered in the trauma and PTSD guide, adult ADHD in the adult ADHD guide, and narcissism, another personality-disorder topic, in the narcissism guide.

Estimates vary a great deal with the survey method. In a US national survey (NESARC) that interviewed 34,653 adults in 2004–2005, lifetime prevalence was 5.9%, with no difference between men (5.6%) and women (6.2%) (Grant et al., 2008). When the same data were reanalysed so that each criterion counted only if it came with significant distress or impairment, the figure fell to 2.7% (in the same table, a British survey gave 0.7% and another US survey 1.4%), and personality disorder as a whole fell from 21.5% to 9.1%, closer to other recent surveys; in that reanalysis women were somewhat more often affected than men (Trull et al., 2010). A review of community studies puts the median point prevalence at roughly 1%, with 10% to 12% in psychiatric outpatient clinics and 20% to 22% among inpatients (Ellison et al., 2018), and a recent comprehensive review gives a lifetime prevalence of 0.7 to 2.7% in the general adult population (Leichsenring et al., 2024). ICD-11 states that the gender distribution of personality disorder overall is approximately equal, while elevations on negative affectivity are more common among women (WHO, 2024).

Korea has no population estimate that we could find. The item list of the 2021 national mental health survey contains no personality disorder module (NCMH, n.d.). There is, however, a study of national health insurance records: between 2010 and 2019 the number of people treated with borderline personality disorder (F60.3) as a primary or secondary diagnosis rose from 3,756 to 4,538, or from 0.96 to 1.06 per 10,000 people; the rate among men stayed almost unchanged (0.81 to 0.80) while the rate among women rose from 1.12 to 1.32, and people in their 20s were the largest group (Shin et al., 2023). These are counts of people who received treatment, and the authors noted that only people who actually used medical services were included and that diagnostic accuracy could not be ascertained. Whether this figure, far below estimates from other countries, means the disorder is rarer or that many people go undiagnosed and untreated cannot be told from these data.

The course is far more hopeful than the common assumption. In a US collaborative study that followed treatment-seeking 18- to 45-year-olds for 10 years, 85% of the 175 people with borderline personality disorder reached a remission lasting 12 months or more (91% on a 2-month definition), and relapse after remission was only 11% on the 12-month definition (21% on the 2-month one). Social functioning improved more slowly: the mean functioning score (GAF) rose only from 53 to 57, and by 10 years just 21% had reached good functioning (GAF above 70), fewer than with other personality disorders (48%) or depression (61%). The authors noted that these remissions occurred in the absence of sustained or disorder-specific treatment (Gunderson et al., 2011). In the McLean study, which reassessed 290 former inpatients every 2 years for 16 years, 99% reached a symptomatic remission lasting 2 years or more and 78% one lasting 8 years or more; recurrence followed 36% of 2-year remissions and 10% of 8-year remissions. “Recovery”, meaning remission plus good social and vocational functioning, was reached by 60% for 2 years and 40% for 8 years, and was lost after 44% of 2-year recoveries and 20% of 8-year recoveries (Zanarini et al., 2012). ICD-11 likewise says personality disorder is relatively stable after young adulthood but may change so that a person no longer meets the requirements by middle age (WHO, 2024). The risk of suicide should be stated plainly. In a study that followed 64 former inpatients for a mean of 27 years, most had improved so much that only five still met the criteria, but 10.3% of the original cohort had died by suicide (Paris & Zweig-Frank, 2001). Over 24 years of the McLean study, 5.9% of the 290 people with borderline personality disorder died by suicide, more than in the comparison group with other personality disorders (1.4%), and those who had not reached recovery were at especially high risk of early death (Temes et al., 2019). Seen the other way, most did not die by suicide and most got better, and treatment, as the section below shows, reduces suicide attempts. If you have thoughts of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

A review of the stigma of personality disorders concludes that public knowledge is low, that people with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness, and that stigma among health providers seems particularly pernicious for borderline personality disorder (Sheehan et al., 2016). Another review notes that the disorder is often viewed negatively by mental health practitioners and the public, that its stigma may go beyond that of other mental illnesses, and that some clinicians emotionally distance themselves; people unusually sensitive to rejection and abandonment may react to that distancing by harming themselves or withdrawing from treatment, and those reactions feed the stigma in turn, a cycle the authors call a self-fulfilling prophecy (Aviram et al., 2006). Calling a person by the diagnosis, or pinning “borderline” on someone after a fight, is the same stigma in everyday form. A diagnosis is a clinician’s; a label explains nothing.

The stigma is unfair because the data point the other way. As shown above, 85% reached symptomatic remission within 10 years and 99% within 16 (remissions of 12 months and 2 years respectively; Gunderson et al., 2011; Zanarini et al., 2012), and several psychotherapies have evidence. The Lancet review says the condition “was previously regarded as untreatable”, but progress in understanding and management has brought earlier diagnosis and better treatment outcomes (Bohus et al., 2021). Nor is the cause a bad character. ICD-11 explains that personality disorder tends to arise when a person’s life experiences provide inadequate support for typical personality development given their temperament (WHO, 2024), and there is convincing evidence that the interaction between genetic factors and adverse childhood experiences plays a central role (Leichsenring et al., 2024). The UK NICE guideline states that people with the disorder “should not be excluded from any health or social care service because of their diagnosis or because they have self-harmed”, asks clinicians to explore treatment options “in an atmosphere of hope and optimism, explaining that recovery is possible and attainable”, and reminds them that many will have experienced rejection, abuse and trauma, and the stigma that often goes with self-harm and this diagnosis (NICE, 2009).

The idea that it is a “women’s disorder” also rests on little. In the US national survey, prevalence did not differ between men and women (Grant et al., 2008); in the stricter reanalysis women were somewhat more often affected (Trull et al., 2010); and ICD-11 states that the gender distribution of personality disorder overall is approximately equal (WHO, 2024). The higher share of women in Korean treatment records (Shin et al., 2023) describes who was treated, not the disorder itself. Evidence on reducing stigma is still thin, but limited evidence suggests that training for health providers can improve attitudes and that interventions combining positive messages about recovery potential with biological causes will be most effective (Sheehan et al., 2016). That is also why this guide puts the course and the treatment evidence up front.

The first-line treatment for borderline personality disorder is psychotherapy (NIMH, 2025; Leichsenring et al., 2024). In a Cochrane review of 75 randomised trials (4,507 participants, predominantly women, mean ages 14.8 to 45.7), psychotherapy tailored to the disorder reduced symptom severity more than treatment as usual (SMD −0.52; 22 trials, 1,244 participants), with moderate-certainty evidence and a clinically relevant size. Self-harm (SMD −0.32; 13 trials, 616 participants), suicide-related outcomes (SMD −0.34; 13 trials, 666 participants) and psychosocial functioning (SMD −0.45; 22 trials, 1,314 participants) also improved, but for these three the evidence was of low certainty and the differences did not reach the pre-defined minimal clinically relevant size. A subgroup analysis by type of therapy found no clear evidence of a difference for severity or functioning (Storebø et al., 2020). Another meta-analysis of 33 trials in adults (2,256 participants) found effects on borderline-relevant outcomes (symptoms, self-harm and suicide) at the end of treatment of g = 0.32 in stand-alone designs and g = 0.40 in add-on designs, and g = 0.45 at follow-up (13 trials). Dialectical behaviour therapy (g = 0.34) and psychodynamic approaches (g = 0.41) were the only types more effective than control interventions, and the authors concluded that the effects are small, inflated by risk of bias and publication bias, and particularly unstable at follow-up (Cristea et al., 2017). A comprehensive review gives effect sizes of 0.50 to 0.65 for core symptom severity against treatment as usual, while noting that almost half of patients do not respond sufficiently and that no approach has proved superior to the others (Leichsenring et al., 2024). So neither “treatment cures it” nor “treatment is pointless” fits the evidence.

A few treatments have accumulated evidence. Dialectical behaviour therapy (DBT) was developed specifically for this disorder; it uses mindfulness and awareness of one’s present emotional state and teaches skills to handle intense emotions, reduce self-destructive behaviour and improve relationships (NIMH, 2025). In a trial that randomised 101 women with recent suicidal and self-injurious behaviour to one year of DBT or one year of community treatment by experts and followed them for a further year, the DBT group was half as likely to make a suicide attempt, needed less hospitalisation for suicidal ideation and dropped out less (Linehan et al., 2006). In the Cochrane review DBT accounted for one third of all trials and did better than treatment as usual on severity (SMD −0.60; 3 trials, 149 participants), self-harm (SMD −0.28; 7 trials, 376 participants) and functioning (SMD −0.36; 6 trials, 225 participants), all low-certainty evidence. Mentalisation-based treatment (MBT) had 7 trials and reduced self-harm (RR 0.62; 3 trials, 252 participants) and suicidality (RR 0.10; 3 trials, 218 participants) compared with treatment as usual, again with low certainty (Storebø et al., 2020). One MBT trial makes an important point: 134 patients were randomised to 18 months of outpatient MBT or “structured clinical management”, both groups improved substantially on every outcome, and the MBT group’s problems, including suicide attempts and hospitalisation, fell more steeply. The authors concluded that structured treatments improve outcomes and that a focus on specific psychological processes adds to that (Bateman & Fonagy, 2009). Schema therapy and transference-focused psychotherapy also have support from randomised trials, but no approach has proved superior (Leichsenring et al., 2024). The NICE guideline says psychological treatment should come with an explicit and integrated theoretical approach shared by team and therapist, structured care and supervision, that twice-weekly sessions may be considered, and that brief psychological interventions of less than 3 months should not be used specifically for the disorder outside such a service; for women for whom reducing recurrent self-harm is a priority, it recommends considering a comprehensive DBT programme (NICE, 2009). In Korea, a systematic review has examined the evidence for DBT and its dissemination (Choi, 2018), but we found no official list of where it is available: ask a psychiatric clinic or counselling service directly whether it runs DBT or another structured programme.

Medicines do not treat the disorder itself. The NICE guideline says drug treatment should not be used specifically for borderline personality disorder or for its individual symptoms, such as repeated self-harm, marked emotional instability, risk-taking or transient psychotic symptoms, that antipsychotics should not be used for medium- or long-term treatment, and that drugs may be considered within the overall treatment of co-occurring conditions. Short-term sedative medication in a crisis may be considered cautiously for no longer than 1 week, with a plan to stop it usually within 1 week after the crisis, and people without a co-occurring diagnosis who are being prescribed drugs should have them reviewed with the aim of reducing and stopping unnecessary treatment (NICE, 2009). A Cochrane review of 46 randomised trials (2,769 participants) found that, compared with placebo, no medication showed a difference at the end of treatment on any primary outcome, namely symptom severity, self-harm, suicide-related outcomes and functioning, mostly with very-low-certainty evidence, and its authors concluded that this supports the understanding that no pharmacological therapy seems effective in specifically treating the disorder (Stoffers-Winterling et al., 2022). NIMH likewise says the benefits of medication are unclear and it is not a first-line treatment, but that a provider may in some cases recommend it alongside psychotherapy for specific symptoms or co-occurring conditions such as depression (NIMH, 2025). This guide names no drugs. Medicines are used only on prescription, and if you are already taking one, do not stop it suddenly on your own: talk to the prescriber first. Treatment when depression is also present is covered in depression: what helps.

If a family member, partner or friend has been diagnosed with borderline personality disorder, there are things you can do. NIMH suggests learning about the disorder to understand what your loved one is experiencing; remembering that change can be difficult and frightening but that things can improve with time; and offering emotional support, validation, understanding, patience and encouragement. It advises encouraging them to ask about family therapy, making sure co-occurring conditions are treated, helping them take medicines as prescribed and encouraging them to talk to their provider before stopping or changing one, learning their treatment plan and supporting its goals, and encouraging structure through daily routines and a healthy lifestyle. Take any comment about self-harm or suicide seriously and encourage prompt contact with a professional or a crisis line, and seek counselling for yourself, with a different therapist from theirs. Caregivers may unintentionally act in ways that worsen symptoms, so therapy for caregivers and family members is often helpful, although NIMH also notes that more research is needed on how much family therapy helps with this disorder (NIMH, 2025). The NICE guideline asks clinicians to ask the person directly whether they want family or carers involved, to encourage that involvement with the person’s consent, and to tell families about local support groups where they exist (NICE, 2009). There is also evidence for family education: 44 relatives from 34 families who took part in Family Connections, a 12-week DBT-based programme led by trained family members, reported less grief and burden and more mastery after the programme, and the changes held at 6 months, though this was a before-and-after study without a control group (Hoffman et al., 2005). You cannot do the treatment for someone, and protecting your own limits and safety is part of caring.

When should you get help yourself? NIMH advises talking to a primary care provider if you have concerns about your mental health; they can refer you to a psychologist, psychiatrist or clinical social worker (NIMH, 2025). Outside Korea, start with a family doctor or your local mental health services. If instability in your emotions, self-image and relationships, together with impulsive actions, has gone on for a long time across situations and is getting in the way of your life, that is reason enough to seek an assessment. In Korea, you can get help from a psychiatrist or your city, county or district mental health welfare centre, and the mental health crisis line 1577-0199 (24 hours) connects you to a nearby centre (Ministry of Health and Welfare, 2025). The conditions for the 2026 counselling voucher are in depression: what helps. mind.io does not offer a borderline personality disorder test; the depression check-in (PHQ-9) looks at depressive symptoms but cannot identify this disorder. The attachment style test shows how you draw close and pull away in relationships and the self-compassion test how you treat yourself, but neither is a diagnostic tool. The NICE guideline says a care plan should include a crisis plan: the triggers that could lead to a crisis, the self-management strategies likely to help, and how to reach services, including a list of numbers, when those strategies are not enough (NICE, 2009).

In a crisis, do this. Anyone thinking of harming themselves or attempting suicide needs help right away (NIMH, 2025). If you have thoughts of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you have injured yourself or are in immediate danger, contact your local emergency services. If you are the person alongside, the attitude the NICE guideline asks of clinicians in a crisis is a useful guide: keep a calm and non-threatening attitude, try to understand the crisis from the person’s point of view, ask about their reasons for distress, avoid minimising the reasons they give, and refrain from offering solutions before the problems are fully clear (NICE, 2009). Do not dismiss talk of self-harm or suicide as attention-seeking: as shown above, the risk of self-harm and suicide in this disorder is real (NIMH, 2025).

Q. Is there a borderline personality disorder test? A. mind.io does not offer a borderline personality disorder test. The diagnosis is made by a licensed mental health professional after a thorough discussion of symptoms and personal and family history (NIMH, 2025), and there is evidence that it can be made reliably with semi-structured interviews (Leichsenring et al., 2024). The result of an online checklist is not a diagnosis, and no test exists for judging someone else. The depression check-in (PHQ-9) looks at depressive symptoms over the past 2 weeks, the attachment style test at how you draw close and pull away in relationships, and the self-compassion test at how you treat yourself, but none of the three is a test for this disorder.

Q. How is it different from bipolar disorder? A. Bipolar disorder has manic, hypomanic and depressive episodes, and personality disorder does not include such episodes (WHO, 2024). The mood shifts of the borderline pattern typically last a few hours, at most several days, and occur without the clearly elevated mood of mania or hypomania (WHO, 2024; NIMH, 2025). The two can co-occur: in a review, approximately 10% of people with borderline personality disorder had bipolar I and another 10% bipolar II, but in the vast majority (80% to 90%) only one was diagnosed (Zimmerman & Morgan, 2013). A clinician makes the distinction by assessing outside a mood episode. See the bipolar disorder guide for details.

Q. Is it for life? A. Much more often it is not. Over 10 years, 85% reached a remission lasting 12 months or more and relapse after remission was 11% (Gunderson et al., 2011). Over 16 years, 99% reached a symptomatic remission lasting 2 years or more and 78% one lasting 8 years or more. Recovery that also includes good social and vocational functioning was slower and less common, at 60% for 2 years and 40% for 8 years (Zanarini et al., 2012). Symptoms can settle a great deal while regaining everyday functioning takes longer, which is why treatment addresses work and relationships as well as symptoms.

Q. Can it be treated with medication? A. No medicine treats the disorder itself. The UK NICE guideline says drugs should not be used specifically for borderline personality disorder or its individual symptoms (NICE, 2009), and a Cochrane review of 46 randomised trials found no difference from placebo on any primary outcome for any medication (Stoffers-Winterling et al., 2022). When a co-occurring condition such as depression is present, medicines can be part of treating it (NICE, 2009; NIMH, 2025). Medicines are used only on prescription, and if you already take one, do not stop it suddenly: talk to the prescriber first.

Q. Does it only affect women? A. No. In the US national survey, prevalence did not differ between men (5.6%) and women (6.2%) (Grant et al., 2008), and in a stricter reanalysis women were somewhat more often affected (Trull et al., 2010). ICD-11 states that the gender distribution of personality disorder overall is approximately equal (WHO, 2024). The higher share of women in Korean treatment records describes who was treated (Shin et al., 2023).

Q. I think my partner or a family member has borderline personality disorder. What should I do? A. First, that judgement belongs to a clinician. Instead of a label, talk about specific behaviours and how they affect the two of you. If the person has been diagnosed, follow NIMH’s advice: learn about the disorder, offer validation and patience, support the treatment plan, take any comment about self-harm or suicide seriously, and get counselling for yourself (NIMH, 2025). A before-and-after study found that a family education programme reduced carers’ burden (Hoffman et al., 2005). If the person says they will harm themselves, contact a crisis line together: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere; if they have injured themselves or are in immediate danger, contact your local emergency services. If there is violence or threats in the relationship, that is a safety matter rather than a caring one. In immediate danger, call your local emergency number; in the US the National Domestic Violence Hotline is 1-800-799-7233 and in the UK the National Domestic Abuse Helpline is 0808 2000 247. For the patterns you yourself repeat in relationships, the anxious attachment guide and the self-compassion guide may also help.

Q. It’s so hard I’m having thoughts of harming myself. A. Please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you have injured yourself or are in immediate danger, contact your local emergency services. As shown above, such thoughts are not rare in this disorder, treatment reduces suicide attempts (Linehan et al., 2006), and most people get better over time (Gunderson et al., 2011).

References: World Health Organization (2024), Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders, Geneva, https://iris.who.int/handle/10665/375767; National Institute of Mental Health (2025), Borderline personality disorder [brochure, revised 2025], https://www.nimh.nih.gov/health/publications/borderline-personality-disorder; National Institute for Health and Care Excellence (2009), Borderline personality disorder: recognition and management, Clinical guideline CG78, https://www.nice.org.uk/guidance/cg78; Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024), Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies, World Psychiatry 23(1), 4-25, https://doi.org/10.1002/wps.21156; Bohus, M., Stoffers-Winterling, J., Sharp, C., Krause-Utz, A., Schmahl, C., & Lieb, K. (2021), Borderline personality disorder, The Lancet 398(10310), 1528-1540, https://doi.org/10.1016/s0140-6736(21)00476-1; Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M., Dawson, D. A., Pulay, A. J., Pickering, R. P., & Ruan, W. J. (2008), Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, Journal of Clinical Psychiatry 69(4), 533-545, https://doi.org/10.4088/jcp.v69n0404; Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010), Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders, Journal of Personality Disorders 24(4), 412-426, https://doi.org/10.1521/pedi.2010.24.4.412; Ellison, W. D., Rosenstein, L. K., Morgan, T. A., & Zimmerman, M. (2018), Community and clinical epidemiology of borderline personality disorder, Psychiatric Clinics of North America 41(4), 561-573, https://doi.org/10.1016/j.psc.2018.07.008; Shin, H., Lee, H. S., Lee, B. C., Park, G., Uranbileg, K., Park, Y., Yun, M., & Seok, J. H. (2023), The prevalence and clinical characteristics of borderline personality disorder in South Korea using National Health Insurance Service customized database, Yonsei Medical Journal 64(9), 566-572, https://doi.org/10.3349/ymj.2023.0071; National Center for Mental Health (n.d.), National Mental Health Survey of Korea (adults): 2021 survey overview and items [in Korean], Mental Health Research Institute, https://mhs.ncmh.go.kr/menu.es?mid=a10206000000; Gunderson, J. G., Stout, R. L., McGlashan, T. H., Shea, M. T., Morey, L. C., Grilo, C. M., Zanarini, M. C., Yen, S., Markowitz, J. C., Sanislow, C., Ansell, E., Pinto, A., & Skodol, A. E. (2011), Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study, Archives of General Psychiatry 68(8), 827-837, https://doi.org/10.1001/archgenpsychiatry.2011.37; Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2012), Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study, American Journal of Psychiatry 169(5), 476-483, https://doi.org/10.1176/appi.ajp.2011.11101550; Paris, J., & Zweig-Frank, H. (2001), A 27-year follow-up of patients with borderline personality disorder, Comprehensive Psychiatry 42(6), 482-487, https://doi.org/10.1053/comp.2001.26271; Temes, C. M., Frankenburg, F. R., Fitzmaurice, G. M., & Zanarini, M. C. (2019), Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up, Journal of Clinical Psychiatry 80(1), 18m12436, https://doi.org/10.4088/jcp.18m12436; Zimmerman, M., & Morgan, T. A. (2013), The relationship between borderline personality disorder and bipolar disorder, Dialogues in Clinical Neuroscience 15(2), 155-169, https://doi.org/10.31887/DCNS.2013.15.2/mzimmerman; Fornaro, M., Orsolini, L., Marini, S., De Berardis, D., Perna, G., Valchera, A., Ganança, L., Solmi, M., Veronese, N., & Stubbs, B. (2016), The prevalence and predictors of bipolar and borderline personality disorders comorbidity: systematic review and meta-analysis, Journal of Affective Disorders 195, 105-118, https://doi.org/10.1016/j.jad.2016.01.040; Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014), Distinguishing PTSD, complex PTSD, and borderline personality disorder: a latent class analysis, European Journal of Psychotraumatology 5, 25097, https://doi.org/10.3402/ejpt.v5.25097; Ford, J. D., & Courtois, C. A. (2014), Complex PTSD, affect dysregulation, and borderline personality disorder, Borderline Personality Disorder and Emotion Dysregulation 1, 9, https://doi.org/10.1186/2051-6673-1-9; Ditrich, I., Philipsen, A., & Matthies, S. (2021), Borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited: a review-update on common grounds and subtle distinctions, Borderline Personality Disorder and Emotion Dysregulation 8, 22, https://doi.org/10.1186/s40479-021-00162-w; Weiner, L., Perroud, N., & Weibel, S. (2019), Attention deficit hyperactivity disorder and borderline personality disorder in adults: a review of their links and risks, Neuropsychiatric Disease and Treatment 15, 3115-3129, https://doi.org/10.2147/ndt.s192871; Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020), Psychological therapies for people with borderline personality disorder, Cochrane Database of Systematic Reviews 5, CD012955, https://doi.org/10.1002/14651858.cd012955.pub2; Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C., & Cuijpers, P. (2017), Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis, JAMA Psychiatry 74(4), 319-328, https://doi.org/10.1001/jamapsychiatry.2016.4287; Stoffers-Winterling, J. M., Storebø, O. J., Pereira Ribeiro, J., Kongerslev, M. T., Völlm, B. A., Mattivi, J. T., Faltinsen, E., Todorovac, A., Jørgensen, M. S., Callesen, H. E., Sales, C. P., Schaug, J. P., Simonsen, E., & Lieb, K. (2022), Pharmacological interventions for people with borderline personality disorder, Cochrane Database of Systematic Reviews 11, CD012956, https://doi.org/10.1002/14651858.cd012956.pub2; Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006), Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder, Archives of General Psychiatry 63(7), 757-766, https://doi.org/10.1001/archpsyc.63.7.757; Bateman, A., & Fonagy, P. (2009), Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder, American Journal of Psychiatry 166(12), 1355-1364, https://doi.org/10.1176/appi.ajp.2009.09040539; Choi, H. (2018), Evidence for dialectical behavior therapy and dissemination in Korea: a systematic review [in Korean], Korean Journal of Clinical Psychology 37(3), 443-463, https://doi.org/10.15842/kjcp.2018.37.3.013; Hoffman, P. D., Fruzzetti, A. E., Buteau, E., Neiditch, E. R., Penney, D., Bruce, M. L., Hellman, F., & Struening, E. (2005), Family Connections: a program for relatives of persons with borderline personality disorder, Family Process 44(2), 217-225, https://doi.org/10.1111/j.1545-5300.2005.00055.x; Sheehan, L., Nieweglowski, K., & Corrigan, P. (2016), The stigma of personality disorders, Current Psychiatry Reports 18(1), 11, https://doi.org/10.1007/s11920-015-0654-1; Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006), Borderline personality disorder, stigma, and treatment implications, Harvard Review of Psychiatry 14(5), 249-256, https://doi.org/10.1080/10673220600975121; Ministry of Health and Welfare (2025), Community mental health welfare centres and the mental health crisis line [in Korean], https://www.mohw.go.kr/menu.es?mid=a10706040100