Understanding Borderline Personality Disorder

Borderline personality disorder (BPD) is a complex condition characterized by pervasive patterns of instability in relationships, self-image, emotions, and behavior. Research indicates that BPD involves dysregulation in multiple systems: emotional regulation circuits (amygdala, prefrontal cortex), stress response systems (HPA axis), attachment systems, and identity formation processes. People with BPD often experience intense emotional reactions, difficulty regulating emotions, fear of abandonment, unstable relationships, and a sense of identity disturbance.

When I evaluate patients with BPD, I'm assessing multiple systems: emotional regulation patterns, relationship dynamics, identity development, trauma history, attachment patterns, and co-occurring conditions. BPD symptoms typically include: intense fear of abandonment, unstable and intense relationships, identity disturbance, impulsivity, recurrent suicidal behavior or self-harm, emotional instability, chronic feelings of emptiness, intense anger, and transient stress-related paranoid thoughts or dissociation.

These symptoms cause significant distress and impairment in functioning. BPD affects approximately 1.4% of U.S. adults, according to the National Institute of Mental Health. It's often associated with a history of trauma, particularly in childhood, and frequently co-occurs with other mental health conditions such as depression, anxiety, PTSD, and substance use disorders.

An Integrative Approach to BPD Treatment

Effective BPD treatment requires a comprehensive approach addressing emotional dysregulation, relationship patterns, identity issues, and underlying trauma. Research indicates that BPD involves dysregulation in emotional processing circuits (amygdala hyperreactivity, prefrontal cortex underactivation), stress response systems (HPA axis dysregulation), and attachment systems. Psychotherapy is the primary treatment, but medication can help manage specific symptoms such as mood instability, impulsivity, or co-occurring depression or anxiety.

When I work with patients with BPD, I'm addressing these systems comprehensively. My approach includes:

Comprehensive Evaluation: Thorough assessment of symptoms, relationship patterns, emotional regulation, trauma history, and co-occurring conditions
Dialectical Behavior Therapy (DBT) Principles: Integration of DBT skills including mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness
Medication Management: When indicated, medications may help manage specific symptoms such as mood instability, impulsivity, or co-occurring depression or anxiety
Trauma-Informed Psychotherapy: Addressing underlying trauma and attachment patterns that may contribute to BPD symptoms
Emotion Regulation Support: Developing skills to recognize, understand, and manage intense emotions
Relationship Skills: Building skills for healthier relationships, including boundary-setting and communication
Identity Work: Supporting development of a more stable sense of self and values
Crisis Management: Developing strategies to manage crises, reduce self-harm, and prevent suicide

BPD treatment is typically long-term, requiring consistent engagement and a strong therapeutic relationship. With appropriate treatment, many people with BPD experience significant improvement in symptoms and functioning.

Emotional Dysregulation and Relationships

Emotional dysregulation is central to BPD—intense, rapidly shifting emotions that are difficult to manage. This can lead to:

Intense emotional reactions that seem disproportionate to the situation
Difficulty returning to baseline after emotional arousal
Impulsive behaviors in response to intense emotions
Relationship difficulties due to emotional intensity and fear of abandonment
Self-harm or suicidal behavior as ways to manage overwhelming emotions

Treatment focuses on developing skills to recognize emotions early, understand their function, and respond to them in healthier ways. This includes mindfulness practices, distress tolerance techniques, and emotion regulation strategies. The therapeutic relationship itself provides a context for practicing these skills and experiencing a stable, consistent relationship. BPD often co-occurs with depression, anxiety, PTSD, and substance use disorders, which may require integrated treatment approaches. Learn more about how psychiatrists safely combine psychotherapy and medication.

What to Expect in Treatment

Your initial evaluation is comprehensive—typically 90 minutes—allowing time to understand your symptoms, relationship patterns, emotional regulation, and treatment goals. We develop a collaborative treatment plan focused on building skills, managing symptoms, and improving functioning.

Treatment typically involves regular psychotherapy sessions focusing on emotion regulation, relationship skills, and addressing underlying trauma. Medication may be used to manage specific symptoms or co-occurring conditions. Treatment is long-term, requiring consistent engagement and a commitment to practicing skills between sessions.

The goal is not just symptom reduction—it's developing skills for emotional regulation, building healthier relationships, developing a more stable sense of self, and creating a life that feels meaningful and manageable. With appropriate treatment, many people with BPD experience significant improvement and go on to lead fulfilling lives.

Serving Los Angeles Area

I provide BPD treatment to patients throughout Los Angeles County, including Hollywood, Beverly Hills, Santa Monica, West Hollywood, Burbank, Glendale, Pasadena, and surrounding areas. The practice is located in Hollywood and offers both in-person and telepsychiatry visits for adults throughout California.

If you're experiencing symptoms of BPD or have been diagnosed with BPD, know that effective treatment is available. BPD is a treatable condition, and many people experience significant improvement with appropriate, consistent care.

References & Resources

For additional information about BPD, I recommend these authoritative sources:

BPD often co-occurs with other conditions. If you're experiencing co-occurring conditions, see our pages on depression treatment, anxiety treatment, PTSD treatment, or addiction treatment.

Contact us to schedule a consultation or learn more about our approach to BPD treatment.