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Borderline personality disorder: understanding symptoms and choosing treatment

Alanoud AlturkiMedical review: Tatmeen team9 min read
دفتر مفتوح عليه وجوه تعبّر عن مشاعر مختلفة، وبجانبه قلم ورأس من قصاصات ورقية.
Article contents
  1. What can the difficulties look like in an ordinary day?
  2. Assessment: understanding patterns and their effect on your life
  3. Where do these difficulties come from?
  4. Treatment starts with a clear plan
  5. A first step towards help
  6. Frequently Asked Questions
  7. Sources and references
  8. Writer and reviewer

Borderline personality disorder (BPD) affects the way a person manages emotions. It can also affect their sense of self1, relationships and daily life. Feelings may change quickly, and calming down after a painful experience can take time and effort. Treatment can help reduce these difficulties2 and improve daily life.

Whether you are trying to understand a diagnosis or make sense of recurring difficulties, start with what happens in your life and what you want to change. A professional assessment can help you understand those experiences and choose care that fits your needs. You do not have to settle on a diagnosis before asking for help.

If you are afraid you may hurt yourself now, have already harmed yourself, or have taken something that could harm you, call an ambulance on 997 in Saudi Arabia. Ask someone you trust to stay with you until help arrives5. After taking a harmful substance, do not wait for symptoms6 and do not drive yourself. Outside Saudi Arabia, call your local emergency number.

What can the difficulties look like in an ordinary day?

A person may feel intense distress when they believe someone close to them will leave. Their feelings about a relationship may shift from reassurance to doubt, or their sense of who they are may change frequently. Some people experience harmful impulses, recurring emptiness, or anger that is difficult to manage. Under stress, some may feel disconnected from themselves or their surroundings. People do not all have the same experiences, and their severity and frequency vary1.

For example, a delayed reply to a message might leave someone preoccupied with the fear that the other person will leave. That fear may persist even after they learn why the reply was late, making it hard to get back to work or carry on with the day. This illustrates an experience; it does not establish a diagnosis. Anger, sensitivity or a difficult relationship conflict is not enough on its own to label someone as having BPD.

Recurring difficulties that affect work, study or relationships are reason enough to seek help, whatever the eventual diagnosis.

Assessment: understanding patterns and their effect on your life

A clinician asks what led you to seek help, when the difficulties began and whether they occur across different relationships or situations. They also discuss your health1, previous treatments, safety and what you want to improve. These details help them understand the pattern over time3. An online quiz or the opinion of someone close to you cannot settle the diagnosis.

Some experiences overlap with depression, post-traumatic stress disorder or other conditions, and more than one condition can occur together. BPD and bipolar disorder are different1 conditions. Tell the clinician about any periods when your sleep or energy changed noticeably. Understanding when symptoms occur and how they develop matters more than trying to distinguish the conditions with a short checklist.

If you have received a diagnosis you do not understand, you can ask: “What supports this diagnosis in my case? Are there other possibilities? How does it change my care plan?” A second professional opinion is an option if important questions remain unanswered.

Notes to bring to an appointment

You do not need to write your whole life story. A few notes about specific situations can help when things are difficult to explain:

What you want to explain An example of a useful note
The difficulty you want help with “After an argument I keep thinking about it for hours, and I struggle to get my work done the next day.”
When it began and how it has developed When did you notice it? Does it occur in more than one situation or relationship?
What you have tried Current treatments and medications, and what helped or caused problems.
Safety Any thoughts of self-harm or harm that has already happened, even if discussing it feels uncomfortable.
What you want from treatment “I want to pause before acting when angry,” or “I want to return to my studies.”

These notes help you talk about your experience. Do not wait for a scheduled appointment if you are afraid you may hurt yourself. Seek urgent help.

Where do these difficulties come from?

There is no single known cause that explains every case. Genetic, biological, environmental and social factors1 may interact. Some people have had harmful experiences, but those experiences do not necessarily lead to BPD, and not having them does not rule it out. Blaming a mother or father alone, or looking for one event to explain everything, does not reflect that complexity.

Past experiences may matter in treatment. You can explore them while also addressing what disrupts your life now: recurring conflict, impulses that cause harm or difficulties that interfere with work or study.

Treatment starts with a clear plan

Structured psychotherapy is the foundation1 of care. Agree with your clinician on what you will work on and how you will track progress3, and ask about their training in the approach they use. A goal might be reducing harmful impulses or handling an argument without losing the next day of work or study.

Dialectical behavior therapy (DBT) is one approach. It teaches skills for managing intense emotions1, improving relationships and reducing harmful behavior. Other psychological approaches also have supporting evidence. Current guidance does not identify one therapy as the best choice3 for every person.

DBT combines acceptance of your current experience9 with work to change a response that causes harm. Returning to the delayed-message example, you can take your fear seriously and learn in therapy how to respond without harming yourself or the other person. Acceptance makes room to understand the feeling; change focuses on what you do when that feeling becomes intense.

Comprehensive DBT includes individual sessions8, skills training, coaching to apply skills between sessions, and regular consultation among therapists to support their work. A skills group alone is different from this programme. If you are offered a shorter or modified format, ask how it fits your needs and what ongoing care accompanies it. The format alone does not determine whether it is suitable for you.

Questions to help you choose a service

Different services may use the name DBT. Before you begin, ask what you will actually receive:

  • What goals will we start with, and how will we know the plan is helping me?
  • Is this comprehensive DBT, skills training, or therapy using some DBT approaches? What does it include?
  • What should I do between sessions if distress becomes intense, and whom do I contact in a crisis?
  • What options are available if cost or appointment times make continuing difficult?
  • What language is the training in? If there is a group, what will I be asked to share, and how is privacy protected?

Ask for clear contact hours, limits and an emergency plan. Coaching between sessions does not necessarily mean a therapist is available around the clock.

The role of medication

Medication is not the first-line treatment for BPD, and no medication has been shown to treat its core features. A doctor may prescribe medication for another condition1 or a specific target within a plan that includes psychotherapy3. Ask what it is intended to address and how benefits and harms will be reviewed. Do not start, stop or change a medication dose based on an article.

Look at progress in your daily life too

Improvement is possible and may take time and adjustments to the plan. When discussing progress with your clinician, talk about symptoms and everyday life. Has it become easier to continue studying? Do you regain your calm more readily after a disagreement? Where do you still need help?

Symptoms may ease while returning to work or building a stable relationship still needs support1. A US study distinguished symptom remission10 from recovery that also included work and relationships; participants began follow-up while receiving inpatient treatment. Those findings cannot predict your course, but they show why everyday functioning deserves attention alongside symptoms. No single treatment duration or success rate is a promise for everyone.

A first step towards help

In Saudi Arabia, you can start with a primary care doctor or a qualified mental health professional. For medical advice about the appropriate next step, 937 is available around the clock. Immediate danger requires ambulance help on 9974.

If you are reading for someone close to you, start by asking what they need rather than inferring a diagnosis. The guide to supporting someone with BPD explains everyday communication and responding to urgent danger.

Frequently Asked Questions

What is borderline personality disorder and what are its symptoms?

Borderline personality disorder (BPD) affects the way a person manages emotions, and can also affect their sense of self, relationships and daily life. A person may feel intense distress when they believe someone close to them will leave. Some people experience harmful impulses, recurring emptiness or anger that is difficult to manage, and under stress some may feel disconnected from themselves or their surroundings. People do not all have the same experiences.

What causes borderline personality disorder?

There is no single known cause that explains every case; genetic, biological, environmental and social factors may interact. Some people have had harmful experiences, but those experiences do not necessarily lead to BPD, and not having them does not rule it out. Blaming a mother or father alone, or looking for one event to explain everything, does not reflect that complexity. Past experiences may still matter in treatment.

How is borderline personality disorder diagnosed?

Through a professional assessment. A clinician asks what led you to seek help, when the difficulties began and whether they occur across different relationships or situations, and discusses your health, previous treatments and safety. An online quiz or the opinion of someone close to you cannot settle the diagnosis. BPD and bipolar disorder are different conditions, so tell the clinician about any periods when your sleep or energy changed noticeably.

What is the treatment for borderline personality disorder?

Structured psychotherapy is the foundation of care. Dialectical behavior therapy (DBT) is one approach: it teaches skills for managing intense emotions, improving relationships and reducing harmful behavior, and other psychological approaches also have supporting evidence. Medication is not the first-line treatment, and no medication has been shown to treat the core features, though a doctor may prescribe it for another condition. Improvement is possible and may take time and adjustments to the plan.

What should I do if I am afraid I may hurt myself?

If you are afraid you may hurt yourself now, have already harmed yourself, or have taken something that could harm you, call an ambulance on 997 in Saudi Arabia; do not wait for a scheduled appointment. Ask someone you trust to stay with you until help arrives. After taking a harmful substance, do not wait for symptoms and do not drive yourself. Outside Saudi Arabia, call your local emergency number.

Writing and article review

Alanoud AlturkiWritten byAlanoud Alturki

Content writer and researcher at Tatmeen, writing in Arabic and English on mental health and everyday life topics, including relationships, stress, work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

Every Tatmeen article is reviewed by care providers licensed by the Saudi Commission for Health Specialties, so what you read is accurate and trustworthy.

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