How to Diagnose Borderline Personality Disorder

How Is BPD Diagnosed?

Borderline personality disorder is diagnosed through a comprehensive evaluation, as there’s no single test for this complex mental health condition. The diagnostic process includes meeting specific criteria in the DSM-5 and undergoing a psychiatric evaluation. This multifaceted approach ensures a thorough understanding of the individual’s symptoms and experiences.

Understanding this process of diagnosing BPD is crucial for those seeking clarity and treatment for BPD. We’ll dive into the DSM-5 criteria for BPD, outlining the key symptoms and behaviors considered for diagnosis, followed by an overview of what to expect during a psychiatric evaluation.

DSM-5 BPD diagnosis criteria

There’s no specific test that can be done, and the process of getting a BPD diagnosis is multifaceted. It can involve a thorough assessment, interviews, psychological exams, personal screenings — and most importantly, meeting the BPD diagnosis criteria set forth by the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

The current DSM-5 criteria for a borderline personality disorder diagnosis states that someone must routinely experience at least 5 of the following symptoms:

• Consistent feelings of emptiness
• Persistent and unstable self-image
• Intensely unstable relationships
• Repetitive suicidal thoughts, threats, gestures, or behaviors
• Energetic effort to avoid abandonment (imaginary or real)
• Inappropriate, intense anger or difficulty controlling temperament
• Sudden mood swings and emotional instability that can last hours or days
• Severe dissociative symptoms and paranoid delusions related to temporary stressors
• At least 2 impulsive behaviors (for example: reckless driving, overeating, overspending, substance abuse, or sex)

It’s also important to be aware of the less obvious manifestation known as quiet BPD, where individuals internalize their struggles, often leading to misdiagnosis or delayed diagnosis. In quiet BPD, symptoms like intense emotional pain are turned inward, which can be just as debilitating but less visible to others.

Getting a borderline personality disorder diagnosis also includes getting a general psych evaluation from your mental health provider and going through the BDP assessment process as described below.

Psychiatric evaluation

A crucial step in diagnosing BPD is undergoing a comprehensive psychiatric evaluation. It’s vital to seek a mental health professional, such as a psychiatrist or therapist, who is well-versed in the complexities of BPD. Their expertise in recognizing and treating this disorder is key to an accurate diagnosis.

In the psychiatric evaluation for BPD, a mental health professional will conduct a thorough assessment, which goes beyond basic questionnaires and interviews. This evaluation delves into your personal history, emotional patterns, and behavioral responses, offering a nuanced understanding of your experiences. The clinician will also consider any past treatments or diagnoses to differentiate BPD from similar conditions.

This comprehensive approach not only aids in accurately diagnosing BPD but also in crafting a personalized treatment plan, making your active participation and honest communication vital to the process.

BPD Assessment Process

Need guidance through the process of diagnosing BPD? You can start with your primary physician to find a mental health professional you trust and would like to work with. Then, you’ll schedule an assessment and begin the process as follows:

1. Attend your initial consultation.
2. Schedule any follow-up sessions needed for a full assessment.
3. Provide detailed information about your symptoms, family life, living situation, and work history.
4. You may need to complete a short questionnaire or a lengthier psychological assessment.
5. A therapist may refer you to a specialist for a more thorough assessment.

Once your full BPD assessment is complete, you’ll receive a diagnosis. It may be for BPD, another mental health condition, multiple conditions, or no discernible condition whatsoever.

Let us reassure you: it’s normal to feel a little nervous at your first session, especially if you’ve never been in therapy before. Good therapists realize it’s not easy to open up about the details of your life. Even though it can be a difficult process, in order to get a borderline personality disorder diagnosis, try to be as honest and direct as possible during the assessment.

For those seeking convenience or facing barriers to in-person consultations, Talkspace offers online access to licensed therapists and psychiatric providers. Through Talkspace, you can connect with professionals to get a diagnosis for BPD from the comfort of your home, so you can start managing your mental health.

Remember how important it is to get help, collaborate with an experienced mental health professional, and find a therapist who uses evidence-based treatment options. BPD may not be entirely curable, but it is very treatable.

How to Receive a Borderline Personality Disorder Diagnosis through Talkspace

If you have reason to think you might have Borderline Personality Disorder (BPD), you can get answers without delay. With Talkspace it’s fast and convenient to connect with a mental health provider for an evaluation of your symptoms and, if appropriate, a diagnosis. 

Talkspace makes it affordable to receive diagnosis and treatment for mental health conditions including BPD, with online therapy and psychiatry plans that take insurance. Your insurer and health plan will determine the specifics of your coverage and copays, but covered members only pay a copay (usually $25 or less). Separately, many employers cover the cost of Talkspace so employees can receive our care for free. You may also choose to pay with pre-tax dollars using your FSA/HSA card or simply pay out-of-pocket at costs lower than those of most in-person mental health providers.

Here’s how it works:

1. Get started any time by answering a few questions on the Talkspace website or app. You don’t need a referral for either therapy or psychiatric care.
2. You’ll be connected with a therapist within about two days or a psychiatric provider within about a week. 
3. If you choose to start with therapy you can message with your therapist as much as you like and also schedule live sessions. If you choose psychiatry you’ll schedule a live video session with your psychiatric provider.

In some cases BPD is most effectively treated with a combination of medication and talk therapy. Online therapy helps you manage symptoms and develop coping skills, while online psychiatry addresses the physiological basis or your symptoms, usually with a prescription for medication and ongoing medication management.

What to Do if You Get Diagnosed with BPD

If you do receive a BPD diagnosis after your assessment, your therapist or other mental health provider will explain in detail the symptoms you’re experiencing and offer effective treatment options you should consider.

Learning about effective BPD treatment is a critical step in working toward a happier, healthier, stable life in the future.

Seek therapy for BPD

Some highly effective types of talk therapy for BPD you can turn to after receiving a borderline personality disorder diagnosis include:

• Cognitive-behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Mentalization-based therapy (MBT)
• Schema-focused therapy
• Systems training for emotional predictability and problem-solving (STEPPS)
• Transference-focused psychotherapy (TFP)

In some cases, BPD medication might also be recommended for short-term symptom management.

Discuss medication for symptoms with a doctor

There are no known medications that work (or that are FDA-approved) specifically to treat personality disorders like BPD. However, some mood stabilizers or antipsychotic medications might be recommended to relieve or address some of the symptoms you experience.

Borderline personality disorder medication can be useful in treating some of the severe symptoms of BPD and some comorbid mental health conditions.

Do your research and ask relevant questions before beginning a new prescription. Doing deep, intense work in therapy can be necessary to diminish your BPD symptoms, and it will most often be more helpful than relying on medication alone.

The process of getting an accurate BPD diagnosis might seem daunting, but it’s worth it. Once you’re diagnosed, you can get the tools you need to live a rewarding and full life. BPD treatment will release you from the tumultuous instability this condition often causes. You can learn to live with BPD, and having a diagnosis in hand is the first step.

If you believe you are showing signs of BPD, consider starting with our BPD test to learn more.