BPD and Personality Disorders
If you’ve landed here, you might have been given a diagnosis of Borderline Personality Disorder. Or someone might have hinted at one without saying it.
Or you might just be exhausted by feelings that arrive too fast and too big, relationships that keep ending badly, and a sense that you’re somehow harder work than everyone else.
Wherever you’re starting from, here’s the short version: what you’re describing is recognised, it’s common, and there are treatments for it that have been properly tested.
What is a personality disorder?
A personality disorder is a long-standing pattern of thinking, feeling and behaving that differs from what most people around you experience, and that tends to cause distress or lead to other problems — relationships breaking down, difficulty holding a job, family cut-offs, a life that keeps getting derailed.
These patterns are usually hard to change on your own, and they generally turn up across many parts of life rather than in one corner of it: at home, at work, with friends, with partners, with family, sometimes even with strangers. Ten personality disorders are recognised in the diagnostic system currently in use.
What is Borderline Personality Disorder (BPD)?
Borderline Personality Disorder, or BPD, is one of the more common of those ten. It causes significant distress for the person experiencing it and often for the people around them, and it is one of the few with well-established, evidence-based treatments available.
BPD is also frequently missed at a first assessment, or not raised at all. Effective treatment for BPD requires specific training that not every clinician has had the opportunity to complete, and where that training isn’t available the difficulties can go unnamed.
What do people who experience BPD symptoms actually struggle with?
The diagnostic label matters far less than what’s actually happening in your life. In practice, people usually come in describing some combination of the following:
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Emotions that hit hard and fast, and take a long time to settle
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Relationships that swing between very close and completely ruptured
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An unstable or unclear sense of who you are and what you want
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A powerful fear of being abandoned, and things you do to prevent it
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Self-harm, suicidal thinking, or suicide attempts
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Impulsive decisions — around spending, substances, driving, sex, or leaving jobs and relationships
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Long stretches of feeling empty or numb
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Anger that feels disproportionate afterwards, even when it made sense at the time
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Feeling disconnected from yourself or your surroundings when under stress.
You do not need to recognise all of these, and you do not need a formal diagnosis to get help with any of them.
What is emotional dysregulation?
Emotional dysregulation is the term for a nervous system that reacts more quickly, more intensely, and for longer than most. Three things tend to be true at once: you feel things sooner than other people, you feel them more strongly, and it takes you longer to come back down to baseline.
That combination explains a great deal. It explains why a small comment can flatten a whole day. It explains why you might do something impulsive to make an unbearable feeling stop, and then feel worse afterwards. It also explains why advice like “just don’t react” has never once worked — you’re not reacting badly to a small event, you’re reacting proportionately to a very large internal experience.
Why are relationships so hard?
Relationship difficulty is often the thing that finally brings people in, and it’s rarely because someone doesn’t care about other people. Usually it’s the opposite.
When emotions run intense, closeness can feel essential and risky at the same time. Small signals — a delayed reply, a shift in tone — can register as genuine evidence that you’re about to be left. What you do next to prevent that, whether that’s pulling closer or pushing away first, often produces exactly the distance you were afraid of. Over time this becomes a pattern that’s painful for everyone involved and very difficult to interrupt from the inside.
This pattern is learnable to change. Interpersonal skills are one of the four core modules in DBT for precisely this reason.
What is Dialectical Behaviour Therapy (DBT)?
DBT is a structured, skills-based treatment developed by Dr Marsha Linehan, originally for people experiencing BPD symptoms and chronic suicidality. It has since been applied much more widely.
The central idea is that two things are held together rather than traded off: acceptance and change. Your emotional responses make sense given your history and your biology — and it can still be worth learning to do something different with them. DBT teaches concrete, practisable skills rather than relying on insight alone.
What do the four DBT skills modules cover?
DBT skills are taught in four groups:
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Mindfulness — noticing what is actually happening, in your body and your mind, without immediately acting on it
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Distress Tolerance — getting through a crisis without making it worse, when the feeling can’t be changed right now
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Emotion Regulation — understanding what emotions are for, reducing vulnerability to them, and changing them over time
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Interpersonal Effectiveness — asking for what you need, saying no, and balancing your needs against other people’s without losing the relationship or losing yourself.
These are practical skills. They take practice, in the same way that any other skill takes practice, and most people find some of them useful long before they finish the full set.
What’s the difference between DBT-informed therapy and a comprehensive DBT program?
This is worth understanding before you book anything, because the two are genuinely different and the right one depends on your circumstances.
DBT-informed individual therapy
One-to-one sessions with me, drawing on DBT principles and teaching DBT skills within our individual work. There’s no group component and no after-hours phone coaching. This suits people who want to work on emotion regulation and interpersonal difficulties in an individual format, or who aren’t in a position to commit to a twelve-month program.
The comprehensive DBT program
The full, adherent model as it was designed and tested. It runs for twelve months and includes weekly individual therapy, a weekly skills training group, and access to after-hours phone coaching so you can use skills at the moment you actually need them. The comprehensive program is delivered through DBTBrisbane, and I provide the individual therapy sessions that sit within it. So you can access either option through me.
Which option is right for me?
That depends on what you’re dealing with, what your week realistically allows, and what you’ve already tried. Rather than guessing from a website, call and ask. I can talk you through both and tell you honestly which one I think fits your situation — including if that turns out to be a service other than mine.
How long does treatment take?
Longer than treatment for many other presentations, and it’s more useful to know that at the start than to discover it at session six. The comprehensive program runs for twelve months by design. Individual DBT-informed work varies considerably depending on your goals.
Progress also isn’t linear. Most people have weeks where things move and weeks where they don’t, and that’s an expected feature of the work rather than a sign it isn’t working.
Can people actually get better?
Yes. This is one of the more encouraging areas of mental health, and it isn’t widely enough known.
Australia’s national clinical practice guideline for BPD, developed by the National Health and Medical Research Council, states plainly that BPD is a treatable condition, that structured psychological therapies are the primary treatment, and that many people experience substantial improvement over time.
It also states that people with BPD symptoms should be treated with the same respect and access to care as anyone else using the health system — which, if you’ve had a difficult experience somewhere before, is worth reading in full.
How do I get started?
Have a chat with your GP about a Mental Health Care Plan. This type of therapy generally works best as an ongoing piece of work rather than a couple of sessions, and a plan from your GP or psychiatrist is what allows you to claim a Medicare rebate towards it.
Then send me your referral and call (07) 3801 7017 to book. If you’d rather self-refer without a plan, you’re welcome to do that too — you’ll just pay the full fee. All the costs are set out on the Fees and Rebates page.