Personality Disorders
Long-standing patterns can change. Understanding them is the first step.
This information is educational and is not a diagnosis. Diagnosis requires a comprehensive psychiatric evaluation.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911.
What it is
A personality disorder is a long-standing pattern of thinking, feeling, relating to others and managing impulses that differs significantly from what is expected in a person's culture, is inflexible, and causes distress or problems in relationships, work or daily life.
These patterns usually begin in adolescence or early adulthood. They are often shaped by a combination of genetics, temperament and life experiences, including trauma. People with personality disorders can and do improve, especially with specialized treatment.
Diagnostic features (DSM-5-TR)
A plain-language summary of key features described in the DSM-5-TR. This is not the official criteria text and is not a self-diagnosis tool.
General features of a personality disorder
- An enduring pattern that differs markedly from cultural expectations in at least two areas: how you see yourself and others, emotional responses, relationships, and impulse control.
- The pattern is inflexible and shows up across many situations.
- It causes significant distress or difficulty functioning.
- It is stable over time, with onset traceable to at least adolescence or early adulthood.
- It is not better explained by another mental disorder, a substance or a medical condition.
The three clusters
- Cluster A (odd or eccentric): paranoid, schizoid and schizotypal personality disorders.
- Cluster B (dramatic, emotional or erratic): antisocial, borderline, histrionic and narcissistic personality disorders.
- Cluster C (anxious or fearful): avoidant, dependent and obsessive-compulsive personality disorders.
Borderline Personality Disorder (BPD)
- A pervasive pattern of instability in relationships, self-image and emotions, with marked impulsivity, beginning by early adulthood and present in many contexts.
- At least five of nine features, such as intense efforts to avoid real or perceived abandonment; unstable, intense relationships; an unstable sense of self; impulsivity in at least two potentially harmful areas; recurrent suicidal behavior or self-harm; intense mood reactivity; chronic emptiness; intense or hard-to-control anger; and stress-related paranoid thoughts or dissociation.
Common signs
- Intense, rapidly shifting emotions
- Fear of abandonment or rejection
- Relationships that feel intense and unstable
- An unclear or shifting sense of who you are
- Impulsive actions you later regret
- Chronic feelings of emptiness
- Anger that feels hard to control
- Self-harm or suicidal thoughts
- Patterns that repeat across many relationships or jobs
How it's evaluated
Personality disorders are diagnosed carefully and never from a single conversation. I take a detailed history of your relationships, emotions and patterns over time, and how they affect your life, often across more than one visit.
I also evaluate for conditions that can look similar or occur alongside, such as PTSD, bipolar disorder, depression, ADHD and substance use, because accurate diagnosis shapes the right plan. Safety is always assessed.
Evidence-based treatment options
Specialized psychotherapy
Psychotherapy is the primary treatment for borderline personality disorder. Dialectical behavior therapy (DBT), mentalization-based treatment (MBT), schema-focused therapy and transference-focused psychotherapy have research support.
Structured psychiatric care
Consistent, collaborative follow-up with a clear crisis plan helps reduce emergencies and builds stability over time.
Medication for specific symptoms
No medication is approved specifically for borderline personality disorder. Medication may be used for co-occurring conditions such as depression, anxiety or ADHD, and is reviewed carefully for benefit and risk.
Family education
Helping loved ones understand the condition and learn supportive skills can improve relationships and recovery.
How I can help
I approach every person with respect and without labels or judgment. My role is to understand your patterns in context, clarify the diagnosis, and identify and treat co-occurring conditions that may be adding to your distress.
I work with you to build a collaborative plan, help connect you with specialized therapy such as DBT, and provide steady, consistent psychiatric follow-up. Understanding your patterns is how you begin building new ones.
Insight
Borderline personality disorder was once thought to be lifelong. With evidence-based treatment, many people experience fewer and less severe symptoms, better functioning and an improved quality of life.
Sources
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
- National Institute of Mental Health (NIMH): Borderline Personality Disorder
- NICE guideline CG78: Borderline personality disorder: recognition and management
- American Psychiatric Association: Clinical Practice Guidelines
Heal • Grow • Thrive
Ready When You Are.
Putting your mental health first is a strength. It is okay to ask for help.