Borderline Personality Disorder

Overview

Several manualized therapies show RCT support. Choice depends on availability, training, and presentation. All share: long treatment, explicit hierarchy targeting life-threatening behavior, and therapist consultation/support.

First-line treatments

• DBT — Dialectical Behavior Therapy

  Largest evidence base — comprehensive DBT (individual + group + coaching + team).

• Schema — Schema Therapy

  Strong RCT evidence; integrates experiential + cognitive + limited reparenting.

Also consider

• IFS

  Works well with parts polarization and self-harming protectors.

• CFT

  Adjunctive — addresses the shame that drives self-attacking and dysregulation.

Cautions

• Open-ended supportive therapy without structure typically does not help and may worsen outcomes.
• Therapists need consultation/team support to manage countertransference and avoid burnout.

Worked cases

• Borderline personality disorder

  Recurrent crises, NSSI, intense unstable relationships; three prior dropouts from individual therapy.

• Non-suicidal self-injury, recurrent; r/o emerging BPD

  High-school sophomore with escalating cutting; identity exploration around gender; family conflict over autonomy.

Related tools

• DBT Skills List — the Complete DBT Skills Toolbox

Related worksheets

• TIPP
• DEAR MAN
• Wise Mind
• Radical Acceptance
• Check the Facts
• Opposite Action