If you or someone you care about has borderline personality disorder (BPD), you’ve probably encountered misinformation about the condition that—let’s be honest—freaked you out.
There was a time in the not-too-distant past when most mental health providers believed BPD was untreatable. Fortunately, clinical trials testing intensive, specialized treatments have disproved this myth (though you might still find people on the internet touting it).
Now the prevailing wisdom is that BPD is treatable, but it will likely take years—and that’s only if you’re lucky enough to find a specialist who is highly trained in one of the proven treatments for the condition.
Of course, for people with this diagnosis, learning that BPD responds to treatment is a vast improvement over hearing that it’s a life sentence. At the same time, facing years of therapy may feel a bit daunting.
Here’s the part that gets less airtime: That “years of therapy” assumption is more a relic of how BPD research got started than a hard rule about what every person with the diagnosis actually needs.
Why Many People Believe BPD Requires Long-Term Care
The most well-studied treatment for BPD is dialectical behavior therapy (DBT). It was developed in the late 1980s to help people experiencing chronic suicidal thoughts and behaviors—not specifically people with BPD, originally. To be included in the first study testing this treatment, patients had to have a BPD diagnosis and had to have engaged in suicidal behavior in the past 8 weeks.
Given the severity of the patients in those early DBT trials, it makes sense that the treatment was long (a year-long commitment), intensive (at least twice a week), and complex (lots of skills). And it worked.
Beyond DBT, we have three more proven treatments for BPD: mentalization-based therapy, transference-focused psychotherapy, and good psychiatric management. The success of these interventions changed the landscape for BPD’s prognosis.
But somewhere along the way, the intensity and duration of those programs got mistaken for the dose every person with BPD needs to recover.
Not All People With BPD Are High-Risk
When most people picture someone with BPD—including many providers—they picture someone who is in and out of the hospital. But epidemiological research tells us that more than 50 percent of people with BPD have not and will not attempt suicide.
These individuals may not need a year’s worth of twice-weekly care to see improvements. And the assumption that all people with BPD require specialist care has a real cost: Waitlists for DBT programs run long, which means the higher-risk patients who absolutely do need that level of care often can’t access it.
That’s why my team created an 18-week treatment for BPD that fits into the traditional, once-weekly outpatient model. Our intervention, BPD Compass, was developed with the understanding that BPD looks different across clients. Some people’s symptoms come from being highly emotionally sensitive, others have more difficulty interpersonally, and still others struggle with impulsivity.
Our clients see gains quickly because we personalize treatment based on the underlying difficulties driving the symptoms. By zeroing in on the skills that matter most for each individual, recovery can be a lot more efficient.
You Don’t Always Need a Specialist
One of the coolest things about BPD Compass, in my opinion, is that we developed it with generalist clinicians in mind. Most of the therapists on our trial were trainees who didn’t have extensive clinical experience, let alone experience with BPD.
This matters because there aren’t enough specialists to help the roughly 4 to 5 million Americans with BPD. Waitlists for the long-form, name-brand programs run six months to a year in many cities, and longer in rural areas. If your only option is a specialist or nothing, “nothing” is what a lot of people end up with.
The more generalist clinicians feel equipped to treat BPD, the more the landscape for this condition will continue to evolve—from untreatable, to treatable with long-term care, to simply treatable.
It’s BPD Awareness Month
May is BPD Awareness Month, and a lot of the well-meaning conversation this time of year focuses on the seriousness of the diagnosis. That’s necessary—BPD is associated with real suffering and real risk, and that shouldn’t get overlooked.
But the rest of the picture matters, too. BPD is one of the most treatable conditions in psychiatry. The majority of people who receive care no longer meet criteria over time. And increasingly, that care doesn’t require you to find a specialist or commit to years of intensive therapy.