May 5, 202611 min read
Types of Family Therapy Explained
Learn about the main types of family therapy, how each approach works, and how therapy can help families build stronger relationships.
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Same-day assessments · Orange County, CA
Same-day assessments · Orange County, CA
Understand the signs of Borderline Personality Disorder you shouldn’t ignore. Recognizing these symptoms can lead to effective help and improved mental health.
Casey
Clinical Editorial Team
Understand the signs of Borderline Personality Disorder you shouldn’t ignore. Recognizing these symptoms can lead to effective help and improved mental health.
Borderline Personality Disorder (BPD) is a challenging but treatable mental health condition marked by strong emotional ups and downs, impulsive choices, and frequent struggles in close relationships. People with BPD commonly fear abandonment and may wrestle with a shifting sense of self, which can make relationships and daily life feel unstable. This guide walks through what to look for, how clinicians make a diagnosis, what factors raise risk, and the most effective treatment options — including how BPD can interact with substance use. With informed care and the right support, many people living with BPD can find steadier ground and meaningful recovery.
Clinically, BPD shows a persistent pattern of unstable relationships, an unstable self-image, intense emotions, and impulsive behavior. Diagnostic criteria focus on recurring emotional dysregulation, episodes of anger or anxiety, and behaviors such as self-injury or risky actions. Recognizing these signs helps clinicians make an accurate diagnosis and connect a person to appropriate care.
Emotional dysregulation in BPD usually means rapid, intense emotional shifts that feel hard to control. Someone might feel euphoric or deeply hopeful one moment and overwhelmed or hopeless the next. These swings strain relationships and daily routines and can lead to misunderstandings or conflict. Because strong emotions are difficult to manage, people with BPD may act impulsively to relieve distress, which can complicate recovery.
Learn about the main types of family therapy, how each approach works, and how therapy can help families build stronger relationships.
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Self-harm and impulsive behaviors are central indicators clinicians look for when assessing BPD. Research shows roughly 60% to 80% of people with BPD engage in self-harming behaviors at some point. Impulsivity can take many forms — reckless spending, substance misuse, or risky sexual behavior — and is often a short-term attempt to escape intense emotional pain or numbness. These behaviors are important clinical signals during evaluation and when planning treatment.
BPD develops from an interaction of biological, psychological, and environmental influences. Knowing these contributors helps identify people at higher risk and shape prevention or early intervention strategies.
Genetic vulnerability appears to increase risk for BPD, especially when there is a family history of mood disorders or personality disorders. Environmental factors — notably childhood neglect, abuse, or other early adversities — also play a major role. These early experiences can alter emotional responses and coping patterns, making BPD symptoms more likely to emerge later.
Childhood trauma (physical, emotional, or sexual) is a well-established risk factor for BPD. Family dynamics such as inconsistent caregiving, emotional unavailability, or chaotic environments can further impair a child’s ability to build stable emotional regulation skills. Together, these influences increase vulnerability and highlight why early support and stable relationships matter for prevention and recovery.
Research continues to underline how genetic predispositions and early-life adversity interact to shape BPD risk.
BPD causes: genetics, trauma, and core symptoms
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Multiple studies indicate that BPD emerges from a combination of genetic and environmental factors (GxE), especially biological vulnerabilities coupled with traumatic childhood experiences. Research has explored changes in biological systems and brain structure linked to childhood trauma and BPD, and has investigated epigenetic mechanisms that may mediate trauma’s effects on vulnerability. Borderline Personality Disorder is characterized by emotional dysregulation, impulsivity, an unstable sense of identity, and difficulties in relationships.
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Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms, 2017
Treatment for BPD is most effective when it combines psychotherapy, medical management when needed, and consistent support from trained professionals. Different approaches address emotion regulation, relationship skills, and co-occurring symptoms to create a balanced path toward recovery.
Dialectical Behavior Therapy (DBT) is a tailored form of cognitive-behavioral therapy developed for BPD. DBT teaches practical skills in mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Evidence shows DBT reduces self-harming behavior and improves emotional stability, making it a central, evidence-based option for many people with BPD.
Cognitive Behavioral Therapy (CBT) can help identify and shift unhelpful thought patterns and behaviors that maintain distress. Medications — including mood stabilizers, antidepressants, and sometimes antipsychotics — are not specific cures for BPD but can ease co-occurring symptoms such as depression, anxiety, or severe mood swings. Many clinicians use a combination of therapy and medications to create a comprehensive, individualized treatment plan.
Treatment type
Description
Effectiveness
Dialectical Behavior Therapy
Skills-based therapy emphasizing mindfulness and emotional regulation
High
Cognitive Behavioral Therapy
Targets negative thought patterns and behaviors
Moderate
Medication
Used to manage specific symptoms such as mood or anxiety
Variable
The table above summarizes common treatment approaches and their relative evidence. Effective care is individualized and often blends psychotherapy, skills training, and medication when needed.
Diagnosing BPD requires a thorough clinical assessment by qualified mental health professionals using standardized criteria and structured interviews to capture the full pattern of symptoms and functioning.
Clinicians typically rely on diagnostic standards like the DSM-5, structured clinical interviews, and validated assessment tools to evaluate symptom presence, severity, and impact. A comprehensive assessment often includes collateral history, risk evaluation, and consideration of co-occurring conditions to inform a precise diagnosis and treatment plan.
Distinguishing BPD from conditions such as bipolar disorder is important because treatment differs. BPD mood changes are often shorter, more reactive to interpersonal triggers, and tied to identity and relationship instability, whereas bipolar mood episodes usually follow longer, more sustained cycles. The presence of self-harm and specific interpersonal patterns also helps clinicians differentiate BPD from other diagnoses. Careful clinical assessment reduces the risk of misdiagnosis.
Further clinical research highlights specific features that help separate BPD from conditions like bipolar disorder.
Differentiating BPD from bipolar disorder
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Telling bipolar disorders (especially bipolar II) apart from borderline personality disorder is a common clinical challenge. Recent reviews compare family history, developmental history, course of illness, differences in mood phenomenology, personality style, and relationship patterns to clarify distinctions and improve diagnostic accuracy.
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Differential diagnosis of bipolar II disorder and borderline personality disorder, A Bayes, 2019
BPD and substance use disorders commonly occur together, and their interaction can complicate diagnosis and treatment. Addressing both issues together improves outcomes.
Research estimates that roughly 40% to 60% of people with BPD also experience substance use disorders at some point. Substance use is often a way to cope with intense emotions or numbness, which can make recovery more complex and increase relapse risk. Integrated care that treats both conditions at once is usually recommended.
The high rate of co-occurring substance use disorders in BPD highlights the need for coordinated, dual-focused treatment plans.
BPD & addiction: comorbidity and treatment
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Borderline personality disorder affects about 2.7% of adults. Studies report that roughly 78% of adults with BPD will develop a substance-related disorder or addiction at some point. Individuals with both BPD and addiction tend to be more impulsive and clinically less stable, show higher rates of suicidal behavior, drop out of treatment more frequently, and have shorter abstinence periods. Combining treatments tailored to both disorders is essential.
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Borderline personality disorder and comorbid addiction: epidemiology and treatment, T Kienast, 2014
Integrated programs combine evidence-based therapies for BPD (like DBT) with specialized addiction treatment, focusing on skills for emotion regulation, relapse prevention, and building stable supports. Treating both conditions together reduces relapse risk and improves overall stability.
Support and recovery strategies are an essential complement to clinical care. Peer support, family education, and reliable online resources can all help sustain progress between therapy sessions.
Families and clinicians can make a big difference by offering predictable support, learning about BPD, and practicing clear, compassionate communication. Family education programs, participation in therapies, and consistent boundaries paired with warmth help create the stable environment many people with BPD need for recovery.
Personal recovery stories often show that sustained therapy, skill-building, and supportive relationships lead to meaningful improvements. Evidence-based outcomes report that many people with BPD achieve reduced self-harm, better emotion regulation, and more stable relationships over time. Sharing these examples can offer hope and practical pathways for others seeking help.
Support resource
Type
Description
Therapy groups
Peer support
Guided groups where people share experiences and practice skills in a safe setting
Family education programs
Educational
Structured information and coaching to help families support recovery
Online resources
Informational
Trusted websites and forums offering evidence-based guidance and connection
The table above highlights common supports that complement clinical care. For more resources and information on mental health topics, visit rizeoc.com.
Long-term effects vary widely. Without treatment, BPD can lead to chronic difficulties with mood, relationships, and self-image, and raise the risk of depression, anxiety, and unstable relationships. With consistent, evidence-based treatment and a strong support network, many people experience meaningful symptom reduction, better emotional stability, and improved quality of life over time.
There’s no single “cure,” but many people learn to manage symptoms effectively. Psychotherapy—especially DBT—teaches concrete skills that reduce self-harm and improve emotional control. With ongoing therapy, supports, and sometimes medication for co-occurring symptoms, many individuals go on to lead fulfilling lives with far fewer BPD-related disruptions.
BPD can make relationships feel intense and unpredictable. Rapid shifts in feelings, fear of abandonment, and trust challenges may lead to conflict or instability. Learning communication and emotion-regulation skills in therapy, and building consistent supports, can help relationships become more secure and satisfying over time.
Healthy routines support clinical care: regular physical activity, balanced nutrition, and consistent sleep improve mood and resilience. Mindfulness practices, yoga, or meditation support emotional regulation. Building a dependable support network and using therapy skills daily also strengthens recovery.
No medications are approved specifically for BPD itself, but certain drugs can target co-occurring symptoms. Antidepressants, mood stabilizers, and antipsychotics may be used to help with depression, anxiety, or severe mood swings. Medication decisions should be individualized and made with a healthcare provider.
Start with referrals from a primary care clinician, local mental health clinics, or reputable national organizations. Directories from professional bodies and mental health nonprofits can help locate therapists skilled in DBT or other BPD-focused therapies. During an initial consult, ask about the clinician’s experience with BPD and their treatment approach to ensure a good fit.
Self-care is a vital part of recovery. Consistent routines, stress-management strategies, and enjoyable activities build emotional stability. Practicing therapy skills, setting realistic goals, and reaching out for support when needed all reinforce clinical work and help maintain progress over time.
Learning about Borderline Personality Disorder is the first step toward better support and treatment. Recognizing symptoms, understanding causes, and knowing available therapies lets individuals and families make informed choices and find effective care. If you or someone you love is affected, reach out to qualified professionals and explore trusted resources — recovery and a more stable future are possible.
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