Borderline Personality Disorder 101

Available with English captions.

What is borderline personality disorder? George W. Smith, LICSW, helps us understand the basics of BPD.

What Is BPD?

Borderline personality disorder (BPD) is often misunderstood, leading to stigma, misdiagnosis, and ineffective support. The key to effectively addressing BPD is to first understand the condition. However, BPD is complex in nature, and many myths surround the disorder.

Watch now to learn more about:

  • How BPD impacts the way a person thinks, feels, and connects
  • How BPD is diagnosed and treated
  • Why stigma surrounding BPD continues

In this session, Smith describes the interpersonal hypersensitivity associated with borderline personality disorder. He points out how people with BPD may desperately seek relationships, yet can be hypervigilant about signs of rejection or betrayal.

Emotional volatility and dysregulation are among the most apparent BPD symptoms. When friends and family support someone with BPD, it’s important to take the person’s emotions seriously, according to Smith.

“One of the things that is a mistake is when people try to take over or try to manage the situation for the person,” says Smith. “Instead, what [the patient] needs is a sense that they’re being taken seriously and that the other person wants to hear what’s going on with them, so that they feel heard and understood.”

Smith explains that when diagnosing BPD, clinicians take a nuanced approach, rather than simply consulting the “Diagnostic and Statistical Manual of Mental Disorders.”

“Today, we use more of a working fluidity, which is to talk with the patient about their emotional experience, try to understand its origins, and then help them to develop skills to contain any erratic behavior,” he says.

Smith points out that other conditions frequently co-occur with BPD. Substance use disorders and PTSD are especially prevalent. He also dispels the myth that BPD rarely occurs in men.

“One of the reasons why [BPD] has been recognized differently for women than men is that men tend to express it in ways that look more antisocial or aggressive, and they get into fights, which can become problems of their own,” Smith explains. “When you move past some of the more antisocial or aggressive-looking behaviors, it turns out that the underlying vulnerability is quite similar.”

Smith states that dialectical behavior therapy (DBT) is especially effective when someone is highly symptomatic. “DBT covers distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness—it teaches specific skills and offers a guidebook for patients to utilize when they’re in moments of emotional distress.”

He points out that DBT is one of several highly effective treatments for the condition, however.

“Despite the troubling reputation BPD has, it’s actually one of the most treatable psychiatric conditions around.”

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Audience Questions

  • How do you define borderline personality disorder (BPD)? How would you best describe it?
  • What do we know about the prevalence of BPD? How common is it?
  • What should we know about the treatability of BPD?
  • What are some basic signs and symptoms of BPD that loved ones could watch for?
  • Are there specific clinical assessments that are used to diagnose BPD?
  • What is dialectical behavior therapy (DBT)? How is it used in the treatment of BPD?
  • Does BPD tend to co-occur with other conditions?
  • Can BPD stem from childhood trauma or disrupted early life attachment?
  • What should we know about self-harm and its relation to BPD?
  • Are there gender differences in presentations of BPD?
  • What are some major BPD misconceptions you’ve encountered over the years?
  • What guidance do you have for clinicians who aren’t specialists in treating BPD?

The information discussed is intended to be educational and should not be used as a substitute for guidance provided by your health care provider. Please consult with your treatment team before making any changes to your care plan.

Helpful Links

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About the Speaker

George W. Smith, LICSW, is the director of outpatient group therapy services for McLean’s Adult Outpatient Services and clinic director of the Borderline Personality Disorder Outpatient Program.

Topics

Series

BPD & Self-Harm Course 2025

Mental Health Webinars