Working with Borderline Personality “Disorder”
In my experience as a Clinical Psychologist working across a range of clinics and hospitals, I’ve often encountered conversations — and strong reactions — around the diagnosis of Borderline Personality Disorder (BPD).
Unfortunately (and I partly blame the DSM), BPD is a diagnosis that carries a heavy burden of stigma, judgment, and avoidance. Many health practitioners feel uncertain or even anxious when treating someone with this diagnosis. I’ve witnessed medical students swing to extremes — either avoiding treatment entirely, believing any depressive or anxious symptoms are “just BPD,” or dismissing serious signs like suicidality as mere attention-seeking.
The DSM defines BPD through symptoms like “identity disturbances,” “impulsivity,” and “recurrent suicidal behaviour.” While these may be present, this symptom-focused lens often misses the deeper essence and lived experience of someone who struggles with the condition. It flattens a complex, painful internal world into a checklist of behaviours.
In my clinical work, I prefer to understand BPD — or traits associated with it — through a more nuanced, psychodynamic lens.
From this perspective, personality is shaped by early experiences and relationships. A person’s capacity to manage emotions, trust others, or maintain a stable sense of self is deeply rooted in their early environment. For someone with BPD traits, it may have been hard to sit with conflicting feelings in early life, and that difficulty continues in adulthood. It may show up as emotional intensity, a tendency to idealise and then devalue others, or patterns of unstable relationships.
In terms of treatment, I’ve found that the most effective approach often involves two stages. First, Dialectical Behaviour Therapy (DBT) can be invaluable — especially for people in crisis or struggling with emotional regulation. DBT teaches practical skills for managing distress, relationships, and impulsivity. Once some stability is achieved, many clients benefit from moving into longer-term psychodynamic or psychoanalytic psychotherapy, which explores the deeper roots of their struggles. This second phase focuses on past trauma, early relational patterns, unconscious defences, and ultimately, developing a more cohesive sense of self.
Personally, I find great meaning in this longer-term work. It’s a privilege to witness someone move from deep emotional pain toward greater self-understanding and healthier, more stable relationships.
If you're interested in exploring your own emotional world, relationship patterns, or personality structure — or if you’re curious about beginning a psychodynamic therapy process — feel free to get in touch.
