Therapist Recommendations For Loving Someone with Borderline Personality Disorder

There has been a lot of recent media attention surrounding Borderline Personality Disorder—Pete Davidson has been open about his diagnosis and more recently Amber Heard was evaluated to have Borderline Personality Disorder by a forensic psychologist who was hired by Johnny Depp’s legal team. I am hoping that I can show you the positive side of Borderline Personality Disorder and offer recommendations on loving someone with Borderline Personality Disorder and making your BPD relationships brighter and healthier.

Borderline Personality Disorder (BPD) can have features that include fear of abandonment, patterns of unstable relationships, rapid changes in self-image, and risky behavior.

With the pervasive nature of these mental health symptoms, treatment is essential, which includes a solid support network.

If you are a friend, family member, or partner of someone with BPD, you are probably well aware of the relationship challenges. Also, keep in mind those with BPD can (often unbeknownst to themselves) create the issues that cause abandonment, which they may fear the most.

Aside from these challenges, having a loved one with BPD can be enriching and rewarding. I can easily cite the positive aspects. I’ve frequently been motivated by the inspiring love for their passions. Their enthusiasm for life can be very contagious. They can offer dark humor and quick wit when you need to be cheered up from your own negative emotions.

In my experiences with clients and loved ones with BPD, I wanted to share some insight. I’ve learned that patience and empathy are the foundation for mutual growth.

Why Do People with BPD Struggle with Relationships?

People with BPD struggle with relationships because the core features of the disorder, including emotional dysregulation, fear of abandonment, and unstable self-image, directly affect how they connect with the people closest to them. The struggle is not about a lack of love or effort. It is about a nervous system that processes emotional signals differently.

Fear of abandonment is one of the defining features of BPD. A person with BPD may interpret a delayed text, a canceled plan, or a brief moment of emotional distance as evidence that their partner is about to leave. This can trigger intense reactions, including panic, anger, or withdrawal, that feel confusing and overwhelming to both the person with BPD and their partner.

Emotional dysregulation plays an equally significant role. Research shows that people with BPD experience emotions at a higher intensity and for a longer duration than people without the condition. A minor conflict that might cause mild frustration in one person can feel like a devastating rupture to someone with BPD. This intensity is not a choice. It is a neurobiological feature of the disorder.

These patterns are treatable. With the right therapeutic support, people with BPD can develop the skills to regulate their emotions, tolerate distress, and communicate their needs more effectively. BPD therapy focuses specifically on building these skills so that relationships become more stable and fulfilling for both partners.

What Triggers BPD?

BPD is most commonly triggered by situations that activate the fear of abandonment, rejection, or emotional invalidation. Real or perceived threats to a close relationship are the most consistent triggers, but everyday stressors can also set off episodes when the person’s emotional baseline is already elevated.

Common triggers include arguments with a partner, feeling ignored or excluded, changes in routine, criticism (even when constructive), being alone for extended periods, reminders of past trauma, and transitions like moving, starting a new job, or ending a relationship. For some people, even positive changes can be triggering because any shift in emotional equilibrium feels destabilizing.

The origins of these triggers often trace back to early life experiences. Research published in World Psychiatry confirms that the development of BPD is strongly associated with childhood adversity, particularly emotional neglect, invalidating environments, and disrupted attachment with primary caregivers. These early experiences wire the brain to treat relational uncertainty as a threat, which is why triggers in adulthood are so often centered on the fear of losing connection.

Understanding your partner’s triggers is one of the most helpful things you can do. It does not mean walking on eggshells. It means recognizing the pattern so you can respond with awareness instead of reactivity. Dialectical behavior therapy teaches specific skills for both identifying triggers and managing the emotional response before it escalates.

I hope to offer some recommendations that can make BPD relationships brighter and healthier:

1. First and most importantly, realize there are limits and boundaries to every relationship. Give and take isn’t always 50/50, but the relationship does not stay healthy if one’s time and energy is on a pattern of depletion.
2. Clear communication of wants and needs are essential. Make sure you have your desires established early into the relationship, while also respecting those of your partner.
3. Individual treatment. For your loved one, appropriate therapy is ideal. This clinician should be experienced in personality disorders. Even more importantly, this clinician should focus on Dialectical Behavioral Therapy (DBT). DBT is a therapy specifically devised for Borderline individuals that focuses on healthier coping and inward reflection. To manage your emotions properly, consider therapy for yourself.
4. Research and learning. Receiving this diagnosis can be overwhelming for the patient as well as their support network. Finding out a loved one has a BPD diagnosis can bring up an array of questions. Make sure you educate yourself using reputable resources.
5. Self-care. Both you and your loved one need care and balance; it is highly important to carve time for yourself. Your health is just as crucial as those around you.
6. Support in any relationship is crucial, but even more so to those living with BPD. Look into joining a “Friends and Family” DBT support group online.
7. Be Aware of Love Languages. Part of BPD in relationships is fear of abandonment, and small gestures can go a long way. Find your love languages and keep these in mind when you want to express appreciation.
   1. Words of Affirmation: Telling the person they are loved or giving sincere compliments even via text.
   2. Gifts: Thoughtful doesn’t have to mean expensive; think about their special interests or even delivering them a treat.
   3. Quality Time: One-on-one, no phones/no distractions. Be present with each other.
   4. Acts of Service: Schedule time to work on tasks they find overwhelming, even if you find it mundane.
   5. Physical Touch: Even close proximity can express to your BPD loved one that you are near and dear.

Can Someone with BPD Be in a Long-Term Relationship?

Yes, someone with BPD can absolutely be in a long-term relationship. Many people with BPD are in committed, loving partnerships. The disorder creates challenges, but it does not make a successful relationship impossible. It makes it harder without the right support and skills.

Long-term longitudinal studies have changed the clinical understanding of BPD significantly over the past two decades. Research shows that BPD is not the permanent, untreatable condition it was once believed to be. The Berlin Borderline Study found that 77% of participants no longer met the diagnostic criteria for BPD after one year of dialectical behavior therapy. A two-year follow-up study found that 87% of individuals who completed DBT sustained their improvements in mood regulation, distress tolerance, and interpersonal relationships.

The key factors that predict relationship success are both partners’ willingness to learn about the disorder, the person with BPD actively engaging in treatment, and the couple’s ability to communicate openly about what is happening during difficult moments. Relationships where only one partner is doing the work tend to burn out. Relationships where both partners invest tend to grow stronger over time.

Couples therapy alongside individual treatment for the partner with BPD is often the most effective combination. Individual therapy for both partners, whether together or separately, gives each person the tools they need to navigate the relationship’s unique demands.

How Does BPD Affect Intimacy?

BPD affects intimacy by creating a push-pull dynamic where the person with BPD intensely craves closeness but simultaneously fears it. This can make the experience of intimacy feel unpredictable for both partners, swinging between periods of deep connection and sudden withdrawal or conflict.

The fear of abandonment drives the craving for closeness. The person with BPD may seek constant reassurance, want to spend every moment together, and feel panicked by even brief separations. At the same time, the fear of engulfment, or losing their identity within the relationship, can cause sudden emotional distance or anger when they feel too close. This cycle is confusing for the partner and exhausting for the person with BPD.

Physical intimacy can also be affected. Many people with BPD have histories of trauma, and physical closeness can trigger difficult emotions or dissociative responses. Others may use physical intimacy to manage emotional distress, which can create patterns that are hard to sustain. Research confirms that BPD is associated with significant impairments across all dimensions of intimacy, including emotional, physical, and sexual connection.

The path to healthier intimacy involves building emotional safety first. When both partners feel secure, physical and emotional closeness follows naturally. DBT skills groups teach distress tolerance and interpersonal effectiveness, which are two of the most important skills for navigating intimacy challenges related to BPD.

The emotional connections we have in life take thoughtful cultivation. There is work required in every relationship, but elevated patience and effort are needed when it comes to those with personality disorders. I encourage you to have open conversations with loved ones with any and all mental health needs so that you can discover more joy.

What Type of Therapy Is Best for BPD?

The best type of therapy for BPD is dialectical behavior therapy (DBT), which was developed specifically to treat the emotional dysregulation, interpersonal difficulties, and self-destructive behaviors associated with the disorder. DBT has the largest evidence base of any BPD treatment, supported by more randomized controlled trials than any other therapeutic approach for this condition.

The American Psychological Association recognizes DBT as a well-established, empirically supported treatment for BPD. The Berlin Borderline Study found that 77% of participants no longer met the diagnostic criteria for BPD after one year of DBT treatment. A seminal 2006 study found that DBT produced a 50% reduction in suicidal behavior and hospitalization rates compared to treatment as usual.

DBT works through four core skill modules: mindfulness (staying present without judgment), distress tolerance (surviving crises without making them worse), emotional regulation (managing intense emotions before they escalate), and interpersonal effectiveness (communicating needs clearly while maintaining relationships). These skills address the exact areas where BPD creates the most difficulty.

Other evidence-based options include mentalization-based therapy (MBT), transference-focused psychotherapy (TFP), and schema therapy. Each has demonstrated effectiveness, and the best fit depends on the individual’s specific symptoms and preferences. BPD treatment at a practice with clinicians trained in these specialized approaches gives you the best chance of meaningful, lasting improvement.

Does BPD Get Worse Untreated?

Yes, BPD can get worse without treatment, particularly in terms of relationship instability, self-destructive behavior, and overall quality of life. While some BPD symptoms may naturally soften with age, the interpersonal and functional impairments often persist or deepen without professional support.

Research published in World Psychiatry found that BPD is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-harm and suicide is significantly elevated. Without treatment, people with BPD are more likely to experience repeated relationship breakdowns, job loss, substance use, and chronic mental health conditions like depression and anxiety.

One of the most concerning aspects of untreated BPD is its impact on relationships. The same patterns that cause distress, including fear of abandonment, emotional volatility, and difficulty communicating needs, tend to repeat across relationships. Each failed relationship reinforces the person’s belief that they are unlovable or fundamentally broken, which deepens the shame cycle and makes it harder to seek help.

The encouraging reality is that BPD is one of the most treatable personality disorders when the right therapy is applied. With structured treatment, most people experience significant and lasting improvement. Online therapy makes it easier to start the process, especially for people who feel overwhelmed by the idea of walking into an office. At Counseling and Wellness Center of Pittsburgh, we have clinicians specifically trained in DBT and other BPD-focused treatments who understand the complexity of this condition and approach it with skill and compassion.

Written by Rachel Taylor, a licensed professional counselor (LPC) and Nationally Board Certified Counselor (NBCC) with Counseling and Wellness Center of Pittsburgh.

Pruthi, S. Borderline Personality Disorder. (2022, May) The Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237