A psychiatrist can diagnose borderline personality disorder (BPD) and offer medication management, but therapy is usually the primary treatment.
Preparing for your first psychiatry appointment involves tracking your symptoms and gathering relevant personal and family history.
Evaluation and diagnosis for BPD typically involves an interview and an observation of your symptoms.
The path to getting a diagnosis of borderline personality disorder (BPD) can involve many steps. A psychiatrist or other qualified mental health professionals such as a psychologist can diagnose you with BPD. And getting the right diagnosis is key to finding the most effective treatment.
If you suspect you might have BPD, or if you’ve been dealing with symptoms like unstable moods, intense relationships, or fear of abandonment, a psychiatrist can help. They can assess, diagnose, and guide your treatment plan.
Consider these steps in getting a BPD diagnosis:
1. Find a psychiatrist
Psychiatrists are medical doctors who specialize in treating mental health conditions. They differ from therapists and psychologists because they can prescribe medication. Medication isn’t the first-choice treatment for BPD. But it can help — especially if you live with a co-occurring condition, like depression.
There are many things to look for when searching for a psychiatrist who meets your needs. Consider things like:
Availability: Do they have open slots for new patients, and do their office hours fit your schedule?
Expertise: Does the psychiatrist have experience in diagnosing and treating BPD, or do they specialize in other conditions?
Personal preferences: Do you feel comfortable with their approach, gender, and communication style?
Insurance and financial concerns: Does the psychiatrist accept your insurance, and are their fees affordable?
Once you’ve narrowed down your list, start reaching out to make your first appointment. Some psychiatrists may want to speak with you briefly on the phone to make sure that they'll be a good fit for you. Others may be willing to schedule your first appointment immediately.
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2. Prepare for your first appointment
Once you have your first appointment scheduled, you can do a few things to prepare. It can be helpful for you to have documentation of your past and present symptoms. You can monitor the symptoms you’re experiencing by keeping a daily log.
For example, you can note down things like your:
Everyday mood, rated on a 1-to-10 scale
Stress levels
Sleeping and eating patterns
Interpersonal challenges
Automatic or negative thoughts
It’s also helpful for psychiatrists to know about your personal and family history with mental health. For example, you might want to bring information about:
Past mental health treatment you’ve received, including psychiatry and therapy
Past hospitalizations for mental health concerns
Past suicide attempts or self-harm*
Family history of mental health, especially of BPD
Information about childhood trauma, if you have it
This information won’t be used to judge you. It can help your psychiatrist understand all of your experiences leading up to today. This can help them understand whether what you're going through might be a sign of BPD or another mental health condition.
If you don’t have access to all of this information, don’t worry. A psychiatrist will still be able to evaluate and diagnose you based on other information.
*A note on safety: If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors.
3. Get evaluated
Next, it’s time for your first appointment with your psychiatrist. This first psychiatry appointment has two main purposes: to start the diagnosis process and to begin building a strong patient-provider relationship.
A BPD assessment usually consists of different components. It can feel more formal or informal depending on each psychiatrist’s style.
Usually, psychiatrists will conduct a psychiatric evaluation to better understand your symptoms. This means they’ll ask questions about things like your:
Thoughts and feelings
Relationships
Mood and emotional ups and downs
Behaviors (like how you cope when you’re feeling triggered)
Answers to these questions can help them get a sense of whether your symptoms could be related to BPD. Your answers will also help them rule out any other conditions and provide diagnoses for co-occurring conditions like depression.
Some providers may also ask you to fill out multiple-choice questionnaires, like the McLean Screening Instrument for BPD, which are more formal instruments used to assess BPD. But there’s no single “test” for BPD that can definitively provide a diagnosis.
After conducting an interview and making their observations, psychiatrists will compare your symptoms with diagnostic criteria for BPD.
According to the standardized set of symptoms recognized by clinicians, you must experience the following symptoms to get a diagnosis of BPD:
Intense fear of abandonment
A pattern of unstable relationships with others
Unstable self-image or sense of self
Impulsive behaviors
Emotional instability
Chronic feelings of emptiness
Inappropriate, intense anger
Stress-related paranoia or dissociation
These questions can feel very personal — especially if it’s your first time seeking mental health treatment. But try to remember that your psychiatrist isn’t there to judge you. They simply need to get a complete picture of what's going on so they can make the most accurate diagnosis.
4. Be patient with the process
Depending on your psychiatrist’s observations, they may diagnose you with BPD. It will likely require multiple visits over a period of time to make an accurate diagnosis. They could also diagnose you with co-occurring mental health conditions like depression or anxiety.
If you receive a BPD diagnosis, you may experience mixed emotions. Some people find it validating to have a label or name for the emotional experiences they’ve gone through, while others may feel sadness because of internalized stigma or other reasons. Whatever your emotional reaction is to getting a BPD diagnosis is valid.
5. Start treatment
If your psychiatrist diagnoses you with BPD, it’s very important to get treatment. There’s a myth that BPD is untreatable, but that’s not true. Many treatment methods — especially dialectical behavior therapy (DBT) — have been found to help people with BPD feel better and build healthier relationships.
Some psychiatrists may offer DBT themselves if they have expertise in borderline personality disorder. But many psychiatrists focus on medication management. If your psychiatrist doesn’t offer therapy, they’ll likely walk you through other treatment options. You can ask them for a referral to a therapist who works with people who have BPD.
Medication isn’t typically the first-choice treatment for BPD, but, in many cases, it might help you manage your anxiety and mood. Over 90% of people who seek treatment for BPD are prescribed at least one psychiatric medication. Your psychiatrist will likely walk you through your options for medication and how each might help you.
Depending on your treatment plan with your psychiatrist, you may need to make follow-up appointments. These appointments are an opportunity to receive therapy, if offered, and medication management.
One way to prepare for an initial psychiatric appointment if you think you have BPD is to track patterns in your relationships, emotions and reactions over time. You can also bring examples of mood swings and triggers for impulsive behaviors you’ve experienced. All this information can help guide the assessment.
Bettina Rodgers RN, MSN-PMHNP
Clinical reviewer
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Getting a diagnosis for BPD and starting treatment can be a challenging but important step toward better mental health. A psychiatrist is one professional who can help. With the right support, you can begin managing your symptoms and improving your quality of life.
At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best.
Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we're here to help you make progress — wherever you are on your mental health journey.
Saya Des Marais
Saya graduated with her Master in Social Work (MSW) with a concentration in mental health from the University of Southern California in 2010. She formerly worked as a therapist and motivational interviewing trainer in community clinics, public schools, mental health startups, and more.
Her writing has been featured in FORTUNE, GoodRX, PsychCentral, and dozens of mental health apps and therapy websites. Through both her clinical work and her personal OCD diagnosis, she’s learned the importance of making empathetic and accurate mental health content available online.
She lives in Portland, Oregon but you can find her almost just as often in Mexico or in her birthplace, Tokyo.
Bettina Rodgers RN, MSN-PMHNP
Bettina is a board certified Psychiatric Nurse Practitioner with over 21 years of experience as a Registered Nurse specializing in mental health. Her background includes extensive work in inpatient and outpatient psychiatric care, crisis intervention, and patient education. She has received advanced training in psychopharmacology and mental health leadership. She is dedicated to promoting overall wellness through a holistic, patient-centered approach.
Bettina is passionate about mental health because it allows her to have honest, down-to-earth conversations and truly connect with people on a deeper level. Outside of work, she loves traveling to new countries with her sister — and sharing those adventures with others. For Bettina, mental healthcare is about meeting people where they are, building trust, and helping people find their way forward.
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