Getting diagnosed with a personality disorder

Getting a diagnosis can bring relief, fear, or both. For many people, a clear name finally explains years of hard relationships, strong feelings, or feeling "different." For others, the label feels scary or unfair. Both reactions are normal.

A personality disorder is a long-lasting pattern of thinking, feeling and acting that is rigid, causes real distress, and affects daily life.² It is not a character flaw, and it is not a sign of weakness. This page explains how a careful assessment works, which other conditions can look similar, and why getting it right matters. Diagnosis is the first step toward treatment that works.

How is a personality disorder diagnosed?

The diagnosis is made by a mental health professional, such as a psychiatrist or psychologist. They look at long-term patterns, not one bad week.² A medical exam may also be done to rule out other causes.¹

A typical assessment includes:

• A conversation about your symptoms, your history and your family history, including any past mental illness.¹
• Questions about patterns over many years. How do you handle strong feelings? How do your close relationships go? How do you see yourself? How do you act when you are upset?²
• A look at earlier records. The clinician may read past notes and evaluations. With your permission, they may also talk with friends or family who know you well.⁴
• A check for other conditions and medical causes, since many illnesses can look alike.¹

The professional compares what they learn with the standard list of symptoms in the diagnostic manual used in the United States, called the DSM-5-TR. It lists 10 specific personality disorders.² You can read about them on our page on other personality disorders.

No single sign settles the question. For BPD, the diagnosis is "not based on one specific sign or symptom," and the process may take more than one visit.⁴

How common are personality disorders?

In one large U.S. survey, about 9 in 100 adults (9.1%) had a personality disorder in the past year. About 1 in 70 adults (1.4%) had BPD.³ That survey is from 2001 to 2003, so today's numbers may differ. Either way, you are far from alone.

What about age?

A personality disorder usually starts to show by late adolescence or early adulthood.² Because a teenager's personality is still forming, doctors are careful with the diagnosis in people under 18. Still, a teen may be diagnosed with BPD when symptoms are severe and have lasted at least a year.¹

For a young person, early help matters more than the label. In the United Kingdom, national guidance says a young person with suspected BPD should be referred to child and adolescent mental health services for assessment and offered the full range of treatments.⁸ Personality can also change late in life for other reasons. If you notice a big change in an older loved one, see personality disorders and personality change in later life.

Conditions that can look like BPD

Many conditions share features such as strong emotions, impulsive acts and rocky relationships. They can also happen together with a personality disorder.^1,4 Sorting this out takes time and good questions. Here are three common examples.

Bipolar disorder

Both conditions involve big mood changes, so they are often confused. The timing and the kind of mood are different.

The key difference is mood that is truly high. In BPD, symptoms happen without the very high mood or energy of mania or hypomania (a milder form of mania) seen in bipolar disorder.¹ Impulsive acts that happen mainly during a high mood may point to a mood disorder instead.¹

The two can also be present together. Your clinician will look at your whole life story, not just how you feel today.⁵ This matters because the treatments differ. See getting diagnosed with bipolar disorder for the other side of the picture.

PTSD and complex PTSD

Post-traumatic stress disorder (PTSD) grows out of a frightening or harmful event. Complex PTSD, a diagnosis in the World Health Organization's ICD-11 system, follows long-lasting or repeated trauma.⁷ Like BPD, it can involve trouble with feelings, self-image and relationships.⁷

Some differences clinicians look for:⁷

• Complex PTSD requires a traumatic stressor. BPD does not.
• Self-harm, impulsive acts and suicidal behavior are more common in BPD.
• In BPD, the sense of self often swings. In complex PTSD, it tends to stay negative.
• In BPD, relationships can swing from very close to very rocky. In complex PTSD, people more often pull away.

Researchers still debate how the two fit together, and many people have both.⁷ PTSD is also common among people with BPD.^1,4 The good news is that therapies for the two share many parts. Read more in getting assessed for PTSD.

ADHD

Adult attention-deficit/hyperactivity disorder (ADHD) and BPD share impulsivity and trouble managing feelings. A research review found that the two share many symptoms. It is not yet clear whether they happen together by chance or share roots.¹⁰

A clue for adults: ADHD symptoms must have started in childhood, before age 12. Because of this, an adult evaluation relies on past reports, such as school records or the memories of family.⁶ See getting an adult ADHD diagnosis for what that looks like.

Others on the list

Depression, anxiety, substance use and eating disorders are also more common in people with BPD.^1,4 If alcohol or drugs are part of the picture, say so. It helps the clinician understand your symptoms, and it is not a reason to be judged. Our page on substance use explains help that is available.

Stigma and misdiagnosis

Few diagnoses carry as much stigma as personality disorders. Some people have been dismissed or treated as "difficult." UK guidance reminds services that many people with BPD have faced rejection, abuse or trauma, and often face stigma tied to self-harm and the diagnosis itself.⁸ It says a person should never be shut out of a health or social care service because of the diagnosis or because of self-harm.⁸

Misdiagnosis happens in several ways:

• Missed or mixed up. Overlapping symptoms make BPD hard to diagnose and treat.⁴ A person may get a bipolar, depression or PTSD label instead, or be told they have BPD when something else is going on.
• Men are often missed. NAMI reports that recent research finds BPD in men at rates close to those in women, yet men are often misdiagnosed with PTSD or depression.⁴
• A label given in a crisis. UK guidance advises reviewing a diagnosis if it was made during a crisis, before treating a second condition.⁸

A wrong label can lead to the wrong treatment, and that can leave a person feeling even more hopeless. If a diagnosis does not fit your experience, you are allowed to say so and ask for another look.

Why a careful assessment helps

A good assessment is not about putting you in a box. It helps in practical ways.

• It points to treatment that fits. Talk therapy is the main treatment for personality disorders. Medicines are not used to treat the disorder itself, though they can ease some symptoms such as depression or anxiety.² See treatment for personality disorders and DBT skills.
• It treats the whole picture. When two conditions are present, treatment should address both.⁴
• It brings hope. BPD is the most studied personality disorder, and the outlook is encouraging. In a well-known 10-year study, about 7 in 8 people with BPD had a symptom-free stretch of at least four years. About half were fully recovered, meaning they no longer met the criteria and were doing well in work and relationships.⁹ Evidence-based treatments help many people have fewer and milder symptoms.¹
• It can bring understanding. A name can help family members understand what is going on. See supporting someone with a personality disorder.

How to get ready for an assessment

1. Write a short timeline. Note when the hard patterns began and what helped or made things worse. A one-page list is enough.
2. List what you take. Include prescriptions, over-the-counter products, supplements, alcohol and other substances.
3. Bring a trusted person if you like. A friend or family member may remember things you forget. With your consent, they can share what they have seen.
4. Share your past care. Bring earlier diagnoses, names of past clinicians and any hospital papers if you have them.
5. Ask questions. What are you looking at? What else could this be? What do you recommend next, and why?

If English is not your first language, ask for an interpreter. UK guidance says treatment should be offered in a person's preferred language where language is a barrier.⁸ You can also ask for written information to take home. It is fine to take time before deciding what comes next.

When to get help

Please reach out if intense emotions, rocky relationships or impulsive acts are hurting your life, your health or your family. You do not need a diagnosis first. A primary care visit is a good start, and our help page lists more places to turn.

People with BPD have higher rates of self-harm and thoughts of suicide than other people.¹ If you are having thoughts of suicide or of hurting yourself, you are not alone and help works. Call or text 988 (the Suicide & Crisis Lifeline), or chat at 988lifeline.org. If you or someone else is in immediate danger, call 911. You can also build a plan for hard moments with our safety plan tool.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.