DBT and borderline personality disorder

DBT was originally developed for people with BPD and has the strongest evidence base there. That association is accurate, and it is also the reason many people who would benefit never consider it.

Why the two are linked

Marsha Linehan developed DBT while working with people experiencing chronic suicidal thoughts and self-harm, many of whom met criteria for borderline personality disorder. The approach was built around the difficulties those clients actually presented with: emotions of unusual intensity, a slow return to baseline, impulsive behaviour, and relationships that felt unstable.

DBT went on to become one of the most studied psychological treatments for BPD.

What BPD involves

Borderline personality disorder is characterised by persistent difficulties with emotion regulation, self-image, impulsivity and relationships. It is a clinical diagnosis, made by a qualified professional after proper assessment, and it is not something to conclude from a website or an online quiz.

It also carries more stigma than almost any other mental health diagnosis, much of it based on outdated ideas about whether people recover. They do.

You do not need a diagnosis to benefit

This is the part worth saying plainly. DBT skills address emotional intensity, impulsivity, distress and interpersonal difficulty. Those are experiences, not diagnoses, and plenty of people have them without meeting criteria for BPD.

People join skills groups after burnout, during a difficult period, alongside anxiety or depression, or simply because they know their reactions cost them more than they should. None of that requires a personality disorder diagnosis.

If you do have a BPD diagnosis

A skills group teaches the skills component of DBT. Comprehensive DBT ordinarily also includes individual therapy, phone coaching and a clinician consultation team. Whether a skills group alone is appropriate depends on your circumstances and is exactly what a suitability screening is for.

See DBT skills groups vs comprehensive DBT for the distinction.

A note on language

Some clinicians and many people with lived experience prefer terms such as complex trauma or emotion dysregulation, on the grounds that “personality disorder” locates the problem in who someone is rather than what has happened to them. That debate is unresolved. What matters practically is that the skills are useful regardless of the label attached.