Borderline Personality Disorder Care in West Ashley, Charleston
Careful evaluation, talk therapy and follow-up for intense emotions and unstable relationships, in person or by secure video.
Understanding Borderline Personality Disorder
A personality disorder is a long-running way of thinking, feeling and acting that differs sharply from what others expect, and it generally takes shape by the late teens or early adult years, according to the American Psychiatric Association (APA). The APA frames BPD as a problem of emotional regulation: feelings arrive with great force and are hard to steer. NIMH calls it a serious mental illness built around four areas, which are difficulty managing emotions, acting on impulse, an unsteady sense of self and strained relationships.
Day to day, that can mean moods that change fast and hard, or an identity that seems to keep moving. Thinking may run to extremes, so that a friend or a job looks entirely good one week and entirely bad the next. Many people dread being left, react strongly to rejection and find that close relationships do not hold steady. Others describe a lasting emptiness, anger that is difficult to rein in, or dissociation, meaning a sense of being cut off from yourself or the world around you. Impulsive acts such as reckless driving can also occur. Signs vary a great deal in severity from one person to the next.
If You Are in Crisis
NIMH says self-harm and suicidal thoughts and behavior are far more common among people with BPD than in the general population. Any talk of self-harm or suicide needs a response right away. If you or someone you know is thinking of either one, call or text 988 now to reach the 988 Suicide & Crisis Lifeline, open at all hours. If a life is in danger, call 911 or go to the nearest emergency room now. Veterans and service members can reach the Veterans Crisis Line by dialing 988 and pressing 1. Hope Behavioral Medicine is not an emergency service, so please do not wait for an appointment.
How Common Is Borderline Personality Disorder?
NIMH estimates that 1.4 percent of U.S. adults had BPD in the past year. A second diagnosis is the rule more than the exception. NIMH survey data put the past-year figure for this group at 84.5 percent, and anxiety disorders came up the most, at 60.5 percent.
What Raises the Risk
Nobody has pinned down an exact cause. NIMH lists family history, differences in brain structure and function, and experiences such as childhood trauma, neglect or growing up with your feelings brushed aside. These are risk factors only. A person can carry several of them and never develop BPD, and a person with none of them can still have it.
How We Evaluate BPD
A diagnosis of borderline personality disorder is made by a qualified clinician using the DSM-5-TR, the American Psychiatric Association's diagnostic manual. In plain words, NIMH explains that a licensed mental health professional reaches it through conversation, going over your symptoms along with your personal and family history. Your provider may also suggest a medical exam, so that other explanations can be checked. Because this is a long-standing pattern, your provider will ask how things have gone across the years, not only how the last few days have felt. Diagnosis usually happens in the late teens or early adulthood, and occasionally before 18 if the condition is serious and has been present for a year or more. Our practice sees patients ages 18 and older.
The overlap with other conditions can make the picture harder to read. NIMH names depression, bipolar disorder, ADHD, PTSD, anxiety and eating disorders among the conditions that often appear with BPD. One useful clue is that BPD symptoms do not depend on the very elevated mood of mania or hypomania, so impulsive acts that happen mainly during such periods may point to something else. Sorting this out is the reason we take our time with an evaluation.
Treatment Options
NIMH says psychotherapy, or talk therapy, is the main treatment. It names dialectical behavior therapy (DBT), created specifically with BPD in mind, along with cognitive behavioral therapy (CBT). Our licensed counselors provide individual therapy using CBT, acceptance and commitment therapy (ACT) and trauma-informed care. We do not have a DBT program, so your care can include a referral when DBT looks like the better match. NIMH adds that therapy involving family or caregivers can also help, although more research is needed on how much it adds for BPD. We do not offer family therapy, so that would also mean a referral. The American Psychiatric Association's 2024 practice guideline calls for a written treatment plan built around you.
Medication is not the first treatment usually tried for BPD, and NIMH describes its benefits as unclear. A provider may raise it alongside talk therapy for particular symptoms or for a second condition such as depression. Any medication when indicated is decided jointly with the patient, and your provider reviews the treatment options with you at follow-up visits.
Supporting Someone With BPD
If someone you love has BPD, NIMH suggests learning about the condition, offering emotional support, patience and encouragement, and getting to know their treatment plan so you can back it. Take every mention of self-harm or suicide seriously, and use the crisis steps above. Caring for another person can wear you down. NIMH suggests finding your own counselor, separate from the one your loved one sees.
Getting Care in the Charleston Area
Charleston County has about one mental health provider for every 214 residents, compared with one for every 437 across South Carolina. Our office is on Gardner Road in West Ashley, and we also see adults anywhere in South Carolina by secure video, so you do not have to wait for a local opening or take time off to drive.
We accept Medicare, most major commercial plans, and all South Carolina Medicaid managed care plans except Select Health (First Choice). New patients are often able to be scheduled within a week of requesting an appointment.
Sources
The facts on this page come from: National Institute of Mental Health, Borderline Personality Disorder (2025); National Institute of Mental Health, Personality Disorders (statistics); American Psychiatric Association, Practice Guideline for the Treatment of Patients With Borderline Personality Disorder, Second Edition (2024); CMS National Provider Identification file, 2024, via County Health Rankings & Roadmaps, 2025.
Common Symptoms
Treatment Options
Frequently Asked Questions
Emotions may hit hard and change quickly, relationships may feel unsteady, and your sense of who you are may shift. Many people also fear being left. Signs differ from one person to the next.
NIMH notes that BPD symptoms happen without the very elevated mood of mania or hypomania. The two can occur together, so a qualified clinician looks closely at your history.
No. NIMH says talk therapy is the main treatment. A provider may suggest medication alongside it for particular symptoms or for a condition such as depression, decided jointly with the patient.
We offer individual counseling from licensed therapists, using CBT, ACT and trauma-informed care. We do not have a DBT program, and your care can include a referral if DBT looks like the better match for you.
Yes. NIMH suggests that people caring for a loved one with BPD consider counseling of their own, with a therapist other than the one their loved one sees.
NIMH estimates that 1.4 percent of U.S. adults had BPD in the past year.