Borderline personality disorder, commonly referred to as BPD, is an example of a commonly misunderstood mental health illness among the public. This misunderstanding often contributes to the stigma individuals experience when living with BPD. Research has indicated that there is a prevalence of 1.6% among the general population and that approximately 20% of those in an inpatient psychiatric program are living with BPD. Keep reading to learn 60 borderline personality disorder questions to ask clients in therapy.

Individuals who are living with borderline personality disorder often experience a combination of symptoms that have a significant impact on their daily lives. As a cluster B diagnosis, BPD is known to cause individuals to have a hypersensitivity to rejection which leads to patterns of unhealthy relationships, poor self-image, and disrupted affect and behaviors.

Several diagnostic tools can be used to assess for BPD in a clinical setting. You may choose to begin with a structured assessment that includes self-report measures or use diagnostic tools including:

McClean screening instrument for borderline personality disorder

Personality diagnostic questionnaire

The Minnesota Borderline Personality Disorder scale

The personality assessment inventory-borderline features scale

A client with BPD may have comorbid disorders that are increasing their level of distress, which should be assessed during their BPD assessment. Comorbid disorders may include:

Mood disorders

Anxiety disorders

Substance use disorder

Eating disorders

ADHD

Bipolar disorder

Somatoform disorders

Treatment options for borderline personality disorder often include psychotherapy and a specialized treatment approach for clients who are living with co-occurring disorders. Therapeutic approaches that are commonly used with individuals who are living with BPD include metalizing-based therapy (MBT), dialectical-behavioral therapy (DBT), transference-focused psychotherapy (TFP), and family therapy.

While there are no medications specifically used for BPD treatment, medications may be used to help individuals with symptoms that they experience as a component of their mental illness. This can include mood stabilizers, SSRIs, and mood stabilizers. 

Getting Ready for Your First Therapy Session with a New Client with Borderline Personality Disorder

Preparing for a session with a new client who is living with BPD will likely look similar to others preparing for sessions with other new clients. You may find yourself reviewing paperwork you have received, including referral paperwork and questionnaires the client has completed before your session. Consider reviewing the paperwork you will be completing for your client chart. This can help you develop a rough template of how your session will proceed based on your familiarity with it.

If you like to incorporate worksheets into your session, TherapyByPro can be a valuable resource. With various therapeutic approaches that can be incorporated into treatment plans for those living with BPD, TherapyByPro offers a healthy range of BPD worksheets and templates.

Last but not least, it is important to check in with yourself and your needs. Being a clinician can cause us to lose sight of ourselves. Take a few minutes to stretch, meditate, drink a lot of water, and eat a light snack before meeting with a new client. By giving ourselves a quick break, we can be more attentive and engaged.

Borderline Personality Disorder Questions to Ask Clients in Therapy

When you are working with clients who are living with borderline personality disorder, it is important to be mindful of how to talk about their mental health and their symptoms. Clients who have been actively struggling, and those who do not fully understand their diagnosis, may believe that their symptoms are reflective of who they are. This pattern of thinking can be harmful to their self-esteem, which can exacerbate their symptoms. Borderline personality disorder questions can provide you with an opportunity to model healthy thought processes related to your client’s experienced symptoms.

Questions asked to diagnose borderline personality disorder will differ from the questions that you ask a client who has already received their diagnosis. The questions that you ask during an intake session will embody the symptoms outlined in the DSM 5-TR so that you can explore the validity of a BPD diagnosis. Continue reading for questions that can be used during an intake to assess for borderline personality disorder symptoms!

Can you tell me about what led to you coming in today?

Is there anything about your mental health that you feel is most impactful on the other areas of your life?

What are some of the challenges or difficulties that you are facing?

Can you tell me a bit about your childhood?

How would you describe your relationships with the adults in your life as a child?

How do you feel about being alone?

Can you tell me about your thoughts and emotions if someone distances themselves or ends a relationship with you?

Can you tell me about the important relationships in your life?

Do you find yourself stressed, worried, or anxious about your relationships?

Do you find that you are texting, calling, or communicating with your partner or friends consistently during the day?

How do you feel when you are unable to reach someone, or they don’t answer you right away?

Can you tell me how you cope in those situations?

Can you tell me about the progression of your friendships and romantic relationships?

Have there been any common threads regarding the reasons your relationships end?

Do you find that you feel relieved when your partner reassures you?

How often do you find yourself wanting reassurance from your partner?

What comes up for you when you are feeling as though you haven’t been receiving the reassurance you would like?

Can you tell me about your values?

How have your values evolved?

Do you feel as though your values are impacted by those around you?

How would you describe yourself?

Do you feel as though you have a steady self-image, or is this something that changes for you?

Can you tell me what hopeless means to you? Is there a time that you experienced this that stands out to you?

Has there been a time in your when you have felt powerless?

Can you tell me about any impulsivity you’ve experienced?

Has there been a time when you were driving recklessly without worry of the possible consequences?

Please tell me about your substance use.

Has there been a time when you did not use safer sex practices?

Can you tell me about your experiences with depression?

Has there been a time in your life when you considered, planned to, or attempted to kill yourself?

Has there been a time when you told others you would hurt yourself, and maybe weren’t sure that’s what you wanted to do?

Has there been a time in your life when you were hospitalized because of your mental health?

Did you learn anything helpful during that time?

How would you describe your mood?

Do you experience mood swings? About how long do you feel they typically last?

Are there any emotions that you find harder than others?

Do you feel as though you can control your emotional experiences? For example, if you are feeling mad, do you know how to manage it?

What are some of your coping skills when you are distressed?

Is there someone in your life that you rely on for support?

Can you tell me about your experience with anxiety?

Do you find yourself worrying often?

Can you think of a time that you felt emptiness? What was this experience like for you?

How would you describe your experience with anger?

Do you find yourself feeling angry often?

Can you tell me about some of the things that make you angry?

Can you think about a time when feeling angry led to you hurting yourself or others?

How has your anger affected your relationships?

Have you experienced any personal consequences for your anger?

Do you feel as though others understand you?

Can you tell me about a time when you felt mistreated?

How often would you say that you feel mistreated or misunderstood?

How would you describe your outlook on the world around you?

Do you find that you view things as right and wrong? Or are there ever areas of gray?

Can you think of a time when you were stressed and felt paranoid? What was happening at that time?

Has there been a time when you disassociated as a result of feeling g stressed?

Do you have any expectations of how you could benefit from counseling?

Can you tell me about any previous counseling experiences you have?

How do you feel that your mental health symptoms affect different areas of your life?

Can you think back to the time you began to notice some of the symptoms we have been exploring? Do you recall how old you were?

How can I best support you?

Final Thoughts on Borderline Personality Disorder Questions to Ask Clients

It’s a pleasure to have you read our post on common borderline personality disorder questions that clients have! Clients who are living with BPD can experience difficulties in various aspects of their life, including within their relationships, their careers, and with other responsibilities. When we use evidence-based and effective treatment strategies, we can help our clients learn to manage and maintain their mental health symptoms.

As your clients decide which treatment strategies they would like to use, you can provide them with unbiased support as they assist in the development of their treatment plan. Your client’s preferences for treatment approaches can be influenced by previous treatment episodes and related stigmas that they experience. Individuals living with BPD often benefit from working with a multidisciplinary team that can provide comprehensive, and holistic care.

If you are working in a clinical setting with clients who are living with BPD, or you find yourself wanting to learn more about borderline personality disorder and effective treatment approaches, we encourage you to look for continuing education opportunities in your area.

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Resources:

Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2023 Jun 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/

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