Living With Co-Occurring Borderline Personality Disorder and Depression

Co-occurring borderline personality disorder (BPD) and depression is a complicated diagnosis. Treatment is challenging but effective if both issues are addressed together. Living with BPD and depression makes normal functioning difficult. Treatment, healthy lifestyle habits, stress relief, social support, and building stronger relationships all help improve function and make living with this dual diagnosis easier.

Borderline personality disorder (BPD) and depression are both serious mental illnesses. They each interfere with the ability to establish and maintain healthy relationships and function normally in day-to-day life.

If you are living with both conditions, you may experience worse and more frequent symptoms, more disruptions, and other complications.

Enjoying life with co-occurring BPD and depression may seem impossible, but with treatment, support, and self-care, you can.

How Borderline Personality Disorder and Depression Can Affect You


Borderline personality disorder is a mental health condition and personality disorder. Like other personality disorders, BPD affects how you see the world, how you view yourself, how you relate to others, and how you behave and react. BPD specifically causes:

  • Difficulty creating a self-identity, even feeling empty inside or as if you don’t exist
  • Intense fear of being abandoned by loved ones
  • Threats of suicide or self-harm
  • Unstable personal relationships
  • Paranoia and loss of touch with reality
  • Impulsive and risky behaviors
  • Intense mood swings
  • Emotional outbursts

With BPD, you have a hard time being alone and figuring out who you are. Emotional outbursts, inappropriate reactions, and anger make satisfying relationships difficult. You may often feel empty or lost, as if you’re a bad person and that others will abandon you.

Depression is also a serious mental illness. It causes persistent feelings of sadness and hopelessness along with anhedonia, the inability to find pleasure in anything. During episodes of depression, you may also have changes in sleep and how you eat, feel anxious or restless, and have difficulty concentrating. Depression can make you feel worthless and guilty and drain your energy.

What Happens When BPD and Depression Co-Occur?


BPD is a disruptive, difficult condition, and it often occurs along with other mental health disorders. Many people with BPD also have depression. The co-occurrence complicates each condition and can make symptoms worse.

The experience of depression with BPD has some significant differences as compared to depression alone:

  • Earlier onset of symptoms
  • More severe symptoms
  • More persistent episodes and symptoms
  • Episodes more often triggered by interpersonal relationships and conflicts
  • An increased risk of suicidal behaviors
  • An increased risk of self-injury
  • Greater impairment in social skills

Researchers have also found that people with depression and BPD respond less well to medications to treat depression. Treatment for depression is more effective when the BPD is under control or being managed with effective treatments.

How to Cope and Live Well With Both BPD and Depression


The prognosis for a diagnosis of both depression and BPD is worse than either condition alone. It can feel hopeless facing this dual diagnosis, but there is hope. With good treatment and support from caring loved ones, it’s possible to enjoy life and to have good relationships.

1. Get Professional, Evidence-Based Treatment for Both Conditions.

The most important thing you can do to manage BPD and depression is get treatment. Treating these two conditions is challenging and requires addressing both at the same time. Good treatment should also consider the way the conditions interact and affect each other.

Choose a treatment center experienced with co-occurring conditions. It is essential that your treatment plan is tailored to your unique needs. BPD with depression will not respond the same way to treatment designed for just one or the other. And BPD is not likely to improve if you only address and treat the depression.

A residential mental health facility is ideal for someone with both conditions. The response to treatment takes time in complicated cases like these. Staying in a residence for a several weeks or a few months allows you to focus on treatment and learning to manage your symptoms.

2. Bring Your Emotions Under Control.

One of the characteristics of BPD that makes it so disruptive is the emotional whirlwind you experience on a daily basis. Take steps to manage your intense feelings and you’ll be better able to cope, relate to other people, and avoid slipping into a depression.

Strong emotions are a reality of BPD, so don’t deny them. Recognize those feelings and accept them. Being mindful, staying in touch with the present moment, will help you live with the big emotions that feel as if they will take over.

In addition to accepting emotions as they arise, focus on physical sensations. Ground yourself in the present moment when emotions well up by paying attention to what you see, smell, feel, and hear.

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3. Reduce and Manage Stress.

Stress only makes symptoms worse, so anything you can do to keep it to a minimum will help. It’s not possible to eliminate all stress from your life, so also practice strategies for coping with it. Find what works best for you: meditation, breathing exercises, progressive muscle relaxation.

Another way to better cope with stress is to practice healthy lifestyle habits. When you feel good physically, you will better tolerate stress and difficult emotions. Get daily exercise, spend time outdoors, get adequate sleep each night, eat well, and avoid drugs and alcohol.

4. Practice Controlling Your Impulses.

Impulsivity is a common characteristic of BPD. You may engage in risky behaviors or lash out at people with little forethought. Impulsive behaviors that you later regret can also trigger depressive episodes. If you can learn to control impulses, you’ll feel better.

Many people with BPD act impulsively because they feel overwhelmed by difficult emotions. To get relief, you may do something you know you shouldn’t. To manage these impulses, you need to learn how to deal with and tolerate the bad feelings.

When emotions build to an intolerable level, pause and assess them. Name your feelings and accept them. It also helps to ground yourself in the moment. Focus on your senses and breathing to calm down. If these strategies fail, try a distraction: Watch TV, call someone, do chores around the house, or anything else that will take your attention away from the emotions you’re feeling.

5. Work on Improving Relationships.

Social support is a powerful tool against depression and other mental health issues. But maintaining positive, mutually beneficial relationships with BPF isn’t easy. Anger, emotional outbursts, threats, and neediness often drive people away.

Be proactive in developing better interpersonal skills and maintaining relationships with the people closest to you. Relationship therapy is useful. It will teach your loved ones about your conditions and how to communicate with you more effectively. You’ll learn practical skills in treatment for questioning your assumptions, not projecting negative emotions onto others, and managing how you interact with people when emotions are high.

6. Plan for a Crisis.

When you’re in the middle of a storm of emotions, you may struggle to do what you know will help or to tell others what you need. Make a plan with loved ones for how to deal with this situation, so they know what to do.

The plan should include a mental health first-aid kit with strategies, coping mechanisms, and objects that calm you and help you bring your feelings back under control. It could include a list of your proven stress busters like a scented candle you like, a favorite book, or sayings that you take comfort in. Whatever triggers calm for you will be ready and waiting if you experience a crisis.

Coping with this difficult dual diagnosis isn’t easy. Living with BPD or depression alone is hard enough, but the two interact and trigger and worsen symptoms. You can live well with complicated mental health issues, but it takes work. Keep up with treatment, even after a residential stay. Use coping mechanisms and the support of loved ones to live your best life.