How Borderline Personality Disorder Can Distort Thinking Processes

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Borderline personality disorder (BPD) is associated with a few different thinking-related problems. These cognitive problems often contribute to other symptoms, including relationship problems, emotional instability, and impulsive behavior. Some treatments for BPD focus on addressing these problems in thinking.

This article discusses some of the thinking problems that are characteristics of borderline personality disorder. It also explores some treatments that can help people manage these thinking problems.

Paranoid Ideation

Many people with BPD experience paranoia as part of their disorder; they believe that others harm them without basis in reality.

This type of thinking typically does not happen all the time. Instead, it tends to occur when a person is experiencing stress. These paranoid thoughts are transient, usually lasting a few days or weeks.

Research suggests that 87% of people with borderline personality disorder experience paranoid ideation.

Chronic paranoid ideation, the long-standing and unchanging delusional beliefs that others plan to harm you, may indicate a psychotic disorder, such as schizophrenia. This can be a debilitating symptom, making the person with BPD feel constantly threatened, even by friends, coworkers, and family.

People with BPD may believe that others have hostile intent toward them. They may see signs of this that reinforce this belief all around them. For example, they might believe there are hidden meanings in people's words, gestures, body language, and eye glances. Because of this, they may feel suspicious and distrustful of others.

Dichotomous Thinking

People with BPD also have a tendency to think in extremes, a phenomenon called "dichotomous" or “black-or-white” thinking. People with BPD often struggle to see the complexity in people and situations and are unable to recognize that things are often not either perfect or horrible, but are something in between.

Dichotomous thinking can lead to "splitting," which refers to an inability to maintain a cohesive set of beliefs about oneself and others. Because of these extreme patterns of thinking, people with borderline personality disorder are prone to slip from one side to the opposite side in their thinking.

For example, they might one day believe their partner is the most wonderful, loving person in the world. The next day, they may think their partner is evil, hateful, and contemptuous. This can harm their potential to hold lasting interpersonal relationships and how they can interact with others.


Another problematic pattern of thinking that occurs in BPD is dissociation. This thinking problem has less to do with the content of thoughts and what people think about, but rather the process of perception.

Dissociation is a common symptom of BPD that involves feeling “unreal,” numb, or separate from one’s own body or psychological experiences. In most cases, people with BPD don't experience this symptom all of the time. Instead, it tends to emerge during times of stress.

Some experts believe that dissociation is a way of coping with very intensely emotional situations by “shutting down” or separating from the experience. This distance can cause people to take more risks since they do not feel connected to the situation.

BPD Treatments

Historically, BPD was regarded as very challenging to treat. More recent evidence indicates that treatments can be effective and help people with the condition cope with thinking problems and other symptoms. Psychotherapy is the most commonly recommended treatment, but medications are also sometimes prescribed.


Most psychotherapies for borderline personality disorder include strategies for addressing the problems in thinking that are characteristic of BPD. Some therapies accomplish this indirectly by working on problems in relationships, as in transference-focused psychotherapy, and some try to intervene directly with thoughts and thinking patterns.

For example, in dialectical behavior therapy (DBT), clients are taught grounding skills, which can help them end dissociative episodes when they occur.

In schema-focused therapy, clients learn the origins of their ways of thinking (for example, many people with BPD come from childhood environments that may promote dichotomous thinking patterns), and work with their therapist and on their own to recognize maladaptive ways of thinking and to change those patterns.


Medications are typically prescribed to manage specific symptoms of BPD. They are often used alongside psychotherapy rather than as a stand-alone treatment.

Mood stabilizers, antidepressants, anti-anxiety medications, and antipsychotics are a few types that may be used. Specific medications that might be prescribed include:

  • Abilify (aripiprazole)
  • Ativan (lorazepam)
  • Buspar (buspirone)
  • Effexor (venlafaxine)
  • Lithobid (lithium)
  • Prozac (fluoxetine)
  • Risperdal (risperidone)
  • Zoloft (sertraline)

These medications can help reduce symptom severity, improve functioning, and treat co-occurring conditions. That can also play a role in decreasing the risk of suicide, which is higher in people who have BPD.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

People with BPD are often affected by several types of distorted thinking. Some ways that a person with BPD thinks include having paranoid ideation, dichotomous thinking, and dissociation. 

If you believe that you might be experiencing thinking associated with BPD, talk to your doctor. They can evaluate your symptoms and refer you to a mental health professional.

Fortunately, BPD is a treatable condition. Psychotherapy can help people address some of the thinking problems that they experience. Medications may also aid in treating symptoms. With the right treatment, you can better cope with the thinking problems characteristic of the condition.

6 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Zanarini MC, Frankenburg FR, Wedig MM, Fitzmaurice GM. Cognitive experiences reported by patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up studyAm J Psychiatry. 2013;170(6):671-679. doi:10.1176/appi.ajp.2013.13010055

  3. Arntz A, Ten haaf J. Social cognition in borderline personality disorder: evidence for dichotomous thinking but no evidence for less complex attributions. Behav Res Ther. 2012;50(11):707-18. doi:10.1016/j.brat.2012.07.002

  4. Vermetten E, Spiegel D. Trauma and dissociation: implications for borderline personality disorder. Curr Psychiatry Rep. 2014;16(2):434. doi:10.1007/s11920-013-0434-8

  5. Choi-kain L, Finch E, Masland S, Jenkins J, Unruh B. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007%2Fs40473-017-0103-z

  6. National Institute of Mental Health. Borderline personality disorder.

Additional Reading
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. American Psychiatric Association: 2013.
  • Glaser J-P, Van Os J, Thewissen V, Myin-Germeys I. "Psychotic Reactivity in Borderline Personality Disorder." Acta Psychiatrica Scandinavica, 121(2):125-134, 2010.

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.