How Borderline Personality Disorder Can Distort Thinking Processes

Young woman sitting on sofa, looking at distressed man at table

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Borderline personality disorder (BPD) is associated with a few different problems related to thinking. 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.

Paranoid Ideation

Many people with BPD experience paranoia as part of their disorder; they have beliefs that others mean them harm, without basis in reality. Most people with BP who have paranoia experience transient symptoms that occur under conditions of stress rather than all the time.

Chronic paranoid ideation, the long-standing and unchanging delusional beliefs that others plan to harm you, may be indicative of 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.

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. This 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 are prone to slip from one side to the opposite side in their thinking. For example, they might one day believe that their partner is the most wonderful, loving person in the world, and the next thing that they are evil, hateful and full of contempt. 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 has less to do with the content of thoughts, what people with BP 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.

Again, in most people with BPD, dissociative symptoms tend to occur under conditions of stress. Some experts believe that dissociation is actually 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, as they do not feel connected to the situation at hand.

BPD Treatments

Most psychotherapies for BP 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.

4 Sources
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  1. Muñoz-negro J, Prudent C, Gutiérrez B, Cervilla J. Paranoia and risk of personality disorder in the general population. Personal Ment Health. 2019;13(2):107-116. doi:10.1002/pmh.1443

  2. 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

  3. 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

  4. 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

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.