DBT-Informed Therapy for Intense Emotions and Borderline Personality Traits
If your feelings arrive like a wave you did not see coming, you already know the aftermath. A comment that stings for days. A relationship that swings from perfect to unbearable in an afternoon. A flash of anger or despair that feels enormous in the moment and leaves you exhausted and ashamed later. Many people in this place have been told they are "too much" or "too sensitive," or have quietly wondered whether something is wrong with their personality itself. The good news is that these patterns are some of the most treatable in mental health, and therapy for personality disorders has come a long way.
I'm Dr. Matthew McKeithan, a licensed clinical psychologist with 15 years of experience helping people with trauma, anxiety, and emotional intensity. In this article I'll explain what personality disorders and borderline personality traits really are, how DBT-informed therapy helps, what the research says, and what getting started looks like. If you are in Huntington Beach or elsewhere in Orange County and want support by secure video, I'll cover that too.
Key takeaways
Borderline personality traits often involve intense emotions, unstable relationships, a shaky sense of self, and fear of abandonment.
Dialectical behavior therapy (DBT) was designed for exactly this, and research shows it can reduce self-harm and hospitalization.
Long-term studies show that many people with borderline personality disorder improve substantially over time.
DBT-informed individual therapy teaches practical skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Trauma often sits underneath these patterns, so treatment works best when both are addressed.
What are personality disorders?
A personality disorder is a long-standing pattern of thinking, feeling, and relating that causes real distress or problems in work, relationships, or daily life. Clinicians describe ten recognized types, grouped into three clusters: those marked by odd or eccentric patterns, those marked by dramatic and emotional patterns, and those marked by anxious and fearful patterns. Borderline, narcissistic, avoidant, and obsessive-compulsive personality disorders are among those people ask about most.
The word "disorder" sounds harsh, and I understand why many people recoil from it. In my experience these patterns are almost always coping strategies that made sense at some earlier time, often in painful or unpredictable surroundings, and that have outlived their usefulness. A diagnosis is a description, not a verdict on who you are.
What borderline personality traits can look like
Borderline personality disorder, or BPD, is the pattern people most often search for when they describe emotional intensity. Common features include:
Emotions that shift quickly and run hot, with a slow return to baseline.
Intense relationships that swing between idealizing and feeling deeply hurt or angry.
A strong fear of abandonment, real or imagined.
An unstable sense of identity or self-worth.
Impulsive choices, such as spending, substance use, or risky behavior, when emotions peak.
Chronic emptiness, or thoughts of self-harm during emotional crises.
You can have some of these traits without meeting criteria for the disorder. Only a licensed professional can assess that. If you ever have thoughts of harming yourself, please call or text 988 right away. Support is available around the clock.
Why emotions feel so big
One helpful way to understand this pattern is the biosocial model developed by psychologist Marsha Linehan. It proposes that some people are born with a more emotionally sensitive nervous system, reacting faster, more strongly, and taking longer to settle. When that sensitivity meets an environment that dismisses, punishes, or misreads their feelings, the person never learns how to name and manage emotions. They are left feeling that their reactions are wrong.
That framework changes the question from what is wrong with you? to what skills did you never get a chance to learn? Skills can be taught, and that is why DBT has been so hopeful for so many people.
What DBT-informed therapy actually is
Dialectical behavior therapy was created by Linehan in the late 1980s for people with chronic suicidal thoughts and intense emotions. "Dialectical" means holding two truths at once: you are doing the best you can, and you need to learn new ways to cope. Acceptance and change are not opposites. They work together.
Full DBT programs typically include individual therapy, a skills group, phone coaching, and a therapist consultation team. What I offer is DBT-informed individual therapy, which weaves core DBT skills and principles into one-on-one sessions. It is a flexible approach that suits many people who want practical tools without a full program, though people who need a comprehensive DBT program can be referred to one.
The four skill areas, in plain English
Mindfulness: noticing what you feel and think without being swept away by it. The aim is a "wise mind" that holds both emotion and reason.
Distress tolerance: getting through a crisis without making it worse, using tools like distraction, self-soothing, and radical acceptance of what you cannot change right now.
Emotion regulation: understanding your emotions, reducing vulnerability to them through sleep, nutrition, and routine, and practicing "opposite action" when an emotion urges you toward something unhelpful.
Interpersonal effectiveness: asking for what you need, saying no, and protecting relationships and self-respect at the same time.
In session, we do not just talk about these skills. We practice them with real situations from your week, and we troubleshoot what got in the way.
What the research says
The landmark early trial by Linehan and colleagues compared DBT with treatment as usual in women with borderline personality disorder and chronic self-harm. Those receiving DBT had fewer episodes of self-harm, fewer days in the hospital, and were more likely to stay in treatment. Many later studies by other researchers have supported DBT's usefulness.
Perhaps even more encouraging is long-term follow-up research. A 16-year prospective study by Zanarini and colleagues found that most people with borderline personality disorder eventually achieved sustained remission of their symptoms. Borderline traits are not a life sentence. Most people get better, and treatment can speed the road.
A word from the home front
I will admit something. I use these skills in my own house. With four kids, there are evenings when the noise level and my patience seem to have a bet going. Last week, with a toddler-sized meltdown happening at the same time as a dinner burning, I caught my own pulse climbing and ran a quick version of what I teach: pause, name the feeling, take a slower breath, and choose the next small step instead of the first reaction. Did it make me a zen master? No. Did the dinner survive? Mostly.
Walt Whitman wrote, "Do I contradict myself? Very well then I contradict myself, (I am large, I contain multitudes.)" I think of that line when clients worry that feeling both love and anger toward the same person means they are broken. It does not. Dialectics begins with the idea that two things can be true together.
The role of trauma
Many people with intense emotions and unstable relationships have also lived through trauma, especially in childhood. The nervous system learned that the world was unpredictable and adapted. That is why treatment often blends skills for the present with processing for the past.
I usually build stability first, so you have tools to calm the storm, and then address trauma at a pace you can handle. For more on how I approach this work, you can explore trauma therapy at Your Kind of Happy. Somatic practices can help too, because strong emotions live in the body, and learning to settle the body makes the skills easier to use.
What to expect when you begin
The first sessions focus on understanding what you are experiencing, what you want to change, and what is working. I will ask about your history, your relationships, your safety, and your goals. We then agree on priorities: safety first, then the behaviors that get in the way of therapy, and then the things that would make your life feel more worth living.
Sessions are structured but warm. You may track emotions and urges between sessions using a simple diary card, which gives us real data to work with. Progress is rarely a straight line. There are good weeks and hard weeks, and both teach something.
DBT-informed therapy by secure video for Huntington Beach and Orange County
Life in Huntington Beach can be busy, and getting to appointments is one more demand when your emotional energy is already stretched. Secure video therapy lets you meet from home, which many clients find helpful when emotions run high and they want to practice skills in their real environment.
Research on telehealth has been encouraging for common mental health conditions. A systematic review by Greenwood and colleagues found comparable outcomes between video and in-person psychotherapy for the conditions it examined, although borderline personality disorder was not its focus. We would review together whether video is a good fit for what you need.
What you can try this week
Name the emotion. Say "I'm feeling anger" or "I'm feeling shame" rather than "I am angry." That small shift creates room.
Pause before acting. When an urge hits, wait 10 minutes before responding to a message or making a big decision.
Check the facts. Ask yourself what actually happened versus what the feeling is telling you.
Protect your baseline. Sleep, regular meals, and movement lower emotional reactivity more than most people expect.
Be curious about your patterns. Notice what tends to happen right before the big feelings.
These are small starts, and they work best alongside professional support.
Your next step
If you have been carrying the label of being "too much," please hear this: you may simply need different skills and someone steady in your corner. When you are ready, Book a free 15-minute consultation or schedule a full session. You can also browse more articles on the Your Kind of Happy blog.
About the author
Dr. Matthew McKeithan, Psy.D., is a licensed clinical psychologist licensed in California and South Carolina, with 15 years of experience working extensively with trauma. He provides integrative, trauma-informed counseling for individuals and couples, including CBT, ACT, EMDR, somatic work, and DBT-informed individual therapy. He is a husband and father of four. Sessions are offered by secure video across California. Learn more about Dr. McKeithan.
Serving Huntington Beach and Orange County by secure video, along with clients across California.
This article is for educational purposes and isn't a substitute for an individual evaluation, therapy, or medical advice. If you are in crisis, call or text 988.
Sources
Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry. 1991;48(12):1060-1064.
Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. American Journal of Psychiatry. 2012;169(5):476-483.
Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.
Greenwood H, Krzyzaniak N, Peiris R, et al. Telehealth versus face-to-face psychotherapy for less common mental health conditions: systematic review and meta-analysis of randomized controlled trials. JMIR Mental Health. 2022;9(3):e31780.
Whitman W. "Song of Myself," Leaves of Grass. 1855.