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What strategies do people with borderline personality disorder use to maintain their well-being and performance at work?

Borderline Personality Disorder and Emotion Dysregulation volume 12, Article number: 18 (2025) Cite this article

Abstract

Background

People with borderline personality disorder (BPD) often experience instability in their career paths. Previous studies have mainly focused on their challenges in work participation. There has been limited attention on their job tenure strategies. This qualitative study aimed to identify job tenure strategies of people with BPD who are currently employed.

Methods

Between November 2021 and March 2024, participants completed an online survey combining questionnaires and qualitative open-ended questions covering eleven themes, such as task management, adherence to workplace rules and self-perception of competence. The sample comprised 103 women, 22 men, and five non-binary persons, with an average age of 35. In addition to BPD, about half of the participants reported co-occurring diagnoses, such as anxiety disorders. For 54% of participants, their current primary job was aligned with their formal training. For 65%, it corresponded to their personal interests, and for 83%, with their competencies.

Results

To maintain well-being and performance at work, participants reported using strategies that involved balancing work and daily life through stable routines and health-supporting lifestyle habits. Key strategies enabling work functioning focused on self-regulation, cultivating positive workplace relationships, as well as task and time management. Organizing a calm work environment that facilitates concentration, using stress reduction and emotional regulation techniques, and seeking support from colleagues and managers were frequent examples.

Conclusions

The findings highlight a variety of self-directed, interpersonal and task-related actions that people with BPD use to maintain job tenure when employed. These personalized strategies can enrich the development of sustainable work reintegration interventions. Future research should examine the empirical effectiveness of these strategies and explore additional job tenure factors, such as work accommodations tailored to the needs of people with BPD.

Introduction

Work is a meaningful occupation throughout adulthood, linked to various psychological, cognitive, and physical health benefits [1]. For people living with serious mental disorders (e.g., schizophrenia), challenges in job acquisition, work functioning, and job tenure have been well documented [2]. Unemployment also affects a large proportion of people with borderline personality disorder (BPD). Although it can vary over time, it has been estimated that up to 45–50% of people with BPD in clinical samples can receive disability pensions at some point in their lives [3, 4]. Their career paths are often punctuated by impulsive job choices [5] and frequent job changes [6]. Annual direct healthcare costs and loss of productivity have been estimated to be 16 times higher in persons with BPD compared to matched controls from the general population [7]. Understanding better the specific challenges of people with BPD in their work functioning has been the focus of recent studies. Findings have indicated that their main difficulties concern management of emotions in the workplace, ineffective coping mechanisms to handle stress and task demands (e.g., avoidance, verbal aggression, self-harm), heightened sensitivity in work-related social interactions, and over-engagement in work, which impacts habits and activities in their personal life [5, 8,9,10]. These difficulties contribute to high absenteeism, estimated at 218 h annually, equivalent to six full-time weeks [11]. In addition, stigma expressed from stakeholders such as employers or insurance agents, can further complicate work participation for people with BPD [9, 12].

As work plays a central role in the recovery journey of people with BPD [13,14,15], not only documenting the challenges they face is important, but also the personal strategies which enable sustainable work functioning. Also, giving a voice to people with BPD who remain employed provides an opportunity to profile those who have a higher level of psychosocial functioning and enrich work-related rehabilitation interventions. This study aimed to identify personal job tenure strategies used by employed individuals with BPD.

Methods

This descriptive study [16] used an online survey data collection method, following the recommendations of Lachance et al. [17]. This type of online method has been successfully used with samples that included people with personality disorders [18, 19] and specifically those with BPD [20].

The survey comprised three sections. The first gathered sociodemographic questions (e.g., age, education level) and employment characteristics (e.g., work status, duration of the current job, and alignment of the job with interests, training, and competencies). The second section involved completing quantitative questionnaires on functioning in everyday life and work-related quality of life. The final section comprised open-ended questions on job tenure strategies across eleven themes based on the Quality of Life at Work Questionnaire [21]. The current article focuses on the qualitative section of the survey.

The survey was designed with the Lime Survey software and revised by all authors. A qualitative pre-test of the online survey was conducted with four individuals from the researchers’ network. The pre-test, using open-ended questions, evaluated completion time, clarity, and ease of use, regardless of the type of technology used (e.g., computer, tablet).

Participants

The eligible population consisted of individuals aged 18 to 65 who were diagnosed with BPD by a qualified healthcare professional and receiving treatment or therapy in a clinical setting. Participants were required to be employed or in a return-to-work process following sick leave. No exclusion criteria were applied. The targeted sample size was 150 participants.

Recruitment was carried out across four clinical sites and one community organization providing mental health services to individuals with BPD in Quebec, Canada. Healthcare professionals at these clinical settings informed service users through a flyer. Interested individuals voluntarily contacted the first author to obtain additional details about the study, including ethical considerations. After expressing interest via email or phone, participants were given a link to the online survey. Before accessing the survey questions, all participants were required to read and electronically sign the consent form.

Measures

The qualitative themes were drawn from the Quality of Life at Work Questionnaire and existing literature on work participation in BPD. The Quality of Life at Work Questionnaire was selected since it was designed for individuals with severe mental disorders working in social enterprises [21]. It consists of 40 items distributed across eight dimensions, including work tasks and environment, relationships with colleagues and manager, and a sense of belonging. Responses are scored on a 4-point Likert scale, ranging from 1 = totally disagree to 4 = totally agree. The questionnaire shows strong psychometric properties, with an internal consistency of 0.92 for the total score and a test-retest reliability of r = 0.91 [22].

The open-ended questions asked participants to describe at least one personal strategy they found useful, across eleven different topics: (1) managing negative emotions when performing tasks (e.g., frustration, decreased motivation); (2) organizing tasks; (3) maintaining concentration in the work environment; (4) adhering to workplace rules; (5) dealing with workplace injustices; (6) feeling competent and valued in work performance; (7) sustaining satisfying relationships with colleagues and managers; (8) resolving conflicts; (9) seeking help and support to complete tasks; (10) balancing effort to complete tasks while ensuring well-being at work; and 11) harmonizing work-life balance to support work functioning.

Analyses

Descriptive statistics (e.g., mean, standard deviation, and percentage) were produced using SPSS software to describe the participants’ characteristics and employment situations. The qualitative comments were analyzed following the thematic analysis approach proposed by Braun and Clarke [23]. Analyses were performed on data from respondents who fully completed the qualitative section of the survey.

First, for each survey question, all comments were exported from Lime Survey into an Excel file and then imported into NVivo software. Next, two authors (removed for peer review process) independently grouped similar strategies for each question. These initial categories were discussed and refined with input from all authors to ensure accurate categorization. For example, strategies such as “finish tasks as you go”, “prepare ahead of time”, “use a list of tasks”, and “break tasks into smaller steps” were grouped under the category of organization of workload and tasks.

Following this step, it was noted that some strategies were mentioned across multiple survey questions. Therefore, the frequency of each strategy category and the specific question under which they appeared were verified by two authors to examine the degree of importance of the categories (removed for peer review process). These findings were discussed with all authors, leading to a refined grouping of categories, sub-themes, and themes. For example, strategies related to balancing work and personal life were not only mentioned in the question addressing this topic but also in questions about managing negative emotions when carrying out tasks or maintaining well-being while putting effort into work. The overarching theme was labeled “strategies oriented towards self,” with the sub-theme “orchestrating work with personal life,” and the category “engaging in pleasant, healthy activities and maintaining stable routines in daily life.”

Results

Data collection took place between November 2021 and March 2024 (during and after the COVID-19 pandemic). The sample included 103 women, 22 men, and 5 non-binary individuals with BPD (Table 1). Participants’ ages ranged from 18 to 63 years, with an average age of 35.4 years. Slightly more than half reported having a comorbid psychiatric condition, primarily anxiety disorders, depressive disorders, or ADHD. One-third reported a physical condition that affected their everyday life functioning, most commonly chronic pain. Participants had various education levels, and one-third were parents.

Table 1 Sociodemographic characteristics of the participants (n = 130)
Full size table

Regarding their employment situation (Table 2), participants held diverse types of jobs (e.g., maintenance, educators, nursing) across various work sectors such as commerce, healthcare, education, administration. Most participants worked full-time, and 46% cumulated more than one job (e.g., a salaried employment alongside their own small business). However, the survey focused on their main occupation. Over the past five years, the number of jobs held by participants ranged from 1 to 20, with a mean of 3.6 (SD = 2.8). At the time they completed the survey, which could have been during or after the COVID-19 pandemic, 27% worked part-time or full-time remotely. More than 75% had been in their current primary employment for over one year. Notably, for 54% of participants, their job aligned with their formal training, while 65% reported that it matched their personal interest. Additionally, over 80% felt their job fitted with their competencies.

Table 2 Employment characteristics of the participants (n = 130)
Full size table

Of the 130 survey respondents, 118 completed the qualitative section in its entirety. Some participants reported more than one strategy for certain questions, leading to a total number of occurrences exceeding the sample size. Very few indicated having no strategies.

The proposed strategies were categorized into three domains:

  1. 1)

    Self-directed strategies:

    1. a)

      cultivating a positive and self-compassionate attitude

    2. b)

      applying emotional regulation strategies

    3. c)

      orchestrating work with personal life through a variety of activities and stable routines

  2. 2)

    Interpersonal strategies:

    1. a)

      engaging in respectful and constructive collaboration and communication

  3. 3)

    Task-related strategies:

    1. a)

      actively planning and organizing tasks, time, and priorities

    2. b)

      setting a distraction-free environment.

The six sub-themes presented in Fig. 1 represent the most frequently reported strategies (occurrences).

Fig. 1
figure 1

Most frequently applied work functioning and tenure strategies (n = 118 respondents). Note. 1 = Self-directed strategies; 2 = Interpersonal strategies; 3 = Task-related strategies

Full size image

Self-directed strategies

Self-directed strategies were used for several purposes, such as managing negative emotions during task performance, feeling competent and valued, adhering to workplace rules, maintaining positive relationships with colleagues and managers, and orchestrating work and personal life.

A commonly reported strategy (110 occurrences) involved maintaining healthy lifestyle habits, particularly ensuring good sleep hygiene and engaging in pleasant activities outside of work, based on personal interests, which could be recreative or social. In addition, participants described cognitive disengagement as a means to separate personal and professional life (e.g., disconnect from work emails when at home). Many also emphasized the importance of maintaining stable routines in their everyday life with some flexibility to consider unexpected events. The following quote is an example of what was applied: "I do physical activities every day (dance classes, running, walking with my dog, working out). It helps me burn off energy and stop thinking about my worries. It always makes me feel good and rested."

Skills and techniques learned from dialectical behavioral therapy (DBT) and mentalization-based therapy were frequently cited (108 occurrences), including deep breathing, mindfulness, and the STOP technique. Participants practiced self-gratification to cultivate a compassionate self-relationship and positive inner discourse (74 occurrences), such as acknowledging their accomplishments and celebrating daily successes. To illustrate, some participants said: (1) “I do activities that make me feel good. For example, I read, I color. It helps me take my mind off things.”; (2) “I try to congratulate myself, to see what I have accomplished well. It helps to motivate me to go to work”.

Although the majority mentioned positive and adaptive strategies, a few (8 occurrences) referred to strategies that could negatively impact work functioning, such as self-mutilation, over-investing in work, and intense self-pressure because they feared being fired.

Interpersonal strategies

Strategies oriented towards others involved relational actions or behaviors that varied depending on the individual’s role in the workplace and focused on communicating with respect, in a constructive manner (474 occurrences). For example, many mentioned that during work conversations, they considered all viewpoints and adopted a listening approach, not a confrontational one. With colleagues and managers, participants primarily mentioned directly seeking help, support, and feedback from the relevant person, establishing and maintaining personal boundaries, and relying on both social and professional support networks to ventilate and ask for advice. As one participant explained:

“l don’t let the situation worsen, I share verbally my view of the matter and immediately bring the problem to the table so that we can handle it together instead of silently dividing.”

Interestingly, specifically in their interactions with colleagues, participants often mentioned limiting personal conversations or self-disclosure to maintain emotional distance. When managing conflictual situations, they usually took breaks or a step back. One participant reported this approach:

I realize that not revealing too much about myself or trying to make friends at work is the best strategy for me. I go there to work and do what I need to do without thinking too much about the rest, and it helps me a lot.

Task-related strategies

To manage their workload and responsibilities effectively, participants actively used diverse planning and organizational strategies (240 occurrences). These included structuring tasks and time (including breaks) based on their energy level, task complexity, and urgency. To support this process, they used practical tools such as agendas, alarms, and note-taking systems.

In addition, setting a distraction-free and pleasant work environment was considered important (63 occurrences), helping participants remain focused as well as emotionally and cognitively available. Many participants mentioned listening to music or podcasts, working in a private office, or creating a sensory ambiance that enhanced concentration. One participant shared a specific example:

I have a diary in which I’m very well organized. It’s an essential tool for me! I use different colors and a legend for each aspect of my work.

Discussion

As Grenyer et al. [13] have shown, when people with BPD function well, work is a meaningful part of their lives. The findings from this study contribute to the understanding job tenure strategies related to work quality of life among people with BPD who are employed.

Some of the identified sub-themes and strategies align with job tenure factors observed in individuals with severe mental illness [2]. Participants in this study generally viewed themselves as competent workers in a job that matched their skills. Many also reported using strategies that reinforced positive self-esteem. A recent meta-analysis demonstrated that, among people with severe mental illness, self-esteem as a worker was significantly correlated with employment outcomes, such as job satisfaction [24]. Self-esteem as a worker has also been shown to be influenced by satisfaction with the supervisor [25]. A strong positive view of oneself as a competent worker can reinforce confidence and motivation to continue working [26].

Maintaining satisfying and supportive relationships with colleagues and managers was another key factor contributing to their work quality of life, and self-esteem as a worker [25]. Participants described using interpersonal strategies to constructively seek help and feedback when needed, as well as to manage conflicts. Research suggests that, for workers with and without mental health issues, relationships with co-workers and managers play a crucial role in fostering recognition when returning to work after a sick leave [27], enhancing engagement [28], and facilitating job tenure [26]. Specifically, for people with severe mental illness, workplace environments that support job tenure are characterized by social interactions grounded in mutual respect, trust, and friendliness [26].

Similarly to individuals with severe mental illness, using both inner and external resources is important for maintaining work functioning [26]. Among participants with BPD, these resources included emotion regulation, stress management, and mentalization learned in therapy, as well as support from family, friends, and healthcare professionals. Participants often reported applying self-directed DBT strategies learned in therapy to manage triggers in the workplace. In a study examining self-directed management of symptoms at work, workers with severe mental illness reported using inward reassurance, mindfulness, and engagement in activities to disconnect during or at the end of workdays to facilitate transition into personal life and reach out for social and emotional support [29].

Subjective life balance, that is, the experience of having a satisfactory quantity and variety of activities in different domains [30], is an important sub-theme. Prior research involving clinical samples of people with BPD highlighted dissatisfaction with time use, combined with a lack of meaningful activities to meet important physical, psychological, and social needs [8, 31]. Participants in this study engaged in various pleasurable activities in their personal lives, prioritized healthy lifestyle habits, and maintained stable routines to support sustainable work functioning.

Given that people with BPD often experience attentional difficulties [32] and executive function challenges [33], many participants described strategies related to adaptation of the physical environment and job duties to maintain their concentration. These cognitive-oriented strategies have been incorporated into job tenure interventions for individuals with psychosis and ADHD, such as Minds@Work [34].

In sum, the strategies shared by the participants emphasize the importance of addressing personal, occupational, and environmental factors in therapy and rehabilitation interventions to achieve a compatible fit between individuals with BPD and their work environment, thereby supporting job tenure. In this sample, the primary job corresponded to a personal interest for more than half of the participants. Matching a job with individual preferences – such as personal interest – has been shown to enhance work satisfaction, performance, and job tenure [26, 35]. The findings from this study validate and enrich the themes addressed in existing work-focused interventions for persons with BPD, who are unemployed or engaged in a return-to-work process, such as Borderline Intervention for Work Integration [8, 12], DBT-Accepting the Challenges of Exiting the System [36, 37] and DBT- Skills for Employment [38]. Informing individuals with BPD in therapy about these peer-reported strategies may serve as a valuable source of information for personal reflection and action planning. This could be followed by experiential and learning based interventions to provide practice opportunities which could be generalized in the workplace.

Strengths and limitations

The study benefits from a sufficiently large sample size, with a high response rate to reach saturation of ideas. The sample included participants with diverse personal and employment characteristics recruited from multiple clinical sites and geographical locations, enhancing the generalisability of the findings. However, qualitative responses were collected through an online survey, meaning that the depth and clarity of the data depended on the extent to which participants elaborated in their answers. Finally, this study could not assess the effectiveness of the reported strategies. Future research should consider longitudinal designs including individuals with BPD at different stages of work participation with and without employment. Also, experimental approaches would be needed to evaluate the impact of these strategies on job tenure and work-related quality of life, differentiated in workers in office jobs and remote jobs.

Conclusion

Employed individuals with BPD reported several strategies to ensure sustainable employment. The most frequently cited personal strategies included self-compassion, the use of emotion regulation techniques, collaborative relationships with colleagues and managers, careful organization of tasks and the physical work environment, engagement in pleasant activities in daily life, and stable routines. A promising avenue for future research is to explore the empirical effectiveness of these strategies to sustain work functioning and well-being. In addition, workplace support and accommodations play an important role in job tenure and work satisfaction [2, 39] and should be tailored to meet the specific needs of individuals with BPD.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

Not applicable.

Funding

This project received funding from the Fondation de l’Institut universitaire en santé mentale de Montréal - Fonds dédié à la recherche sur les personnes ayant un trouble de la personnalité.

Author information

Authors and Affiliations

  1. School of Rehabilitation, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, QC, J1H 5N4, Canada

    Nadine Larivière & Eve-Lyne Robitaille-Beaumier

  2. Department of Education and Pedagogy, Université du Québec à Montréal, 1205, rue Saint-Denis, Montréal, QC, H2X 3R9, Canada

    Marc Corbière

  3. Montreal Mental Health University Institute, 7401 rue Hochelaga, Montréal, QC, H1N 3M5, Canada

    Pierre David & Lionel Cailhol

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  1. Nadine Larivière
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Contributions

N.L., M.C., P.D., and L.C. wrote initial protocol and secured funding, N.L. and E.L.R.B. collected the data with the collaboration of P.D. and L.C. for recruitment of participants, E.L.R.B. and N.L. prepared data entry, all authors participated in data analysis, N.L. prepared initial version of manuscript with M.C., all authors reviewed and edited the manuscript.

Corresponding author

Correspondence to Nadine Larivière.

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This study was approved by the research ethics committee of all clinical sites collaborating with recruitment: (CIUSSS de l'Est-de-l'Île-de-Montréal; CIUSSS-Estrie-CHUS; CIUSSS du Nord-de l'Île-de-Montréal; CIUSSS de la Capitale-Nationale), project # MP-12-2022-2742. All participants were required to provide informed written consent.

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Larivière, N., Corbière, M., Robitaille-Beaumier, EL. et al. What strategies do people with borderline personality disorder use to maintain their well-being and performance at work?. bord personal disord emot dysregul 12, 18 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40479-025-00293-4

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40479-025-00293-4

Keywords

Borderline Personality Disorder and Emotion Dysregulation

ISSN: 2051-6673