Borderline personality disorder involves intense, rapidly shifting emotions, unstable relationships, fear of abandonment, impulsivity and often self-harm. The primary treatment is structured psychotherapy, especially dialectical behavior therapy (DBT), with medication used to target specific symptoms such as mood instability or impulsivity. Most people improve substantially, and the majority achieve remission over time. Stedfast Psychiatry treats borderline personality disorder at 19 Shelter Cove Lane in Hilton Head Island and by video across South Carolina; new patients call (561) 320-4330.
Borderline Personality Disorder at our Hilton Head Island office
Patients come to the Hilton Head Island office for borderline personality disorder treatment from Shelter Cove, Palmetto Dunes, Sea Pines, Hilton Head Plantation and Port Royal Plantation, and from nearby Bluffton, Okatie, Daufuskie Island and Hardeeville. The office is at 19 Shelter Cove Lane, Suite 202, close to Shelter Cove Towne Centre.
Free surface parking is available at the building, with accessible spaces near the entrance. Suite 202 is on the second floor. If you need elevator access, call our office before your visit. Summer traffic on William Hilton Parkway can add ten minutes, so plan ahead in season. Hours are Monday to Friday, 8:00 AM to 5:00 PM, with weekend appointments by arrangement. New patients call (561) 320-4330; existing patients use (561) 402-3971.
Stedfast Psychiatry's Deep TMS and Spravato programs are open to South Carolina patients: the evaluation, screening scales and insurance authorization are done at the Hilton Head Island office or by video, and treatment sessions are scheduled at our Florida treatment centers. Your Hilton Head Island provider will tell you plainly whether a treatment course is practical for you.
Who you will see in Hilton Head Island
The Hilton Head Island team includes psychiatrist Dr. Josh Walters. Children and teens are seen by Josh Walters.
Dr. Josh Walters, MD
Psychiatrist · Adolescents through older adults
Signs of borderline personality disorder
- Frantic efforts to avoid real or imagined abandonment
- Intense, unstable relationships that alternate between idealizing and devaluing
- Unstable self-image or sense of who you are
- Impulsive behavior in areas like spending, sex, substance use, driving or eating
- Recurrent self-harm, suicidal threats or attempts
- Intense mood shifts lasting hours to a day
- Chronic feelings of emptiness
- Intense anger that is hard to control
How we diagnose it
We diagnose BPD through a careful clinical interview focused on long-standing patterns rather than the current crisis: how relationships typically go, how you react to perceived rejection, how quickly moods change and what triggers them, impulsivity, self-harm and suicidal behavior, and your sense of identity. The McLean Screening Instrument for BPD is a useful screen, and we may use the structured interview for personality disorders. Distinguishing BPD from bipolar disorder is central: BPD mood shifts last hours and are triggered by interpersonal events, while bipolar episodes last days to weeks and arise more autonomously; the two can coexist. We also assess for PTSD and complex trauma, depression, ADHD, eating disorders and substance use, all of which are common companions and change the plan. A safety assessment is part of every visit.
About 1.4 percent of US adults have borderline personality disorder in a given year.
Source: NIMH, National Comorbidity Survey Replication
Roughly 75 percent of people diagnosed with BPD are women, though community studies suggest the true gender gap is smaller.
Source: American Psychiatric Association, DSM-5-TR
In long-term follow-up studies, about 85 percent of people with BPD achieved remission within 10 years, and most did not relapse.
Source: McLean Study of Adult Development (Zanarini et al., 2012)
Dialectical behavior therapy reduces suicide attempts, self-harm and psychiatric hospitalizations compared with treatment by community experts.
Source: Linehan et al., Archives of General Psychiatry, 2006
Treatment for borderline personality disorder in Hilton Head Island
Medication management
No medication is FDA-approved for BPD, and medication does not treat the disorder itself, but it can reduce specific symptoms while therapy does the core work. SSRIs such as sertraline or fluoxetine help when depression or anxiety is present. Low doses of atypical antipsychotics such as aripiprazole or quetiapine can reduce anger, impulsivity and stress-related paranoia. Lamotrigine or topiramate are sometimes used for mood instability and impulsivity, with mixed evidence. We avoid benzodiazepines, which worsen impulsivity and disinhibition, and we keep regimens simple because polypharmacy is a common problem in BPD and increases overdose risk. We prescribe limited quantities when safety is a concern and review each medication's usefulness regularly, stopping what is not clearly helping.
Psychotherapy
Psychotherapy is the primary treatment for BPD. Dialectical behavior therapy (DBT) has the strongest evidence and teaches four skill sets: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, typically through weekly individual therapy plus a skills group over six to twelve months. Mentalization-based treatment, schema therapy, transference-focused psychotherapy and good psychiatric management are also effective. Our therapists provide DBT-informed individual therapy and we refer to full DBT programs with skills groups and phone coaching when that level of care is needed. Therapy is where the reduction in self-harm, hospitalization and relationship chaos happens, and medication is the support, not the reverse.
What to expect
The first visit is a 60-minute evaluation, in person or by video, that focuses on long-term patterns as well as current symptoms. You leave with a diagnosis explained in plain terms, a therapy plan, a safety plan, and medication if a specific symptom warrants it. Psychiatric follow-ups are every four to eight weeks; therapy is weekly. We coordinate closely between prescriber and therapist, because consistency between providers is itself part of effective BPD care. Telehealth is available across Florida and South Carolina for both medication visits and therapy.
The complete guide, including causes, subtypes and research, is on our Borderline Personality Disorder page.
Emergency and crisis resources near Hilton Head Island
In an emergency, call 911 or go to Hilton Head Hospital Emergency Department (25 Hospital Center Blvd, Hilton Head Island). The 988 Suicide and Crisis Lifeline is available by call or text 24 hours a day. Coastal Carolina Hospital Emergency Department and 988 Suicide and Crisis Lifeline are also listed on the Hilton Head Island office page.
Frequently asked questions
Who provides borderline personality disorder treatment at the Hilton Head Island office?
The Hilton Head Island team includes psychiatrist Dr. Josh Walters. Every provider works under psychiatrist oversight and the same evaluation standard: about an hour for a first visit, validated screening scales, and a written plan.
Can I be seen by video instead of coming to Hilton Head Island?
Yes. Stedfast Psychiatry providers are licensed in South Carolina and offer video visits for evaluations and follow-ups. Some situations, including certain controlled-substance prescriptions and first visits for young children, require an in-person appointment at 19 Shelter Cove Lane.
Does the Hilton Head Island office take my insurance?
We accept most major commercial plans and Medicare. Call (561) 320-4330 with your member ID and we will verify benefits before the visit. Self-pay new-patient evaluations are $185.
How soon can a new patient be seen in Hilton Head Island?
Most new patients are scheduled within one to two weeks. If you need to be seen sooner, ask about a video visit; those often open up within days. If you are in crisis, call or text 988 or go to the nearest emergency room rather than waiting.
Can I get Deep TMS or Spravato as a Hilton Head Island patient?
Yes. Stedfast Psychiatry is licensed for both. Your Hilton Head Island provider does the evaluation and the prior authorization; treatment sessions are scheduled at our Palm Beach Gardens TMS center and the Palm Beach Gardens Spravato rooms.
Is BPD the same as bipolar disorder?
No, although they are often confused. Bipolar disorder involves mood episodes lasting days to weeks that come on largely independent of events. BPD involves mood shifts lasting hours to a day, usually triggered by interpersonal events like perceived rejection, along with unstable relationships, identity disturbance and fear of abandonment. Bipolar disorder responds to mood stabilizers; BPD responds to structured therapy. About 10 to 20 percent of people have both, and a careful history sorts it out.
Is borderline personality disorder treatable?
Yes, and the outcomes are better than most people, including some clinicians, believe. In the largest long-term study, 85 percent of patients reached remission within 10 years and most stayed there. DBT and other structured therapies substantially reduce self-harm, hospitalization and emotional chaos within a year. The 'untreatable' reputation comes from an era before these therapies existed.
Nearby Stedfast offices
If you are in crisis, call or text 988 or go to the nearest emergency room. Educational content; individual results vary. Reviewed by Dr. David Husted, board-certified psychiatrist.