Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD) are two of the most clinically complex presentations in the area of psychosocial disability. Both are classified as Cluster B personality disorders under DSM-5. Both cause severe and chronic functional impairment. Both are frequently misunderstood and undertreated. And for those whose presentation meets the NDIS substantially reduced functional capacity threshold, both can form the basis of a legitimate NDIS psychosocial disability access application — though neither is included in NDIS Condition List A or B by name, and both present specific challenges in establishing the functional evidence required.

This article explains what BPD and ASPD are, how each affects daily functioning and what a Functional Capacity Assessment must document to support NDIS access and planning for people with these presentations.

Borderline Personality Disorder: what it is and how it affects daily functioning

What is BPD?

Borderline Personality Disorder is a DSM-5 Cluster B personality disorder characterised by a pervasive pattern of instability in interpersonal relationships, self-image and affect, combined with marked impulsivity, beginning by early adulthood and present across a range of contexts. A diagnosis of BPD requires that a person meets five or more of the nine DSM-5 criteria. BPD is estimated to affect approximately 1.7 per cent of the general population, rising to approximately 11 per cent in outpatient psychiatric settings and up to 20 per cent in inpatient psychiatric settings. Research indicates that the risk of suicide in people with BPD is approximately 50 times higher than in the general population.

The nine DSM-5 criteria for BPD

• Frantic efforts to avoid real or imagined abandonment, not including suicidal or self-mutilating behaviour covered in criterion 5
• A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
• Identity disturbance: persistently and markedly unstable self-image or sense of self
• Impulsivity in at least two areas that are potentially self-damaging, such as spending, sexual behaviour, substance use, reckless driving or binge eating
• Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour
• Affective instability due to a marked reactivity of mood: intense episodic dysphoria, irritability or anxiety lasting hours to days
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty controlling anger
• Transient, stress-related paranoid ideation or severe dissociative symptoms

How BPD affects daily functioning

The functional impact of BPD is pervasive and severe. It is not limited to interpersonal relationships, though these are profoundly affected. Every area of daily functioning is affected by the instability of emotion, self-image and behavioural control that characterise the condition.

Emotional regulation and daily activities

Emotional dysregulation is the central functional impairment of BPD. Emotions are experienced with extreme intensity and shift rapidly in response to perceived interpersonal cues, particularly perceived rejection or abandonment. The intensity of emotional responses means that routine daily activities that involve any interpersonal interaction, uncertainty or change of plan can trigger profound emotional distress that is disproportionate to the objective circumstances. The person may be unable to maintain daily routines, attend appointments, manage household responsibilities or sustain participation in work or education during episodes of severe emotional dysregulation.

Self-harm and suicidality

Recurrent suicidal behaviour and self-injury are DSM-5 diagnostic criteria for BPD and are among the most clinically significant features of the condition. Self-injury, including cutting, burning and other forms of deliberate self-harm, often functions as a means of regulating overwhelming emotional pain. It is not primarily attention-seeking behaviour, despite common misperceptions. Suicidal ideation is chronic in many people with BPD, and suicidal crises are frequent. The functional implications include the person’s capacity to live safely alone, the level of supervision or support required during crisis periods and the disruption to daily functioning caused by crisis episodes, hospital admissions and recovery periods.

Relationships and community participation

The relational instability of BPD profoundly affects the person’s capacity to maintain employment, housing and community participation. The pattern of intense idealisation and rapid devaluation in relationships means that workplace and service relationships are frequently disrupted. Fear of abandonment can drive behaviours that are perceived as demanding or inappropriate by others and that result in the loss of relationships and supports. Social isolation is common despite, and partly because of, the person’s intense need for connection.

Housing and independent living

People with BPD frequently experience housing instability, including difficulty maintaining rental agreements, conflicts with landlords or housemates and periods of homelessness or couch surfing following relationship breakdowns. The impulsivity of BPD affects the person’s capacity to manage finances, make forward plans, maintain household routines and navigate the administrative demands of independent living. Independent living requires a level of self-regulatory capacity that is significantly affected by the BPD presentation.

Antisocial Personality Disorder: what it is and how it affects daily functioning

What is ASPD?

Antisocial Personality Disorder is a DSM-5 Cluster B personality disorder characterised by a pervasive pattern of disregard for and violation of the rights of others, present since the age of 15. A diagnosis of ASPD requires that the person is at least 18 years of age and has evidence of a history of Conduct Disorder before the age of 15. The person must meet three or more of the seven DSM-5 criteria. ASPD is associated with significant overrepresentation in criminal justice settings, elevated rates of substance use disorders, gambling disorder and comorbid psychiatric conditions, and elevated mortality, particularly in young people, due to reckless behaviour, accidents and violence.

The seven DSM-5 criteria for ASPD

• Failure to conform to social norms with respect to lawful behaviours, indicated by repeatedly performing acts that are grounds for arrest
• Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
• Impulsivity or failure to plan ahead
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults
• Reckless disregard for safety of self or others
• Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations
• Lack of remorse, as indicated by being indifferent to or rationalising having hurt, mistreated or stolen from another

How ASPD affects daily functioning

The functional impairment in ASPD is primarily expressed through the person’s persistent inability to sustain the social, occupational and interpersonal functioning required for independent daily life. This impairment is neurobiological in origin, involving documented abnormalities in the prefrontal cortex affecting decision making, impulse control and emotional regulation, and is typically compounded by significant histories of early trauma, childhood adversity, Conduct Disorder and co-occurring conditions.

Employment and financial management

Consistent irresponsibility is a diagnostic criterion of ASPD and has direct implications for employment and financial management. People with ASPD frequently have significant employment instability, including difficulty sustaining employment due to conflict with supervisors and colleagues, impulsive resignation, dismissal following misconduct or absence. Financial management is severely affected by impulsivity and irresponsibility, including inability to manage bills, debt accumulation and financial exploitation of or by others. These functional limitations directly affect the person’s capacity for independent living.

Community safety and justice involvement

The consistent disregard for social norms, impulsivity and aggression that characterise ASPD place people with this presentation at elevated risk in community settings. Criminal justice involvement is common and is itself a source of significant disruption to daily functioning, housing stability and family relationships. The functional implications of justice involvement, including periods of incarceration, supervision orders, travel restrictions and the stigma associated with criminal history, must be documented where relevant in the Functional Capacity Assessment.

BPD and ASPD compared 

BPD, ASPD and NDIS eligibility

Neither BPD nor ASPD is included in NDIS Condition List A or List B by name. NDIS access for a person with BPD or ASPD must be established through functional evidence demonstrating that the condition results in substantially reduced functional capacity across one or more NDIS functional domains. Two specific challenges arise for both conditions.

Establishing permanence

Personality disorders are by definition chronic, longstanding conditions with onset in adolescence or early adulthood. The permanence criterion for NDIS access is generally met for both BPD and ASPD where the diagnosis is well-established, consistent over time and documented by appropriately qualified professionals. However, the NDIS may be cautious where the person’s presentation has been episodic, where there have been significant periods of remission or where treatment has not yet been adequately attempted. The Functional Capacity Assessment must document the clinical history of the condition, the chronicity of the functional impairment and the evidence base for the conclusion that the impairment is likely to be permanent.

Stigma and unfamiliarity with personality disorders as NDIS disability

People with BPD in particular frequently encounter resistance from NDIS planners who are unfamiliar with BPD as a basis for psychosocial disability access or who hold the misperception that BPD is a characterological rather than a neurobiological condition. Research consistently demonstrates significant, measurable functional impairment across all daily living domains in people with BPD, and the condition meets the NDIS substantially reduced functional capacity threshold in many cases. A Functional Capacity Assessment that documents specific, observed functional impairments in objective, clinical language provides important protection against the misapplication of stigma to the NDIS access process.

Co-occurring conditions

Both BPD and ASPD frequently co-occur with other conditions that compound functional impairment and may themselves meet NDIS eligibility criteria. These include complex PTSD, major depressive disorder, anxiety disorders, ADHD, substance use disorders and, in ASPD, a history of Conduct Disorder that may be associated with FASD, intellectual disability or ASD. Where co-occurring conditions are present, the Functional Capacity Assessment must document each condition and its functional contribution, as the combined functional impairment is typically greater than any single diagnosis alone.

What a Functional Capacity Assessment covers for BPD and ASPD

• Documentation of the diagnostic history of the condition, including the duration, chronicity and consistency of the presentation
• Assessment of emotional regulation and its functional impact on the person’s ability to maintain daily routines, attend appointments, manage household responsibilities and sustain community participation
• For BPD: assessment of self-harm and suicidality and their functional implications, including the level of supervision or support required during crisis periods and the disruption caused by crisis episodes and hospital admissions
• Assessment of interpersonal functioning and its impact on the person’s capacity to maintain employment, housing, service relationships and community participation
• Assessment of independent living capacity, including financial management, household management, medication management and navigation of daily administrative demands
• For ASPD: assessment of impulsivity, irresponsibility and their functional impact on employment stability, financial management and housing
• Assessment of safety, including the risk of self-harm, substance use, financial exploitation and involvement with the justice system
• Assessment of the functional impact of any co-occurring conditions and their interaction with the BPD or ASPD presentation
• Assessment of the person’s treatment history and the evidence base for the conclusion that the functional impairment is likely to be permanent
• Documentation of functional fluctuation: both BPD and ASPD may present with periods of relatively higher and lower functioning, and the assessment must document functioning across the full range, not only at best

The complex social picture: housing instability, justice involvement and substance use

For many people with BPD or ASPD, the clinical presentation does not exist in isolation. It sits within a complex, interconnected social context involving housing instability, involvement with the justice system and substance use that compounds the functional impairment and makes every aspect of daily life more precarious. Understanding this complex picture is essential for a Functional Capacity Assessment that accurately reflects the person’s actual functional situation.

Housing instability and homelessness

Housing instability is one of the most significant and most direct functional consequences of both BPD and ASPD. The emotional dysregulation of BPD, the impulsivity and irresponsibility of ASPD and the interpersonal difficulties of both conditions create a persistent vulnerability to losing and failing to maintain stable housing.

People with BPD frequently experience housing instability as a direct consequence of relationship breakdowns. A sudden deterioration in a relationship with a housemate, partner or family member can result in the person leaving or being asked to leave their accommodation with little planning and no stable alternative. The fear of abandonment that drives the BPD presentation can also lead to situations where the person refuses to leave a property, resulting in conflict and eventual eviction. Crisis episodes that lead to hospital admission can interrupt rent payments and tenancy management to the point where a tenancy is lost.

People with ASPD frequently experience housing instability as a consequence of the consistent irresponsibility and disregard for social norms that are core features of the diagnosis. Failure to pay rent on time or at all, property damage, conflicts with neighbours that result in formal complaints and eviction proceedings, and criminal activity that disrupts tenancy are all common. For people in government-managed social housing, accumulated tenancy breaches can result in termination of the tenancy, creating a situation where the person is homeless and placed on a waiting list that may take years to resolve.

Homelessness or marginal housing — couch surfing, sleeping in cars, staying in crisis accommodation or in temporary arrangements with acquaintances — severely compromises every other aspect of daily functioning. Without stable housing, managing mental health treatment, attending appointments, maintaining daily routines, managing medication and participating in the community all become substantially harder. The Functional Capacity Assessment must document the person’s current housing situation and the housing history, including periods of homelessness, the reasons for housing loss and the functional implications of housing instability for the person’s daily life and health.

Tenancy management difficulties

Even where a person with BPD or ASPD has housing, managing the requirements of a tenancy agreement represents a significant functional challenge. Tenancy management involves a range of tasks that are directly affected by the functional impairments of both conditions: paying rent on time and managing a household budget, maintaining the property in reasonable condition including basic housekeeping and reporting maintenance issues appropriately, managing relationships with neighbours and avoiding behaviour that constitutes a nuisance or breach of tenancy conditions, understanding and complying with the terms of a lease agreement, and responding appropriately to communications from a landlord or housing authority.

For a person with BPD, these tasks are complicated by emotional dysregulation, impulsivity and the relational difficulties that affect every interaction with landlords, housing officers and neighbours. For a person with ASPD, they are complicated by irresponsibility, impulsivity, disregard for social norms and the tendency toward conflict and rule-breaking that are diagnostic features of the condition. Housekeeping, which requires sustained initiation and effort across routine daily tasks, is frequently significantly impaired in both presentations.

The cognitive difficulties associated with both BPD and ASPD, including difficulties with planning, organisation, attention, impulse control and working memory, directly affect the person’s capacity to manage the administrative demands of tenancy. Unopened letters, missed payment deadlines, unanswered notices from housing authorities and failure to attend tenancy-related appointments are common functional presentations in this population. The Functional Capacity Assessment must document these specific functional barriers to tenancy management and the support required to address them.

Neighbour conflicts

Conflicts with neighbours are disproportionately common among people with BPD and ASPD and represent a significant driver of tenancy loss, particularly in social housing settings where proximity to neighbours is unavoidable and noise, shared spaces and interpersonal friction are constant features of the environment.

For people with BPD, intense and rapidly escalating emotional responses to perceived slights, injustices or provocations from neighbours can result in verbal altercations that are disproportionate to the triggering event and that quickly become the basis of formal complaints or apprehended violence orders. For people with ASPD, the disregard for the impact of behaviour on others, property damage and the tendency toward aggression and intimidation in conflict situations frequently generate complaints, police involvement and ultimately proceedings that threaten the tenancy.

Where neighbour conflicts have occurred, the Functional Capacity Assessment should document the nature and frequency of incidents, any formal consequences including complaints, police involvement or legal proceedings and the functional basis of the conflicts in the person’s disability presentation.

Justice involvement and imprisonment

Both BPD and ASPD are associated with elevated rates of involvement with the criminal justice system. For ASPD, criminal behaviour is directly embedded in the diagnostic criteria. For BPD, impulsive behaviours including driving offences, destruction of property during crisis episodes, assault during emotionally dysregulated altercations and self-harm-related public incidents can all result in police contact and criminal proceedings.

Periods of imprisonment have profound functional consequences that extend well beyond the period of incarceration. Employment history is disrupted. Housing is lost while in custody and is extremely difficult to re-establish after release, particularly for people with criminal records and limited social support networks. Mental health treatment is often discontinued during custody and the transition back to community-based treatment following release is frequently poorly managed. Supervision orders, parole conditions, bail conditions and domestic violence orders all impose restrictions on the person’s movement, associations and daily activities that interact with the functional impairment of the personality disorder in complex ways.

The Functional Capacity Assessment must document the person’s history of justice involvement — not in a manner that stigmatises or reduces the person to their criminal history, but in a manner that accurately captures the functional consequences of that involvement for their current daily life situation. This includes the impact on housing, employment, social support networks and mental health service access.

Substance use as a coping mechanism

Substance use occurs at elevated rates in both BPD and ASPD and must be understood in its functional context rather than treated as a separate character failing. For people with BPD, substances including alcohol, cannabis and other drugs are commonly used to manage the intense and overwhelming emotional pain that characterises the condition. When a person cannot tolerate the level of emotional distress they are experiencing and does not have access to adequate mental health support or effective coping strategies, substance use represents an accessible, rapid-acting means of temporary relief. It is a functional coping strategy that carries significant risks.

For people with ASPD, substance use is associated with impulsivity, risk-seeking behaviour and the social environments associated with the lifestyle pattern that accompanies the diagnosis. Alcohol and stimulant use in particular are associated with increased impulsivity and aggression, exacerbating the behavioural patterns that drive social conflict, criminal activity and relationship breakdown.

The functional consequences of substance use for people with BPD and ASPD are significant and must be documented where present. These include: further impairment of impulse control and emotional regulation while under the influence; disruption to medication management, as many psychotropic medications interact adversely with alcohol and other substances; financial depletion that further undermines housing security and basic living standards; involvement with criminal activity related to drug supply or possession; and the physical health consequences of chronic substance use including liver disease, cardiac effects and the increased risk of accidental overdose.

Where substance use is present, the Functional Capacity Assessment should document its functional role in the person’s daily life, the substances used, the pattern and frequency of use, the functional consequences and the interaction between substance use and the personality disorder presentation. The presence of substance use does not disqualify a person from NDIS support. It is a clinically relevant functional factor that must be assessed and documented as part of the complete picture.

Why this complexity matters for NDIS documentation

The convergence of housing instability, tenancy management difficulties, neighbour conflicts, justice involvement and substance use creates a functional picture that is far more complex than the personality disorder diagnosis alone. Each of these factors compounds the others. Homelessness makes mental health treatment harder to access and sustain, which worsens the personality disorder presentation, which makes it harder to manage housing, which perpetuates homelessness. Justice involvement disrupts housing and mental health treatment. Substance use impairs the judgment and impulse control needed to manage housing and avoid further justice involvement.

A Functional Capacity Assessment that documents only the clinical features of BPD or ASPD without capturing this broader functional context will underestimate the person’s actual support needs and will not provide an accurate picture of the substantially reduced functional capacity that characterises their daily life. The NDIS requires a clinical picture of the whole person in their real circumstances — and for this population, that picture is genuinely complex.

The 2026 NDIS context

The Securing the NDIS for Future Generations Bill 2026, introduced to Parliament on 14 May 2026, strengthens the requirement that NDIS supports must have a direct causal connection to the eligible impairment. For people with BPD or ASPD, this means the Functional Capacity Assessment must clearly and specifically document how the personality disorder presentation causes the functional impairment documented, using clinical language that draws the direct causal link between the diagnosis, the functional mechanism and the specific limitation in each NDIS domain. A generic psychosocial disability assessment that does not address the specific features of BPD or ASPD and their functional consequences will not provide adequate evidence under the current and forthcoming legislative framework.

Who can refer?

Referrals are accepted from participants and families, support coordinators, psychiatrists, psychologists, GPs, community mental health teams and legal representatives involved in NDIS appeals. Sina OT has completed Functional Capacity Assessments for individuals with psychosocial disability across a range of presentations across Adelaide, Melbourne and Sydney. All assessments are completed in person in the participant’s home and community environment.

Refer to Sina OT

Sina OT is an independent Occupational Therapy practice providing Functional Capacity Assessments across Adelaide, Melbourne and Sydney.

Sina OT has completed Functional Capacity Assessments for individuals with acquired brain injury across a range of causes and presentations. All assessments are completed in person in the participant’s home and community environment by a registered Occupational Therapist.

Services are available in English and Farsi (Persian).