BIRP Notes for Personality Disorders: Template + Examples (2026)
Overview
The BIRP Notes format provides an excellent structure for documenting Personality Disorders because it separates subjective experience from objective observations while emphasizing clinical assessment and planning. When working with clients presenting with Personality Disorders, the key is to document how the specific symptoms, behavioral patterns, and treatment responses are understood through the lens of this particular format.
Each section of the BIRP Notes note should serve a specific purpose when documenting Personality Disorders. Rather than generic descriptions, each section should contain clinical information that directly relates to the diagnostic criteria, treatment indicators, and progress measures relevant to Personality Disorders. This requires understanding both how the format works and what aspects of Personality Disorders are most important to capture for insurance justification, treatment planning, and clinical decision-making.
Documentation quality matters significantly when treating Personality Disorders. Insurance companies need to see clear evidence of medical necessity, meaningful progress on treatment goals, and appropriate use of evidence-based interventions. The BIRP Notes structure, when properly applied to Personality Disorders, communicates this clinical picture clearly and compliantly.
How to Document BIRP Notes for Personality Disorders
Behavior
Document observable client behaviors, actions, and presentation in session
When documenting Behavior for personality disorders, focus on capturing client-reported symptoms, presenting concerns, identifiable triggers, and observable mood or affect fluctuations that characterize their personality pathology.
- Client reports patterns of interpersonal difficulties or conflict.
- Description of mood instability or emotional dysregulation observed during the session.
- Identification of specific environmental or relational triggers exacerbating symptoms.
- Noting client’s expression of maladaptive coping strategies or defense mechanisms.
- Observation of affect congruence or incongruence with reported mood states.
Intervention
Record specific therapeutic interventions and techniques used
In the Intervention section for personality disorders, document clinical techniques and therapeutic modalities employed to address maladaptive behaviors and thought patterns characteristic of these disorders.
- Use of dialectical behavior therapy (DBT) skills training or mindfulness exercises.
- Implementation of cognitive restructuring to challenge dysfunctional beliefs.
- Application of validation techniques to acknowledge client experiences.
- Facilitation of role-play or behavioral rehearsal to improve interpersonal skills.
- Clinician’s observation and management of transference or countertransference dynamics.
Response
Note the client's response to interventions and observable changes
The Response section should capture the client’s reaction to interventions, clinical impressions of progress or setbacks, and any emerging diagnostic considerations related to their personality disorder.
- Client demonstrates increased insight into maladaptive patterns.
- Evidence of emotional regulation improvement or continued dysregulation.
- Client’s expressed motivation or resistance to therapeutic work.
- Noting any shifts in diagnostic clarity or symptom severity.
- Clinician’s assessment of therapeutic alliance strength and engagement.
Plan
Outline next steps, continued interventions, and session scheduling
Document the next steps for treatment, including homework assignments, modifications to the therapeutic approach, referrals, and scheduling considerations tailored to managing personality disorder symptoms.
- Assigning specific DBT or coping skills homework to reinforce session work.
- Planning for increased focus on interpersonal effectiveness in upcoming sessions.
- Referral to psychiatry for medication evaluation if indicated.
- Adjusting frequency or type of therapy based on client’s current stability.
- Scheduling follow-up sessions with consideration for crisis management needs.
SOAP Notes for Personality Disorders
Alternative format for documenting personality disorders
DAP Notes for Personality Disorders
Alternative format for documenting personality disorders
Progress Notes for Personality Disorders
Alternative format for documenting personality disorders
SIRP Notes for Personality Disorders
Alternative format for documenting personality disorders
GIRP Notes for Personality Disorders
Alternative format for documenting personality disorders
PIE Notes for Personality Disorders
Alternative format for documenting personality disorders
Tips for BIRP Notes for Personality Disorders
Connect to Diagnostic Criteria
Always link your observations and interventions back to the specific diagnostic criteria for Personality Disorders. If you're documenting generalized anxiety disorder, reference the specific DSM-5 criteria. If you're documenting major depressive disorder, show evidence of the required number of depressive symptoms. This demonstrates clear clinical reasoning and justifies continued treatment.
Use Quantifiable Measurements
Don't simply write "Personality Disorders improving." Instead, use rating scales (0-10 severity scales, PHQ-9 scores, GAD-7 scores, etc.) to show concrete progress. Document specific behavioral changes: "Client reported anxiety decreased from 8/10 to 6/10 when discussing social situations," or "Depressive symptoms reduced by 3 points on PHQ-9."
Document Functional Impact
Show how Personality Disorders affects the client's daily functioning. Insurance requires evidence of functional impairment to justify treatment. Document specific impacts: "Unable to attend work meetings due to anxiety," or "Staying in bed until 2 PM due to depressed mood." Then show how treatment addresses these functional limitations.
Track Intervention Specificity
Rather than vague interventions, be specific about what you did and why. For Personality Disorders, document: "Taught progressive muscle relaxation for anxiety management," or "Assigned behavioral activation with goal to schedule one pleasant activity daily." Show how each intervention targets the specific symptoms of Personality Disorders.
Demonstrate Treatment Progress
Connect each session to overall treatment goals for Personality Disorders. Show how this session moved the client forward. Document barriers encountered and your response: "Client engaged in avoidance despite exposure assignment. Explored ambivalence about facing feared situations. Adjusted timeline."
Note Comorbidities
Clients with Personality Disorders often have other conditions. Document any comorbid diagnoses and how they interact. For example: "Client's Personality Disorders is complicated by concurrent depression, which reduces treatment response. Added behavioral activation to address depressive symptoms alongside anxiety-specific exposure work."
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Further Reading
- DSM-5-TR — Provides the diagnostic criteria and clinical features essential for accurately identifying personality disorders.
- APA Documentation Guidelines — Offers detailed guidance on clinical documentation practices relevant to mental health professionals using formats like BIRP.
- SAMHSA — Contains resources and best practices for behavioral health documentation and treatment planning for personality disorders.