Mental Health

How to Treat Borderline Personality Disorder

Borderline personality disorder is a chronic condition that may include mood instability, extreme difficulty with interpersonal relationships, and also has a high rate of self-injury and suicidal behavior among sufferers.

Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. Instability from the complications related to BPD commonly causes the following issues:

  • Disruptive family and work life
  • Difficulties in long-term planning
  • Distorted individual sense of identity

Additionally, Borderline’s suffer from difficulties with emotion regulation, they also exhibit high rates of self-injurious behavior, such as cutting and elevated rates suicidal behavior. Fortunately, suicide risk and injurious behavior tend to decrease with age. BPD is more common in women than in men, with 75 percent of cases diagnosed among women.

People with borderline personality disorder often need extensive mental health services and account for 20 percent of psychiatric hospitalizations. Yet, with help, the majority stabilize and lead productive lives.

Borderline Personality Disorder Symptoms

According to the DSM-5, individuals with BPD exhibit some or all of the following symptoms:

  • Efforts to avoid real or imagined abandonment.
  • Intense bouts of anger, depression, or anxiety that may last only hours or, at most, a few days that are often strongly correlated with extreme episodes of impulsive aggression, self harm, and drug or alcohol abuse.
  • Distortions in thoughts and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, identity, and values.
  • People with BPD often view themselves as fundamentally bad or somehow unworthy.
  • People with BPD often may complain of boredom, an empty feeling, or that they are unfairly misunderstood or may receive additional mistreatment.
  • Recurrent suicidal ideations
  • Transient, stress-related paranoid thinking, or dissociation. People with BPD complain of or exhibit symptoms of “losing touch” with reality.

BPD and Relationships

Another common symptom of Borderline Personality Disorder is that they often exhibit highly unstable patterns of social relationships. People with BPD  may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike) with family and friends. This means that Borderlines often form an immediate attachment and idealize another person. However, with the occurrence of a brief separation or a slight conflict, they will switch unexpectedly to the other extreme and angrily accuse the other person of not caring or loving them at all.

While the majority of the population are able to cope with experiencing two contradictory states at one time, BPD almost mandates that there must be an extreme shift back and forth between good and bad states. This means, if they are in a bad state, for example, they have no awareness of the good state.

Individuals with BPD are highly sensitive to rejection, reacting with anger and distress to mild separations. A vacation, a business trip, or a sudden change in plans can cause negative thoughts to occur.  Fear of abandonment appears to be related to difficulties in feeling emotionally connected to important people when they are physically absent. This often leads to the individual with BPD feeling lost or worthless. During this same time period, there is an increased occurrence of suicide threats and suicide attempts may occur along with irrational anger at the perceived abandonment and disappointments.

Types of Borderline Personality Disorder

 

Borderline Personality Disorder Treatment

 Dialectical Behavior Therapy (DBT)

This form of therapy focuses on the concept of mindfulness, or paying attention to the present emotion. DBT teaches skills to control intense emotions, reduce self-destructive behavior, manage distress, and improve relationships. It seeks a balance between accepting and changing behaviors. This proactive, problem-solving approach was designed specifically to treat BPD. Treatment includes individual therapy sessions, skills training in a group setting, and phone coaching as needed. DBT is the most studied treatment for BPD and the one shown to be most effective.

Mentalization-Based Therapy (MBT)

MBT is a talk therapy that helps people identify and understand what others might be thinking and feeling.

Transference-Focused Therapy (TFP)

TFP is designed to help patients understand their emotions and interpersonal problems through the relationship between the patient and therapist. Patients then apply the insights they learn to other situations.

Good Psychiatric Management

GPM provides mental health professionals an easy-to-adopt “tool box” for patients with severe personality disorders.

Medications

It is a fact that medication cannot cure BPD. Medications help treat other conditions that often accompany BPD such as depression, impulsivity, and anxiety. Often patients are treated with several medications, but there is little evidence that this approach is necessary or effective. People with BPD are encouraged to talk with their prescribing doctor about what to expect from each medication and its side effects.

Self-Care activities include:

  • regular exercise
  • good sleep habits
  • nutritious diet
  • taking medications as prescribed
  • healthy stress management

Good self-care can help to reduce common symptoms of BPD such as mood changes, impulsive behavior, and irritability.