Treatment for Borderline Personality Disorder (BPD)
“I'm so good at beginnings, but in the end I always seem to destroy everything, including myself.” ― Kiera Van Gelder.
What is Borderline Personality Disorder?
Marsha Linehan, the creator of the dialectical behaviour therapy (the form of psychotherapy with the most evidence for helping with borderline personality disorder) said this: “People with Borderline Personality Disorder (BPD) are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” How did she have the audacity to make such a statement on behalf of her patients? As she revealed a few years ago, she had borderline personality when she was younger, which is probably part of the reason that she was able to create such an effective form of therapy for the condition.
So a diagnosis of borderline personality means being emotionally sensitive, but what else does it mean? First of all, we want to acknowledge that the title of the diagnosis tells us little at all about what it actually means, and that we personally find the idea of labeling a personality as a disorder offensive. That said, we've worked with people who have found it incredibly useful to find a name for the difficulties that they experience, so one size doesn't fit all.
The criteria for fitting a diagnosis of borderline personality disorder are at least five of the following:
Frantic efforts to avoid real or imagined abandonment.
A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating). This does not include suicidal or self-harming behaviour.
Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
Affective instability due to a marked reactivity of mood - intense feelings that can last from a few hours to a few days.
Chronic feelings of emptiness.
Inappropriate intense anger or difficulty controlling anger.
Transient, stress-related paranoid ideas or severe dissociative symptoms.
If you're reading this and thinking that these criteria describe you, we recommend that you don't self diagnose, but instead talk to one of us, or another professional about your concerns.
What causes Borderline Personality Disorder?
With the current state of the research on BPD, anyone who claims to know the answer to this question is being overconfident. However, clients that we have worked with often find that DBT's biosocial theory fits with their own personal experience.
Biosocial theory says that BPD is essentially a difficulty with emotional regulation, or of maintaining good enough emotional balance. The bio part of the theory refers to the idea that people diagnosed with BPD may be biologically predisposed to feel emotions very strongly. In of itself, feeling emotions strongly is not enough to produce BPD. The second part, the social aspect is also required. This is an invalidating environment - circumstances usually early in life in which a person receives the message that their emotions are not valid or that they are unimportant. Trauma, various forms of abuse, or PTSD can contribute to this invalidating environment.
So that's the theory of the set-up for BPD: strong emotions which have been repeatedly invalidated. However, there is likely to be another component. Sometimes people's circumstances are such that they only receive validation or support when they express themselves in an emotionally out of control way. In essence, these circumstances sometimes teach people to act "borderline", because it's actually an effective way (in the short term), of getting help/support. This can be important to understand, but this theory should never be used to ignore potentially dangerous behaviour, such as suicide attempts.
Is there hope for those with a diagnosis of BPD?
In a nutshell, yes. Contrary to popular belief, the research shows that actually most people do achieve a lasting recovery from a diagnosis of BPD. However, there's a catch. Good recovery rates are only seen in people who receive psychotherapeutic treatment, and it takes time - usually years. Furthermore, not all treatments are equally helpful. For instance, standard cognitive behaviour therapy (CBT), a popular form of therapy, generally does not help for BPD, because it feels too emotionally triggering and invalidating. Schema Therapy, Mentalisation Based Therapy, and Dialectical Behaviour Therapy have all been proven to be effective for BPD, though Dialectical Behaviour Therapy shows the highest success rate out of these modalities. The best results are achieved by working with a therapist who is specifically trained in working with one of these modalities. At Lucid Psychotherapy & Counselling, we are both experienced and trained in practicing DBT.
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