What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is defined as “A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts” People with BPD are generally very emotional and react very strongly to even minor irritants. They can also be very sensitive to rejection. This is called rejection sensitivity and even the perception of being rejected can cause a huge reaction in someone with BPD. They tend to idealise people until they become disappointed after which they completely change to hating that person. These symptoms can cause them great difficulty in their personal lives and without psychological treatment most people with BPD find them uncontrollable. To get an official diagnosis of BPD you have to have 5 of the following 9 symptoms
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
- Identity disturbance: markedly and persistently unstable self-image or sense of self.
- Impulsivity in at least two potentially self-damaging areas (e.g., spending, sex, substance abuse, reckless driving, binge eating).
- Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
Other Signs of Borderline Personality Disorder
Further, people with borderline personality disorder are much more likely than other people to have experienced some form of emotional, physical or sexual abuse, particularly as children. Clients with borderline personality disorder also drop out of therapy at much higher rates than other people, generally in the range of 15-75%.
Suicidal thoughts are also quite common amongst people with BPD, much more than in the general population and people with BPD often struggle with feelings of worthlessness. For these reasons BPD can be very frustrating for psychologists as well as their borderline clients who may find it difficult to get treatment that they feel is valuable. Below we discuss three different treatments for BPD though there are many more.
The Treatments for Borderline Personality Disorder
There are many different treatments for BPD, some of which are perceived as better or more effective than others. However it’s important to note that if you’re getting treatment and it doesn’t feel right to you it’s okay to suggest trying something else out as just because something works for most people doesn’t mean it has to work for you.
Dialectical Behaviour Therapy
The most well evidenced treatment for BPD is Dialectical Behaviour therapy(DBT). This treatment was specifically designed people with BPD who have suicidal thoughts though it can be generalised to other issues as well. Primarily DBT works to help people manage extreme emotions and evaluate the way they are feeling more positively and calmly. They do this mainly by teaching clients the skills to manage strong emotion. DBT is the treatment with the strongest evidence that it works for Borderline Personality disorder though it is most useful for helping people manage suicidal behaviour and may not be as effective in other areas.
Mentalisation Therapy
Another treatment for BPD is mentalisation therapy. Mentalisation therapy involves teaching clients about how other people’s emotions influence their behaviour and helps clients learn skills for better understanding why other people act the way they do. This helps clients react more appropriately to other people’s actions. MT also involves teaching a client about how their own emotions can affect their behaviour. Basically MT helps clients process how they are feeling before they react and also allows them to better understand other people resulting in less intense emotions in the first place. Mentalisation therapy is also one of the BPD treatments with the lowest dropout rates.
Conversational Model
A final BPD treatment is the Conversational Model which is primarily concerned with helping someone develop their core sense of self. The central belief of the CM is that trauma inhibits the development of a sense of self and that an underdeveloped sense of self can cause problems that result in the symptoms of borderline personality disorder. This approach involves simple conversation and developing a clients sense of self through discussion of their life experiences with an open mind and a sense of unconditionally being on the client’s side. It is a process of shared meaning making and developing a relationship together.
References
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Stoffers-Winterling, J. M., Storebø, O. J., Kongerslev, M. T., Faltinsen, E., Todorovac, A., Sedoc Jørgensen, M., Sales, C. P., Edemann Callesen, H., Pereira Ribeiro, J., Völlm, B. A., Lieb, K., & Simonsen, E. (2022). Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis. British Journal of Psychiatry, 221(3), 538–552. https://doi.org/10.1192/bjp.2021.204