What is Borderline Personality Disorder?

Understanding Borderline Personality Disorder can be difficult. It is a very complex personality disorder that can be tough to treat. Many times Borderline Personality Disorder can be confused with Bipolar Disorder. The extreme “ups and downs” (mood swings) are a common thread between the two disorders but are vastly different in many other ways.

Most of the time the person suffering from this personality disorder is very “black and white”, “all or nothing” and lacks the ability to see any middle ground.

What is Borderline Personality Disorder?

There are many symptoms of Borderline Personality Disorder. These can include: having difficulties feeling empathy for others, intense mood swings that can change very quickly, very impulsive, unstable relationships that can change from extreme love and idealization to extreme hate and fear of real or imagined abandonment.

According to the diagnostic and statistical manual of mental disorders 5th edition (DSM 5), Borderline Personality Disorder can be defined and diagnosed 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, as indicated by five (or more) of the following:

• Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
• A pattern of unstable and intense interpersonal relationships characterized 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). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
• Affective instability due to a marked reactivity of mood (e.g., in- tense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only 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.

Causes of Borderline Personality Disorder

The exact cause of Borderline Personality Disorder is still unknown. Unfortunately, this is the case with many mental health issues. There is a lot of research that shows there is a correlation between an individual’s biology and their past and present environment.

There are a few factors that might contribute to one having a borderline personality disorder:

Does the individual have a parent or sibling with Borderline Personality?

Having a parent or sibling with borderline personality disorder makes the chances of one developing it much higher.

Brain structure

There are parts of the brain that control emotions and impulses. Many people with borderline personality disorder have problems with impulse control and regulating their emotions. It is still not clear if these issues in the brain are as a result of having a borderline personality disorder or if they are just part of the cause of this disorder.

Has the person experienced trauma?

First and foremost, going through a traumatic event or events does not mean that somebody would develop a borderline personality disorder. However, research has shown that there is a correlation between this disorder and some sort of traumatic event. This can be any kind of abuse, neglect or even being separated from a parent or caregiver at a young age.

Stigma

Unfortunately, there is a stigma with Borderline Personality Disorder, just like many mental health conditions. In my opinion, Borderline Personality Disorder is the most stigmatized mental health condition. People with this diagnosis can be seen as attention seeking, manipulative and even “treatment resistant.”

Since the stigma is so strong many people who have this diagnosis do not seek treatment. One of those reasons is going to be the stigma attached and another might be a bad experience with previous mental health providers. This is why I stress the importance of finding mental health providers who specialize in and have specific training to treat people who suffer from Borderline Personality Disorder.

Self-Harm

A good portion of people with Borderline Personality Disorder engages in self harm behaviors otherwise known as, non-suicidal self-injury (NSSI). This kind of self harm does not have the intention of trying to commit suicide.

There are many reasons that somebody might self harm. A few of these reasons might be: distracting themselves or taking control of a situation that might be out of control, feeling a release, wanting to feel the pain of self injury when they might feel numb otherwise, a way to communicate intense emotion and for some people it gives them a very temporary feeling of euphoria. It is important to take self harm seriously. It is so much more than “attention seeking behavior”.

If there is a threat of suicide, it is important to take that very seriously.

Treatment for Borderline Personality Disorder

Borderline Personality Disorder can be seen as difficult to treat. There is no magic pill to “cure” somebody. If the individual reaches out to get help from a mental health provider treatment can help minimize and possibly eliminate many of the symptoms. Finding somebody who specifically specializes in Borderline Personality Disorder is critical.

Having a mental health evaluation first is going to be key. It is important to determine the level of care needed for the patient because sometimes a more serious medical intervention is needed. The evaluation will determine if Borderline Personality is the correct diagnosis, as well. Here are some treatment options might be:

Psychotherapy

The most common type of therapy used for somebody with a borderline personality disorder is dialectical behavioral therapy (DBT). This kind of therapy helps with changing unhealthy behavior and being more “mindful” of the current emotions and reactions that the individual has.

Medication Management

While there is no current medication that is going to specifically treat this disorder it can help with some of the symptoms like depression and anxiety. Many times people are treated with antidepressants, mood stabilizers, and antipsychotics.

Possible Hospitalization

Many people who have borderline personality disorder have extreme emotions that cause them to self harm or have suicidal ideation. This can mean short term hospitalization. It is not uncommon for somebody to frequent emergency rooms and psychiatric hospitals when diagnosed with this disorder.

DBT Skills Classes

Having a skills group is ideal because the patient will learn mindfulness techniques, emotional regulation, distress tolerance, radical openness, and interpersonal effectiveness.

Intensive DBT Program

One thing I always try to encourage clients with this diagnosis is a DBT intensive program. This is an all in one treatment that does take a big time commitment. This way somebody can have psychotherapy, group work, learn skills management and see a prescriber to see if medication management is needed.

Many of these programs also offer between session consultations as problems arise in patients lives. All areas are addressed in an intensive program to specifically treat borderline personality disorder. This is where somebody is going to find the most success if you have the time to dedicate to the program.

There are many intensive programs available in the Seattle area. Going through a full program and following it up with a DBT therapist is going to offer the BEST treatment.

Here are a few programs I recommend if somebody is serious about treatment and lives in the Seattle area:

Harborview DBT
Mental Health & Addiction Outpatient Clinic, JoAnn Marsden
(206) 744-9600
401 Broadway, 1st floor
Seattle, WA 98104
www.uwmedicine.org/locations/psychotherapy-harborview

The DBT Center
Evidence Based Treatment Centers of Seattle
(206) 374-0109
1200 5th Avenue, Suite 800
Seattle, WA 98101
ebtseattle.com/dbtcenter.html

If you don’t live in Seattle do some research to find an intensive program in your area that fits your needs.

If you are going down the route of trying to find a therapist it is important to make sure that the provider you choose specifically treats Borderline Personality and has specific training to treat this disorder. There are a lot of providers who do not have the training to treat Borderline Personality and can do more harm than good.

Many times the patient leaves frustrated and feeling judged and in many cases, the provider is at a loss as to how to help. I have included a link under resources for people who live in that Seattle area that provides resources for full DBT programs, DBT therapists, skill groups, parent programs, self-help groups and advocacy/family organizations that specifically treat borderline personality disorder and are certified.

What exactly is Dialectical Behavior Therapy (DBT)?

I think Psychology Today offers the most concise and to the point explanation of DBT and how it works.

“Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual’s ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.”

Psychology Today goes on to explain how it works.

“DBT is a cognitive-behavioral treatment developed by Marsha Linehan, Ph.D., in the 1980s to treat people with borderline personality disorder. Those diagnosed with BPD often experience extremely intense negative emotions that are difficult to manage. These intense and seemingly uncontrollable negative emotions are often experienced when the individual is interacting with others—friends, romantic partners, family members. People with borderline often experience a great deal of conflict in their relationships.

As its name suggests, DBT is influenced by the philosophical perspective of dialectics: balancing opposites. The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white—the all-or-nothing styles of thinking. In service of this balance, DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change.”

https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy

In Closing

While Borderline Personality Disorder can be difficult to treat it is important t to know that there is always hope if the individual chooses to seek out help. Many people do recover and find relief when the right intervention is used. Whether you personally suffer from this illness or have a loved one who does there are many resources available. Reach out for help today, a better way of living is possible.