Borderline Personality Disorder (BPD) Treatment Options by Toni Hoy

By Sarah Fader |Updated August 2, 2022
CheckedMedically Reviewed By Whitney White, MS. CMHC, NCC., LPC

Personality disorders such as Borderline Personality Disorder (BPD) are among the most misunderstood mental health disorders, especially among people who lack medical or mental health and therapy expertise. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is published by the American Psychiatric Association, recognizes ten specific personality disorders. The National Institute of Mental Health (NIMH) reports that approximately 1.6 percent of adults in the United States have Borderline Personality Disorder. Dialectical behavior therapy (DBT) is one of the recommended types of therapy for BPD. Online therapy is an emerging option for BPD treatment.

A Borderline Personality Diagnosis Doesn't Need To Be Crippling

What Is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is a mental health disorder that impacts the way a person thinks or feels about themselves and others. In most cases, symptoms begin in adolescence or early adulthood. A borderline personality disorder is characterized by a long-term pattern of strong emotional responses, unstable relationships, a distorted sense of self-image, and impulsive behaviors that impact the way affected individuals feel about themselves and how they relate with other people. 

Symptoms Of Borderline Personality Disorder

While some people refer to BPD as suffering from BPD, it’s more appropriate to say living with BPD or having symptoms of BPD.

Symptoms of BPD vary among individuals. Some people experience several symptoms and others may only experience limited signs of the disorder. Additionally, the severity and duration of symptoms may also vary among affected individuals.

The symptoms of borderline personality disorder may be triggered by what some consider simple events. For example, an individual with BPD may become distressed when being separated from people they feel close to, such as when traveling to work or school. 

Some common symptoms of borderline personality disorder include:

Risky/impulsive behaviors: Someone with a borderline personality disorder is more likely than the average person to engage in risky behaviors, such as unprotected sex, reckless driving, alcohol or substance use, or binge eating. They may also exhibit impulsive behavior, including gambling, going on spending sprees, or suddenly ending positive relationships for no apparent reason.

Intense fear of abandonment: Fear of abandonment is commonly experienced by people with borderline personality disorder experience. This fear can be so severe that a person may engage in extreme measures, such as faking illness or threatening self-harm to avoid perceived separation or rejection from others.

Periods of paranoia: Stress-related paranoia or loss of contact with reality is common. These episodes may be as brief as a few minutes or last for much longer periods.

Extreme mood swings: Intense, inappropriate anger may occur. Such anger may present as suddenly losing one’s temper or acting bitter or sarcastic. Some people engage in physical fights. Where anger turns to violence, it’s important to contact the National Domestic Violence Hotline.

A pattern of intense, unstable relationships: Individuals with a borderline personality disorder often experience relationships that involve extreme emotional shifts. This may result in patterns that swing from extreme idealization (being madly in love) and closeness to anger and intense dislike.

The symptoms of borderline personality disorder are similar to those of bipolar disorder. The primary difference is that people living with bipolar disorder experience longer periods of mood stability. A mental health professional can be helpful in determining the proper diagnosis.

People who live with either borderline personality disorder or bipolar disorder may resort to drug abuse to help mask the negative symptoms they’re feeling. The combination of a mental health disorder and a drug abuse issue greatly disrupts a person’s life and well-being. As a result, an affected individual may need concurrent treatment for substance use and their mental health disorder.

What Causes Borderline Personality Disorder?

The exact cause of borderline personality disorder is unknown, and researchers and clinicians vary somewhat in their theories. According to the National Institute of Mental Health, three risk factors primarily contribute to BPD including family history, the structure and function of the brain, and environmental, cultural, and social factors. Some research suggests that the structure and function of the brains of people with borderline personality disorder differ from those without the disorder, particularly in the areas that affect the regulation of emotions and control impulses, primarily the prefrontal cortex. Additionally, genetics, social, cultural, and environmental factors are also believed to impact one’s risk of developing BPD.

People who have experienced neglect or abuse, experienced post-traumatic stress disorder, or lived in an unstable environment, especially during the developmental stages of early childhood, may also be at increased risk of developing borderline personality disorder. Having a first-degree relative, such as siblings or parents, with BPD has also been associated with the occurrence of BPD.

Another theory regarding the cause of BPD involves brain chemistry. A hormone compound in blood called serotonin, which is responsible for mood regulation, transmits signals from one area of the brain to another. Abnormalities in serotonin production and absorption are believed to make some people more susceptible to developing a borderline personality disorder.

Getting An Accurate Diagnosis

Borderline personality disorder is believed to have first been diagnosed in the early 20th century. Because BPD is not as commonly known as other personality disorders, misdiagnoses have been common over the years. Fortunately, as more research is being done and mental health providers are better equipped with the knowledge necessary to treat personality disorders, more people with the disorder are receiving accurate diagnoses and treatment.

The process of diagnosing borderline personality disorder is multilayered. A medical exam, which can help rule out underlying medical conditions that may be the cause of symptoms, is usually the first step. Diagnosis also involves completing a clinical interview, gathering family histories, and administering assessments or tests. Only a mental health professional, such as a psychologist, clinical social worker, or psychiatrist, should make a diagnosis of borderline personality disorder. 

Because personality is believed to continue developing through adolescence, diagnosing children with a borderline personality disorder is still an issue of debate among mental health professionals. The Diagnostic and Statistical Manual of Mental Disorders sets standards for diagnosing behavioral, personality, and mood disorders as well as other mental illnesses. The DSM-V does suggest caution when evaluating and diagnosing children with any personality disorder because some personality disorders present with symptoms that mirror typical adolescent behavior.

Overall, an official diagnosis of borderline personality requires that at least five primary borderline personality disorder symptoms be present in an individual. Those primary symptoms include:

  • Intense and/or unstable interpersonal relationships
  • Impulsive behavior
  • Self-destructive behavior such as cutting, burning, or hitting
  • Fear of abandonment
  • Poor self-image
  • Emotional instability
  • Difficulty controlling intense anger
  • Feelings of emptiness or worthlessness
  • Extreme suspiciousness or feelings of being “disconnected”

Overcoming The Stigma Associated With A Diagnosis Of BPD

Because borderline personality disorder and other mental health disorders are often misunderstood and stigmatized, diagnosis has the potential to negatively impact the lives of diagnosed individuals as well as their friends and loved ones. Being educated about BPD and being able to separate fact from fiction can help combat the potentially negative stigma that is often associated with the disorder. 

Treating Borderline Personality Disorder

The symptoms of borderline disorder may shift from lows to highs, making it extremely difficult for people with BPD to form stable interpersonal relationships. Recovery and management of symptoms vary among people with the disorder. However, treatment options are available.

The treatment approach for a borderline personality disorder may include medication, psychotherapy, and/or hospitalization. Treatment plans are generally determined by the severity of a person’s symptoms and their willingness to comply with a recommended plan of care.

Although medication does not cure borderline personality disorder, some medications may be useful in relieving symptoms associated with the disorder. Everyone responds to medication differently. Therefore, it is important to follow directions for medications, keep follow-up appointments, and report any changes in mood or behavior or any unpleasant side effects. 

The most common treatment for borderline personality disorder is psychotherapy, often referred to as talk therapy. Psychotherapy is a method of helping individuals deal with mental health issues and emotional difficulties. It focuses on eliminating or controlling psychological symptoms so that the affected person can function more effectively. Types of psychotherapy that are commonly used include dialectical behavioral therapy (DBT) and cognitive-behavioral therapy (CBT). 

Cognitive-behavioral therapy helps to identify and change unhealthy beliefs, behaviors, and inaccurate perceptions that an individual engages in regarding themselves or others. CBT is designed to teach healthy ways to react to feelings of anxiety, anger, and insecurity. For people living with BPD who don’t want to visit a therapist in person, BPD online therapy may prove to be helpful. Moreover, online therapy is convenient and cost-effective.

What Is DBT?

Dialectical behavior therapy was designed specifically for people with borderline personality disorder. It is a special type of cognitive-behavioral treatment for borderline personality disorder developed by Dr. Marsha Linehan.

DBT takes participants through several stages and builds core skills like mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance.

Dialectical behavioral therapy (DBT) generally involves focusing on individual psychotherapy and group skills training. DBT includes learning how to apply the skills learned in dialectical behavioral therapy in real-life situations by structuring one’s environment and continuing to work with a treatment team. Dialectical behavior therapy typically requires therapy appointments weekly so mental health professionals can monitor progress using the techniques.

Individual psychotherapy focuses on helping a person grasp an understanding of borderline personality disorder, what symptoms may occur, and how to deal with symptoms when they arise.

Group skills training includes the following four modules:

  • Practicing mindfulness or awareness in the present moment
  • Tolerating distress and pain in challenging situations but not changing them
  • Being more effective in interpersonal relations by asking for what you want or saying no in appropriate ways
  • Regulating emotions by changing emotions you want to change

While both medical and psychological treatment for borderline personality disorder can be effective independent of each other, many people find that a combination of medication and psychotherapy creates the best treatment results.

Getting Help for Borderline Personality Disorder

Borderline personality disorder is a psychological condition that does not have a “cure.” However, various treatments can help individuals with BPD learn to communicate and manage symptoms more effectively. A treatment program is essential for the long-term health of anyone with BPD; treatment can help prevent problematic life choices and other chronic health issues, as well as lower rates of attempted self-harm and suicidal behavior. Additionally, talk therapy may help those who are close to someone with BPD know how to provide safe and caring support.

A recent study by Cambridge University shows that certain symptoms of BPD such as antagonism and disinhibition generate stress as a result of the affected individual’s behaviors and choices. Researchers hope to develop new interventions to specifically address the root causes of stress in people living with BPD>

Remember that an estimated 1.6 percent of adults in the United States are living with borderline personality disorder which equates to several million people. If you or a loved one is experiencing symptoms of BPD, you are not alone, and you have options for help.

If you are experiencing thoughts of self-harm or suicide, seeking emergency medical care is critical. If you don’t want to go to an emergency room, call the National Suicide Prevention Lifeline at 1-800-273-8255.This lifeline is available 24 hours a day.

Your primary care provider can also give you referrals for mental healthcare providers in your area. Online counseling is a flexible, accessible option, particularly for anyone who wants to find therapeutic support but would prefer not to meet in person for some reason. No matter how you might choose to pursue treatment, remember that you deserve to feel in control of your life and your symptoms. If you are experiencing symptoms of borderline personality disorder or any other mental health concerns, these services are available to help.

When You Need Help

The DSM-V defines a borderline personality disorder as “a chronic disorder that includes symptoms such as frantic efforts to avoid real or imagined abandonment, unstable relationships, identity disturbance, impulsive and dangerous behaviors, recurrent suicidal threats or self-mutilating behaviors, affective instability, feelings of emptiness, difficulties controlling anger, and/or stress-related paranoid thoughts or dissociation.”

If you are experiencing any of these symptoms, keep in mind that you are not alone. A combination of therapeutic approaches may help you to manage your symptoms in the long term, and one of the most highly recommended approaches is psychotherapy, also sometimes called talk therapy.

Online therapy, such as the services provided by BetterHelp, focuses on offering professional mental health care to individuals in formats that work for them. Online therapy has several particular advantages over in-person services. Because you can arrange your sessions with a therapist around your schedule and lifestyle, you can keep the entire process as private as you wish; you can work with a licensed therapist at BetterHelp on your schedule, by video chat, or phone call, email, or text messaging. If you’d like more evidence, consider these reviews from BetterHelp users who have worked with online therapists to address their personality needs and challenges:

The most important thing to remember is that your mental health and wellbeing matter. With the right support and guidance, you can understand and manage the symptoms of borderline personality disorder and live a happier, healthier life. Take the first step today.

A Borderline Personality Diagnosis Doesn't Need To Be Crippling

BetterHelp Therapist Reviews

"Karyn's perspective on my life and my experiences, particularly in my relationships, has opened my eyes to things I've never been able to see before in my personality and behavior. She challenges me! She affirms me! She laughs with me! When I cry, she talks me through it and lets it happen! It's been so helpful and wonderful to have an outside perspective on my feelings during a pandemic, especially. She's helping me become the best version of myself."

How can I control my BPD?

There are several ways you can control your BPD with the most popular being therapy services.

Every individual’s ability to cope with BPD is different, thus, it may take trial and error to find an effective therapy. A common therapy technique used to treat BPD is dialectical behavior therapy (DBT). This type of behavior therapy involves teaching individuals how to live in the moment, regulate their emotions, cope with stress in healthy and positive ways, and help affected individuals repair relationships and form stable interpersonal relationships. It was originally developed to treat BPD but since has been used to help other mental health conditions including eating disorders (such as binge eating or bulimia nervosa), anxiety disorders, and substance abuse disorders. 

You can treat BPD on your own, however, there are always risk factors involved when not seeking out professional help for treating a mental health disorder. If you do not want to participate in individual therapy services, group therapy is an option for treating BPD as well.

 

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