BPD Therapy: Managing Borderline Personality Disorder
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It’s estimated that around five million people living in the US have borderline personality disorder (BPD). Personality disorders are mental illnesses characterized by ways of seeing and reacting to others that can cause interpersonal and behavioral problems in life and relationships. Common signs of borderline personality disorder, in particular, include emotional instability and difficulty maintaining healthy connections with others. Learning more about the treatments available for borderline personality disorder, such as dialectical behavior therapy, may help you make an informed decision on your mental healthcare.
What is borderline personality disorder (BPD)?
Borderline personality disorder is a mental illness characterized by an unstable sense of self, which can lead to trouble controlling one’s reactions and a lack of emotional predictability. While BPD is its own condition, it may sometimes co-occur with other diagnosable mental illnesses—like bipolar disorder or major depressive disorder—and certain symptoms may overlap or exacerbate each other.
According to the National Institute of Mental Health, BPD-related challenges with emotional control may impact self-esteem and self-image, increase impulsivity, and negatively impact relationships. Without treatment, people with BPD may also be at higher risk of symptoms like risky behavior (such as reckless driving), thoughts or actions related to self-harm, substance misuse, and/or suicidal thoughts and behaviors.
Common symptoms of borderline personality disorder
Therapists and psychiatrists typically look for symptoms across a few key categories when considering a diagnosis of borderline personality disorder, including:
- Emotional and behavioral symptoms, such as not being able to manage emotions well, mood instability, impulsivity, anger, and a strong fear of abandonment
- Interpersonal difficulties, like unstable relationships with friends and family members, "splitting", trouble holding down a job, and a high sensitivity to rejection and abandonment
- Risky, impulsive behaviors, like unsafe sex or uncontrolled spending
- Stress-related symptoms, like trouble controlling stress and experiences of stress-related paranoia
- An unstable sense of self, which can involve trouble understanding one’s personality or identity, persistent boredom or emptiness, and dissociation
- Self-harming behaviors, suicidal thoughts, and/or suicide attempts
What causes BPD?
Researchers are still studying exactly what causes BPD. However, like most mental illnesses, they suspect it develops due to a combination of factors, such as:
- Genetic predisposition, like a family history of BPD or other disorders similar to or that often accompany BPD
- Brain abnormalities—specifically, changes in brain areas related to emotional regulation or abnormalities in neurotransmitter systems
- Early trauma, such as neglect, abuse, or other adverse childhood experiences
- Environmental stressors, like racism, poverty, domestic violence, or community violence
- Insecure attachment styles stemming from insecure relationships with early caregivers
- Lack of healthy coping mechanisms during childhood or adolescence
How is borderline personality disorder diagnosed?
Borderline personality disorder is often diagnosed and treated after age 18. This is because an individual’s personality typically evolves so significantly throughout childhood and adolescence that providing an accurate diagnosis of a personality disorder in these phases of life can be difficult. Many children or teens who will go on to receive a borderline personality disorder diagnosis as adults may be initially diagnosed with depression or anxiety disorders in their younger years.
Diagnostic criteria for a BPD mental health evaluation
A person with BPD might seek help from a therapist for a co-occurring condition, like anxiety or depression, or a loved one may encourage them to seek help for possible signs of BPD. The therapist or psychiatrist will conduct a mental health evaluation to determine whether the person’s symptoms may align with BPD or another condition.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person must show at least five of the nine symptoms listed in the diagnostic criteria for BPD in order for a diagnosis to be considered. Symptoms must begin by early adulthood and be present across a variety of contexts.
Ruling out related conditions
Part of the diagnostic process for borderline personality disorder is ruling out any possible related conditions. For example, some people with post-traumatic stress disorder (PTSD) may also show symptoms like reckless behavior and trouble controlling strong emotions, so the clinician must determine which diagnosis is accurate.
It’s also possible for a person to have BPD and PTSD or another condition. An accurate diagnosis is key for effective treatment planning.
Other mental health conditions that commonly co-occur in a person with BPD include:
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Complex post-traumatic stress disorder (C-PTSD)
- Sleep disorders
- Eating disorders
- Depression
- Substance use disorders
- Bipolar disorder
- Narcissistic personality disorder (NPD)
- Various psychotic disorders
Talk therapy treatments for conditions like these can often be delivered online or in person, offering flexibility to those experiencing symptoms.
Getting started with BetterHelp is simple:
- Take a short questionnaire. Answer a few quick questions about your goals, preferences, and the type of therapist you’d like to work with.
- Get matched quickly. In most cases, you can be matched with a licensed provider in as little as 48 hours.
- Start therapy on your terms. Schedule sessions by video, phone, or live chat, and join from anywhere you have an internet connection.
Finding the right therapist isn’t just important – it’s everything.
Find your matchWhat treatments are available for BPD?
While more research on treatment methods is always being done, talk therapy is currently considered the main treatment for BPD. In some cases, a mental health provider may also recommend medication as a part of the mental health care plan for more severe symptoms. Do not start, stop, or change any medication without consulting your doctor or psychiatrist.
Keep in mind that each person is different, so a care provider for a person with BPD will usually monitor the effectiveness of various approaches over time and adjust as needed. If you are experiencing self-harming behaviors, suicidal thoughts, or other urgent symptoms and need immediate support, call 988 or your local emergency services number.
Types of therapy that are commonly recommended for those who develop borderline personality disorder are listed below. Approaches like these can help BPD patients learn skills—such as social skills and emotional regulation techniques—to help them manage their symptoms. Keep in mind that many talk therapy approaches for BPD can be effectively delivered online or in person.
Finding the right therapist isn’t just important – it’s everything.
Find your matchDialectical behaviour therapy was developed by Dr. Marsha Linehan specifically to treat borderline personality disorder, though it’s now also used for other conditions as well. DBT treatment is usually a structured program that involves a workbook and frequent sessions. It can be done via individual therapy or group sessions within therapeutic communities, and it involves four modules:
- Emotional regulation
- Distress tolerance
- Mindfulness skills
- Interpersonal effectiveness
Borderline personality disorder symptoms may lead to distress within a family dynamic. In such cases, family therapy can be part of a long-term therapeutic plan for adult children, siblings, partners, or mothers with borderline personality disorder and their loved ones. The process involves the individual, their immediate family members, and a therapist meeting together to develop coping skills and communication strategies that aim to accommodate various people’s mental states, feelings, and needs within the household.
Schema therapy can be effective for people with personality disorders who may not have responded to other treatments, as it’s a combination of elements from multiple forms of therapy. With this type of treatment, the therapist focuses on targeting your schema, or a pattern of unwanted thoughts, to reduce self-destructive personality behaviors that may have developed during childhood
Cognitive behavioral therapy is backed by significant research suggesting its effectiveness in treating various mental health conditions, including borderline personality disorder. This therapy focuses on identifying unwanted or harmful thought patterns, behaviors, and perceptions of self and others and developing strategies to shift them. Like DBT, CBT may take place via both individual and group therapy sessions.
Also, for BPD, cognitive behavioral therapy approaches may sometimes be combined with systems training. This type of care is when family members of the person are also educated about the condition and equipped with constructive strategies for interacting with their loved one.
Researchers believe that TFP treatments may help those with borderline personality disorder who experience a split optimistic and pessimistic view of themselves and their primary caregiver due to excessive childhood aggression. TFP aims to merge the positive and negative perspectives of personality to form a realistic view of the self and others.
Coping with BPD
In addition to working with your mental healthcare provider on a plan to treat your specific symptoms, there are various coping skills and lifestyle changes you might use to manage emotions and symptoms and promote your well-being. Your provider might recommend strategies like:
- Journaling
- Building distress tolerance
- Practicing mindfulness
- Identifying accountability
- Working self-focused time into your routine
- Practicing yoga or other forms of calming movement
- Distracting yourself with sensory stimulation
- Not assuming intentions
- Caring for your physical health
- Taking walks in nature
Tips for supporting a loved one with BPD
If someone you love has been diagnosed with borderline personality disorder, there are several ways you can support them. Some recommendations include the following.
Learn about borderline personality disorder
If a family member or partner has borderline personality disorder, attending family or couples therapy together with them could help strengthen your bonds. Either type of care could teach you both helpful coping strategies for communication, connection, and crisis response.
In the end, it’s the choice of the individual with borderline personality disorder whether or not to attend therapy or seek other treatments for their condition. However, it could be beneficial for you as their loved one to gently encourage them to seek or stick with treatment long-term. Knowing that they have your support through the process could help them start or stay the course.
Finding a balance between supporting your loved one and caring for yourself can be crucial. This can look like setting and enforcing boundaries related to your space, belongings, body, and time, for example. If you feel you could benefit from support with this or another aspect of loving someone with borderline personality disorder, speaking to a therapist yourself may be beneficial.
Counseling options for those with BPD or their loved ones
If you experience trouble maintaining healthy relationships, feelings of emptiness, an intense fear of abandonment, poor impulse control, and/or other symptoms of borderline personality disorder, consider reaching out to a therapist for guidance. A therapist can also be helpful if you’re facing challenges due to a loved one’s BPD symptoms. If you face barriers to treatment—like cost, distance, or lack of provider availability near you—online counseling for BPD could be a more convenient option.
A recent study suggests that clients attending DBT treatments online had a higher attendance rate than those in a traditional in-person clinical environment. Overall, the study also suggests that online DBT can often be as effective as in-person options for treating BPD.
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Takeaway
Borderline personality disorder is a mental illness that can come with challenging and emotionally distressing symptoms. Mental health counseling with an online or in-person therapist may help a person with BPD learn to manage their symptoms. If you're ready to explore your options, you might consider reaching out to a therapist for compassionate insight and support.
What is borderline personality disorder and how does it affect emotions and relationships?
Borderline personality disorder is a mental health disorder that involves an unstable sense of self, trouble with emotional regulation, and difficulties maintaining healthy relationships as a result. People with BPD may also experience paranoid thoughts or chronic feelings of inadequacy and may engage in self-destructive behaviors in an attempt to cope with perceived abandonment.
What can cause borderline personality disorder?
Researchers believe that a variety of factors can contribute to the development of borderline personality disorder (BPD), including having a family history of mental illness, childhood trauma, environmental stressors like poverty and racism, and certain abnormalities in brain structure and function. BPD is usually diagnosed in the late teens or early adulthood.
What is the best form of therapy for borderline personality disorder?
While each person’s treatment plan for BPD may be different, dialectical behavior therapy (DBT) is one of the most common forms of therapy for this disorder. It focuses on teaching the person distress tolerance, emotional regulation, and other key skills that may help their symptoms improve.
Can BPD be treated with medication?
Borderline personality disorder (BPD) is not typically treated with medication alone, but it’s sometimes prescribed in combination with talk therapy. An approach like dialectical behavior therapy (DBT) is usually the first-line treatment recommendation for BPD.
What type of therapy is best for BPD?
Dialectical behavior therapy is one of the most commonly recommended therapy approaches for borderline personality disorder. It teaches skills like distress tolerance and emotional regulation, as it was designed specifically to address BPD symptoms. Other types of therapy for BPD include schema-focused therapy, family therapy, and mentalization-based therapy.
How long does therapy for borderline personality disorder take?
Therapy for BPD is usually longer-term, often over a year. It can take time for the therapist to gain the patient’s trust and build a strong therapeutic relationship, and it can take time to work on shifting habits related to emotions and relationships that have often been ingrained since childhood.
Why is it hard to live with borderline personality disorder?
Living with BPD symptoms can be difficult because they tend to impact so many areas of life. Trouble with emotional regulation, for example, can make it hard to maintain healthy relationships or keep employment. Seeking treatment for BPD symptoms can often be helpful in improving daily functioning and quality of life.
What are the common triggers for BPD symptoms?
One of the most common situations that may cause BPD symptoms to flare up is perceived abandonment. Those with this personality disorder tend to be highly sensitive to feelings of abandonment and, because of difficulties with emotional regulation, may react strongly to it.
What should you not do when supporting someone with BPD?
Setting healthy boundaries with a person who has BPD can be important, so allowing these to be crossed is not recommended. It’s also usually helpful to avoid believing that you’re alone in supporting them, as care (from a therapist, a support group, etc.) for you is available too.
Do symptoms of borderline personality disorder improve over time?
Symptoms of borderline personality disorder may improve over time with professional treatment, which usually includes therapy and, sometimes, medication. Without professional treatment, BPD symptoms may worsen over time.
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