Borderline Personality Disorder (BPD) Symptoms And Treatments
Content Warning: Please note that this article mentions trauma, self-harm, suicide, risky behavior, stigma, and other potentially triggering subjects. Read with discretion.
You're not alone if you have been diagnosed with therapy for borderline personality disorder (BPD). Over five million Americans were living with BPD in 2022. Common symptoms of BPD can include emotional instability and difficulty maintaining healthy relationships. While therapy can be an effective treatment for BPD, results may not be immediate, and a robust support system can be beneficial. Learning more about the treatments available for BPD, such as dialectical therapy, may help you make an informed decision on your mental healthcare.
What Is Borderline Personality Disorder (BPD)?
According to the National Institute of Mental Health, emotional control issues may impact self-esteem, increase impulsivity, and negatively impact close relationships. Without treatment, those with BPD may experience depression, self-harm, risky behavior, substance use, or suicidal thoughts.
If you are experiencing thoughts or urges of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support. If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
What Causes BPD?
A 2018 study found that common factors believed to lead to BPD included neurobiological abnormalities, a combination of specific genetic factors, and a history of childhood trauma.
How Is BPD Diagnosed?
Borderline personality disorder is often diagnosed after age 18, as a person's personality evolves through childhood and adolescence. Many children or teens may be initially diagnosed with depression or anxiety, discovering their BPD diagnosis as adults. A licensed mental health professional can diagnose the condition through interviews, self-testing, and observations.
Therapists or psychiatrists may look for the following symptoms when diagnosing BPD:
A fear of abandonment
Emotional distress related to actual or imagined loss of significant relationships
Emotional instability or challenges controlling emotions
Unstable relationships with friends and family
Self-destructive relationship habits
Difficulty holding a job for an extended period
Risky, impulsive behavior like unsafe sex or uncontrolled spending
Difficulty managing anger or irritability
Dissociation (feeling "out of your body")
Rapid mood swings
Persistent feelings of depression or anxiety
Feeling bored or empty
Challenges understanding one's identity or personality
Cycling patterns of recognizing and denying the value of one's relationships, often referred to as "splitting"
BPD can also occur alongside other mental health conditions, including the following:
Post-traumatic stress disorder (PTSD)
Complex post-traumatic stress disorder (C-PTSD)
Substance use disorders
Narcissistic personality disorder (NPD)
What Treatments Are Available For BPD?
Psychotherapy, or talk therapy, is considered the cornerstone of BPD treatment, according to the National Alliance on Mental Illness (NAMI). A comprehensive treatment plan for borderline personality disorder may include a combination of psychotherapy and repairing social connections. Your mental health provider may also recommend medication to help manage your symptoms if appropriate. Do not start, stop, or change a medication without consulting a general practitioner or psychiatrist.
Dialectical Behavior Therapy (DBT)
DBT is a form of cognitive-behavioral therapy (CBT) focused on the impact of your beliefs, thoughts, and behaviors, emphasizing mindful living and acceptance to manage symptoms. Dialectical behavior therapy is a structured program that involves a workbook, worksheets, and frequent sessions. It can be done in an individual or group format and was developed specifically to treat BPD, as its inventor, Dr. Marsha Linehan, was diagnosed with BPD as a young adult. It involves four modules, including:
The authors of a journal publication on DBT for BPD state, "dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD. Randomized controlled trials have shown the efficacy of DBT not only in BPD but also in other psychiatric disorders, such as substance use disorders, mood disorders, post-traumatic stress disorder, and eating disorders."
BPD symptoms may lead to distress in a family dynamic. Family therapy can be a potential long-term therapeutic plan for Individuals such as mothers with borderline personality disorder often feel emotionally unstable and experience difficulty maintaining healthy relationships. Through family counseling, individuals with BPD and immediate family may meet with the therapist to discuss behavioral and emotional interventions and learn healthy coping skills and communication.
Humanistic talk therapy centers on a person's nature and goals instead of treating every client equally. Sessions focus on positive behaviors and traits and developing the ability to use instincts to build positive patterns. The humanistic approach to therapy can foster a trusting relationship between a therapist and their client.
Schema therapy can be effective for people with personality disorders that may not respond to other treatments by combining elements from multiple forms of therapy. In schema therapy, the therapists focus on targeting your schema, a pattern of unwanted thoughts and behaviors which may have developed during childhood.
Cognitive-Behavioral Therapy (CBT)
Cognitive behavioral therapy is backed by significant research and has been demonstrated effective in treating various mental health conditions, including BPD. This therapy focuses on identifying unwanted or harmful thought patterns, behaviors, and perceptions of self and others and developing strategies to change them.
Mentalization-Based Treatment (MBT)
MBT therapy centers on increasing your curiosity about and ability to accurately identify your emotions and thoughts and form a realistic expectation of others' thoughts. Researchers suspect difficulties in mentalization may result from challenges during the early attachment phase of development in childhood. While there are numerous therapies available, one of the most useful options for those with BPD is mentalization based therapy (MBT).
Transference-Focused Psychotherapy (TFP)
Researchers believe that TFP treatments can help those with BPD 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 to form a realistic view of the self and others.
Coping With Borderline Personality Disorder
In addition to working with your mental healthcare provider to develop a treatment plan, there are various coping skills and lifestyle changes you can use to manage your symptoms and adjust to living with BPD, including the following:
Building distress tolerance
Working self-focused time into your routine
Practicing yoga or other forms of calming exercise
Distracting yourself with sensory stimulation
Not assuming intentions
Paying attention to your physical health
Taking a walk in nature
Another skill developed through DBT, radical acceptance, may also be beneficial. With this skill, you can learn to accept situations and emotions that seem challenging or impossible to change.
Tips For Supporting A Loved One With BPD
If you love someone who has been diagnosed with BPD, there are a few ways you can support them, including the following.
Educate yourself to learn everything you can about BPD, its symptoms, and effective treatments. If you're unsure where to start, ask your loved one for recommendations, or consider reaching out to a therapist for professional guidance. A wealth of stigma and misinformation exists, so finding proper resources can be essential. NAMI has published common myths and facts about BPD for those unsure to learn more about the condition.
Consider Family Or Couples Therapy
You can consider family or couples therapy to strengthen bonds and support your loved one through their symptoms. You may also learn helpful coping strategies for communication, bonding, and crisis response.
Encourage Your Loved One To Attend Therapy
A strong bond between a therapist and their client may benefit those living with BPD. It can take time to establish a safe bond, so encouraging your loved one to continue attending therapy and working through their treatments may help them feel motivated and on track.
Establish And Maintain Boundaries
Finding a balance between supporting your loved one and caring for yourself can be crucial. Set firm boundaries and hold to them. Boundaries can include rules for your space, belongings, body, and time. Note that you do not have to continue a relationship with someone who disrespects your boundaries, despite their diagnosis. Ending a relationship can be a form of a boundary. If you require support, speaking to a therapist may be beneficial.
Helping a loved one manage the symptoms of borderline personality disorder can be overwhelming. A therapist's support, guidance, and objective opinion may help you make decisions and defend your mental health.
Deciding to reach out for help can be challenging. If you experience trouble maintaining healthy relationships, an intense fear of abandonment, poor impulse control, or any other symptoms of borderline personality disorder, consider reaching out to a therapist for guidance. If you face barriers to treatment like cost, distance, or lack of availability, there are forms of treatment for BPD available that can reduce these barriers, including online counseling.
Establishing healthy thought and behavioral patterns can be challenging when living with BPD. With the ability to participate in therapy from home through live phone, video, or online sessions, you can receive the benefits of reduced cost and increased flexibility. A recent study shows that clients attending DBT treatments online had a higher attendance rate than those in a traditional in-person clinical environment. Overall, the study found that online DBT treatments are more reachable than and as effective as face-to-face options.
If you're interested in trying DBT or another form of counseling online, consider signing up for a platform like BetterHelp for individuals or ReGain for couples. Both platforms offer a growing database of over 30,000 therapists specializing in many symptoms or concerns, including BPD, trauma, and personality disorders.
BPD can come with challenging and emotionally distressing symptoms. If you're considering treatment, you're not alone. Partaking in mental health counseling with an online or in-person therapist can reduce the chances of hospitalization in clients with personality disorders significantly. If you're ready to get started, consider reaching out to a therapist for compassionate insight and support.
Frequently Asked Questions (FAQs)
Below are a few frequently asked questions about borderline personality disorder (BPD).
Can You Self-Treat BPD?
Treating borderline personality disorder independently may not yield the same results as talking to a licensed professional. In addition, withdrawing from support may worsen symptoms. BPD is a mental illness best treated by a licensed therapist. Various therapy types can be used to offset BPD symptoms, such as group or individual DBT therapy. Reach out to a therapist to learn more about these options.
Can BPD Be Treated With Medication?
Medication may benefit those with BPD experiencing a co-occurring mental health condition. For example, anxiety or depression medications or anti-psychotics may be beneficial. However, talk to a general medical practitioner or psychiatrist before starting, stopping, or changing medication.
Please note that BetterHelp does not prescribe or discuss medication. Consult a qualified medical professional if you want to try medication for your symptoms.
Can BPD Be Cured Without Therapy?
Studies have found that recovery from BPD is possible with treatment like DBT. However, it may not be linear, and re-addressing therapeutic approaches after treatment may be beneficial to reduce the chance of symptoms reappearing. You may not experience recovery without therapeutic support.
How Long Does Therapy For BPD Take?
The length of treatment for BPD depends on your treatment program. Many individuals find it beneficial to try a structured therapy like DBT, which can last around 20 sessions. Afterward, you might try intermittent or sustained treatment with a licensed therapist for counseling.
Why Do Therapists Find It Difficult To Treat Borderline Personality Disorder?
Therapy has been proven effective in reducing BPD symptoms. However, the mental illness has many stigmas and myths associated with it, which may cause unfair bias. Finding a compassionate therapist specializing in personality disorders and trauma may benefit you. If you face unkind, aggressive, or targeted harm from a professional, consider leaving sessions and finding a new provider. Therapy may not be effective unless you feel safe, validated, and respected by your provider.
What Can Cause Borderline Personality Disorder Episodes?
An individual might experience heightened symptoms or emotions regarding several types of stimuli or situations, including but not limited to the following:
Real or imagined abandonment
Setbacks in personal life, such as the loss of a job
Rejection or criticism
Therapy can be an effective way for people with BPD to improve relationships, control intense emotions, and accept challenging situations.
What Is The Best Form Of Therapy For BPD?
DBT is often seen as the golden standard for BPD and is a well-studied treatment. It is also highly effective in treating symptoms. DBT is a structured form of therapy that can be attended in individual, family, or group settings.
Are You Born With Borderline Personality Disorder?
BPD is diagnosed based on the diagnostic criteria listed in the DSM-5 and is an adult diagnosis. Adolescents may be diagnosed with traits of BPD. However, the condition is rarely diagnosed in children or teens. In addition, many researchers believe it is caused by childhood trauma or adverse life events. Others may believe it has genetic components. However, despite the cause of BPD, it is a manageable condition.
How Do You Calm Down With BPD?
If you are experiencing emotional dysregulation, you can try the following relaxation techniques:
Taking a warm bath
Taking a walk in nature
Trying self-soothing skills from DBT
Utilizing the TIPP skill from DBT
Talking to a friend
Cuddling a stuffed animal or blanket
Playing with your pet
Writing poetry or journaling
Utilizing the radical acceptance skill from DBT (mentioned above)
Eating a healthy meal
Talking to a therapist
Calling a crisis line
Practicing the opposite action skill from DBT
What Happens If Borderline Personality Disorder Is Left Untreated?
If BPD is left untreated, the individual diagnosed may not know which skills to use to manage their symptoms and experience benefits. Symptoms like self-harm, suicidal thoughts, splitting, or risky behaviors might be more common in those who have not attended therapy or are not using coping mechanisms. If you struggle to reach out for support, know there are options. Online therapy may be a cost-effective way to talk to a therapist, and you can practice common forms of therapy like DBT online.
Is BPD A Psychotic Disorder?
BPD is not a psychotic disorder. BPD stands for borderline personality disorder, which is listed under the category of personality disorders in the DSM-5. More specifically, BPD is a cluster B personality disorder.
Are People With BPD Intelligent?
Many people with BPD can be intelligent and intuitive. They might be in touch with rational thinking and empathy outside episodes or symptoms. When treatment plans are followed, and skills are utilized, their intelligence might be utilized for healthy avenues.
Do Therapists Hate People With BPD?
A therapist should not express hate to a client or their mental health condition. Mental health professionals can help people with BPD control intense emotions, treat specific symptoms, improve relationships, and mitigate self-destructive behavior. Find a new provider if you face discrimination, unkindness, or bias from a licensed therapist due to your diagnosis or symptoms. Although stigma exists, research and education can reduce these beliefs in communities.
Can A Person With Borderline Personality Disorder Love?
Yes, a person with BPD can form close emotional bonds and may actively seek them. However, BPD often includes interpersonal challenges as diagnostic criteria, which can include difficulty forming healthy bonds, feeling loved, or remembering how someone has treated you in the past. It can also be challenging for a person with BPD to trust within a relationship. In these cases, relationship and individual therapy may be beneficial.
Does BPD Go Away With Age?
If left untreated, borderline personality disorder may worsen or stay the same over time. Many people find that BPD symptoms can be reduced through an effective treatment plan with a licensed therapist specializing in personality disorders or trauma.
You may see a reduction in symptoms after age 25 if you are a young adult or teen experiencing BPD symptoms, as the emotional control center of the brain tends to be fully formed around that age. However, seeking professional care can still be essential. Consult with a licensed provider for further guidance.
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