Treating Borderline Personality Disorder

By Laura Greenstein | Jun. 07, 2017

 

Imagine having difficulty controlling your thoughts and actions. Imagine that your sense-of-self is almost entirely dependent on your relationships with others. Imagine struggling to manage stress, rejection or conflict. This is what it’s like to live with Borderline Personality Disorder (BPD): a mental health condition characterized by a pattern of ongoing instability in moods, behavior, self-image and functioning.

BPD is a highly-misunderstood condition—even within the mental health field. So, to better understand this complex condition, I talked with a NAMI HelpLine volunteer who bravely told me his story.

Randy* was diagnosed with BPD at 17 after a suicide attempt landed him in the hospital. “The concept of being able to like yourself and want to live just went over my head,” he explained. “I also couldn’t handle being rejected. If I sent a text message and they didn’t get back to me for five minutes, I’d already be thinking about killing myself.”

After several years of talk therapy and one month of cognitive behavioral therapy, Randy's therapist suggested dialectical behavior therapy last January. Dialectical behavior therapy (DBT) is a cognitive behavioral treatment developed to help people manage symptoms that are considered “difficult to treat,” such as: impulsivity, interpersonal problems, emotional dysregulation, self-harm and suicidal behaviors. DBT works for a range of conditions (substance abuse, depression, PTSD, among others), but it was originally developed to treat chronically suicidal individuals with BPD.

Skill-Building Through DBT

DBT is a combination of group therapy and individual treatment designed to help therapists offer the best treatment possible. What makes DBT unique and effective is its focus on teaching participants a set of behavioral skills that help them cope with their difficult symptoms. “The skills are what people talk about when they talk about DBT; they are the active ingredient in DBT,” explains the creator of DBT, Dr. Marsha Linehan. These skills include:

  1. Mindfulness: Being fully aware and present
  2. Distress Tolerance: Tolerating difficult or uncomfortable situations
  3. Interpersonal Effectiveness: Asking for what you want and saying no when you need to (while still maintaining self-respect and healthy relationships)
  4. Emotion Regulation: Changing emotions that you want to change

Each skill is a separate module of DBT and it takes a full year to go through all four modules in group therapy. Some may choose to repeat a module to help make those specific skills stick—like Randy, who repeated all the modules twice and the distress tolerance module three times because that’s the skill he struggles with the most. It takes a lot of time and energy to learn these coping mechanisms and implement them when symptoms flare.

Everything in DBT is connected and works together to help people manage their symptoms. Skills are introduced in group therapy lessons and are learned through practice and homework. “We have a handbook,” Randy says. “It ranges from things like how to talk to someone you don’t agree with without getting emotional to ‘I’m freaking out, what do I do?’” This is followed with individual therapy that includes lessons tailored to each person so they can apply what they’ve learned to everyday life.

The Gold Standard

While it takes time and effort, the components of DBT work together effectively. Even though DBT has only been around for a couple decades, it has already improved and saved the lives of many. Research shows it’s incredibly effective—one study from 2014 showed that 77% of participants no longer met criteria for BPD diagnosis after undergoing treatment.

DBT is recognized as the “gold standard” for people with BPD. “It’s weird how much better I’ve gotten from it. Looking back, I was so different; I didn’t know how to handle life. Sometimes I still don’t, but I’m getting there. I’m getting better.”

*Name has been changed to protect our volunteer's privacy

 

Laura Greenstein is communications coordinator at NAMI.

 

If you or someone you know is interested in entering a DBT program, you can search for a certified clinician here.
In addition, you can contact the NAMI HelpLine at 800-950-6264 or info@nami.org, and we will help direct you on how to find the closest DBT program.

Comments
Andi
I really enjoyed this article. I was diagnosed with bpd, depression, anxiety and panic disorder 14 years ago. I've gone through a lot of therapy, both inpatient and out. I still struggle with a lot of it at times, especially times of stress or grief. I have been married to a wonderfully understanding man for almost 18 years now although when I was first diagnosed things were really hard for us and we ended up taking a year-long break. We still saw each other frequently but we couldn't live together. I'm glad I have him in my life but I find myself longing for the closeness of a really good friend, of which I have none. I have many, many acquaintances or friends but no one I allow to get too close. There's still such a negative connotation to mental health issues that I choose to keep it to myself for the most part. The main reason I chose to comment here though is because I searched for a clinician for dbt and there's no one near me. How can someone like me find people who know how to teach me coping mechanisms if there's no one around? We need more people!
7/11/2017 2:06:12 AM

Bettie Johnson
This is all new information. I have always been told its untreatable although I do remember going through cognitive therapy. My Dx's are bipolar, BPD, ptsd. I was 23 when flipped out for the first time. Twice in hospital.
7/3/2017 6:31:08 PM

Joan
This article was very helpful, thank you.
7/1/2017 11:09:08 AM

beth
I was diagnosef with BPD and took DBT for more than two years. After the first year I stopped trying to kill myself and the 2ndyear I tried unsuccessfully to make friends.Unfortunately my insurance changed and I had to change my psychiatrist and my therapist.The new team decidedI have never had BPD-just depression. Withhe newDiagnosis in my charts I have had 4 therapists_and have had little support when I can't make sense out of my over motional response to stupid things that happen.I AM still better than I used to be,butI m so embarrassed when I FEELlike someone doesn' t like me. I often pray the earth will just open up and swallow me. Somehow I know I AM BPD but who am I to argue with a psychiatrist. So I have no counselor, because they upset me more than help. I WISH could think like others.
6/29/2017 5:54:59 PM

Christa Biber
My heart goes out to both-the" afflicted ones" and the people who love them."Stop walking on Eggshells" has been very helpful, finding a therapist who is understanding of the illness and the circumstances the parent, spouse,friend etc. find themselves in ,is almost impossible. Therefore these NAMI posts, articles are incredibly helpful. "Oh, it happens to others too"...sigh.
6/29/2017 4:19:09 PM

Lee Savage
Really enjoyed the information
6/29/2017 7:23:19 AM

Kai17
In my experience with BPD. Medication is of little use. I take a benzodiazepine for anxiety about everything and Ambien for sleep. The mood stabilizers and antidepressants made my situation worse. After 2 years of DBT, I realized is wasn't helping but in some cases exaserbating my Personality Disorder. My best defense against this insidious condition that has ruined my past, haunts my present and threatens to ruin any hope of a peaceful future is being aware of what I do because of this disorder. Knowing my limitations. Accepting what is an letting go of the pain of realizing that I will not be able to have relationships that I want and need. Doing the best with what I have. Realizing when the BPD is rearing or has reared its ugly head and stopping it or forgiving myself for it. I also have accepted that people are going to understand even if I try to explain. I try to have friends,but it always turns out the same so I have acquaintances with whom I never let get to close because they will find out and run and hurt me. Oh well, I have shared enough. I hope this helps someone. We are not alone.......maybe we are. It it very difficult for someone with BPD to have normal friends much less ones with BPD. That is a disaster waiting to happen. It's happened tome to many times. This is as close as I get, but I'm here........ Kai
6/29/2017 3:17:23 AM

SM
thanks
6/28/2017 4:49:32 PM

H Sutton
I have long time boyfriend who is BPD and it is very taxing to remember to not let his emotions get to me and put me on the defensive. As long as I can remain in focus I usually can rein him in. But he wears me out. I have to keep my distance when he's in his 'cycle' so to speak I find it's best to ignore him. For I don't know what else to do. He accuses me of not caring. But in the past when I've engaged it became toxic and I was codependent unknowingly. Now through healing and my own therapy I have come out of the clouds and see things better. I only want to help him help hilself though is the difference from the beginning when I entered this relationship. But it doesn't make it easier emotionally on me. It hurts because I see him hurting so. He as alienated himself sue to his behavioer but doeasne see it either. He has such a kind heart too. Such an oxymoron. What has helped me understand most and aided me is when my therapist said I was healthy enough to read "stop walking on eggshells" It helped me so much! A great read for anyone trying to understand anyone with BPD!
6/15/2017 10:39:10 AM

E
We are just starting this journey. My daughter is 16, her psychologist didn't give the diagnosis of BPD yet, she said she's too young to diagnose, but it is what she is leaning towards. Wow, it is hard to raise a teenage girl without mental health struggles, but this makes it even harder. Days I want to throw my hands up and say "I just can't do it anymore" We face judgment as a family due to some of her behaviors. Started DPT 2 weeks ago, praying we get some changes with this therapy.
6/11/2017 9:47:36 PM

Kimberly Spence Moore
Thank you.
6/10/2017 2:44:02 AM

Shelly
I have bipolar 2, bpd, anxiety, ptsd, depression. Was in dual diagnosis rehab center for 30 days. I took a dbt session, a year long one. Was advised it did not seem to be helping me. I agreed. Meds were adjusted during rehab. I got tattoos to cover up my cutting scars. I have not cut since I got the tattoos. I see my meds Dr frequently and a counselor. Take care of yourself and take your meds.
6/7/2017 9:38:50 PM

Lizanne Corbit
This is an incredibly helpful, and insightful read. Understanding BPD is such a dense topic, but it is absolutely vital that we continue to strive for understanding and removing stigma surrounding. This one is particularly difficult because the behavior that is often associated with BPD can be negative, frustrating, and confusing for people who are not familiar with the disorder. Posts like this are so important for educating and removing the stigma.
6/7/2017 5:22:00 PM

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