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
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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