Dialectical behavior therapy for borderline personality disorder

Dialectical behavior therapy for borderline personality disorder

According to the National Institute of Mental Health, borderline personality disorder (BPD) is a very serious personality disorder. It is traditionally marked by unstable moods, emotional dysregulation, impulsivity, interpersonal issues, self-harm, suicidal behavior and unstable relationships. Borderline personality disorder carries a lot of the same attributes as other personality disorders hence the name “borderline” personality disorder. There hasn’t been a specific gene that has been shown to directly cause BPD, however studies in twins suggest this illness has strong hereditary links. Environmental factors such as traumatic life events, childhood abuse or neglect from parents is also said to put people at a higher risk of developing BPD. Because of the trauma factor in BPD, it is very similar to PTSD.

The National Institute of Mental Health also notes that people with BPD suffer from problems regulating emotions and thoughts, impulsivity and reckless behavior, as well as unstable relationships with other people. It is estimated that 1.6 percent of the adult U.S. population has BPD but it may be as high as 5.9 percent. Studies show that BPD affects 2 percent of the general population and most diagnoses are made in females.

Characteristics of borderline personality disorder

According to the National Institute of Mental Health, some common characteristics associated with borderline personality disorder are:

  • A distorted view of reality regarding the self and other people. This impression triggers a constant need to be reassured and validated
  • Extreme mood shifts within a short period of time
  • Impulsivity in spending habits, sex, sexual identity, substance abuse, reckless driving
  • Eating disorders
  • Attempts to force relationships or intimacy; frantic efforts to avoid relationships or intimacy
  • Making threats, comments or plans of suicidal behavior
  • Exhibiting inappropriate, intense anger and have difficulty controlling temper; showing recurrent behavior of physical fights and combative behavior
  • A transient, stress-related, paranoid or dissociative personality

Treatment

Dr. Marsha Linehan, Ph.D. of the University of Washington developed a treatment model called dialectical behavior therapy (DBT). DBT is an evidence-based, cognitive behavioral treatment specifically developed for people diagnosed with BPD. Some of its components include using mindfulness, the practice of being fully aware; distress tolerance — the practice of tolerating pain without attempting to change anything; interpersonal effectiveness — the practice of asking for what one wants and saying “no” to things one doesn’t want while maintaining relationships and self-respect and lastly emotion regulation – the practice of changing emotions that one wants to change.

DBT uses a hierarchy of treatment targets to pinpoint the priority of a person’s issues:

  1. Life threatening behaviors include any behaviors that could lead to the client’s bodily harm or death.
  2. Therapy-interfering behaviors include any behavior that interferes with the client receiving effective treatment. These could be actions or non-actions on the client’s part.
  3. Quality of life behaviors include any behavior that interferes with a reasonable quality of life, such as mental disorders, relationship issues or financial/housing problems.
  4. Skills acquisition refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors to help them achieve their goals.

DBT also is organized to allow a patient to go through stages of treatment which work to identify and help their mental and emotional state. The stages are as follows:

  • Stage 1: The client is out of control, miserable and possibly acting out in suicidal behaviors; self-harming behaviors, such as using drugs and alcohol.
  • Stage 2: The client is quietly desperate. Their behavior is under control but they continue to suffer. Very often these feelings are due to past trauma issues and feelings of invalidation. The goal of Stage 2 is to help the client move from the state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.
  • Stage 3: The client is challenged to learn how to live, to define their goals, to build self-respect and to find peace and happiness. The goal for the client is to a life with ordinary levels of emotion.
  • Stage 4: The client may be ready at this stage to find a deeper meaning through a spiritual existence. Linehan specifically set this stage for those who feel that ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. This stage is for the client to transition from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

Borderline personality disorder can effectively be treated with dialectical behavior therapy. This treatment was, after all, specifically developed for people diagnosed with BPD. This particular therapy model is especially useful when treating BPD because of it’s specific focus on accepting patterns of thoughts and feelings a person with BPD tends to have. DBT also helps patients gain the capability and tools to be able to take a true look at themselves, their lives and their past experiences to understand how their behaviors might correlate with negative thoughts regarding their past experiences. Once a person with BPD is willing to take a look at themselves in this way, they can better gauge what thoughts, feelings and behaviors are life threatening, therapy interfering or interfering with their quality of life. DBT allows a person with BPD to begin a journey to a better understanding of themselves, as well as why they think and feel the way they do; most importantly, DBT skill-building will teach the patient how to accept, care for and respect themselves.

If you or someone you know is struggling with borderline personality disorder or would like to find out more about Dialectical Behavior Therapy call our helpline at 855-653-8178 for more information.