Borderline personality disorder (BPD) can cause many problems in a person’s life and is characterized by a pattern of unstable moods, behavior and relationships; many people with BPD also have brief psychotic episodes (NIMH 2014). It is very common for people with BPD to exhibit life-threatening behaviors such as risky substance abuse behaviors, risky sexual behaviors and promiscuity and hostile or aggressive outbursts.This personality disorder is also characterized by several other symptoms including the following:
- Instability in interpersonal relationships, behavior, mood and self-image
- Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image
- Unpredictable and self-destructive actions
- Self identity issues
- Experiencing the world in extremes
- Viewing others as all good or all bad
- Forming intense personal relationships with others and then quickly abandoning them
- Fear of abandonment
- Self harm or suicidal thoughts or actions
- Chronic feelings of boredom or emptiness
- Bouts of intense and inappropriate anger
BPD, trauma and suicide
Studies show that a large majority of people with BPD were abused mentally, physically or sexually as children. It has also been revealed that there is a distinct link between BPD and childhood abandonment or neglect. In general, these factors highlight the fact that trauma is heavily linked to BPD (van der Kolk; Hostetler; Herron; Fisler 1994).
Research also shows an extremely high correlation between suicidal ideation and BPD. According to the National Institute for Mental Health, nearly 80 percent of people with BPD have suicidal behaviors and 4 to 9 percent commit suicide. Studies show that suicidal ideation among people diagnosed with BPD generally starts in their 20s; however, all attempts made that were completed didn’t occur until later in life. A particular follow-up study reported the mean age of patients who committed suicide was 30, while in another, it was 37. (Paris; Zweig-Frank 2001)
Treating borderline personality disorder
Psychotherapy and pharmacological treatment are suggested treatments for BPD, it is currently debated whether hospitalization should be avoided or not as some doctors believe that hospitalization should be kept to a minimum. Most patients treated for BPD are able to be successfully treated and quality recovery can result from outpatient treatment (Bateman 1999).
One particularly effective method of treatment for BPD is Dialectical Behavioral Therapy or DBT. DBT was designed to treat people with BPD who have chronic suicidal behavior. DBT is very similar to cognitive behavioral therapy (CBT); however, DBT teaches the patient skills to accept and live with uncomfortable memories, feelings and thoughts.
The skills taught in DBT are strategies that balance polar opposite concepts and utilize the synergistic qualities that arise from combining both components. These skills include:
- Mindfulness: the practice of being fully aware and present in the moment
- Distress Tolerance: how to tolerate pain in difficult situations, not change it
- Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
- Emotion Regulation: how to change emotions that aren’t desired
Many people with BPD have life-threatening emotions and behaviors and very often the way thoughts and emotions are handled is through abusing substances or acting out in promiscuous or risky behaviors. DBT helps people who are dealing with these types of emotions and teaches them how to accept exactly what is being felt and thought through ‘distress tolerance’.
DBT will also prioritize certain treatment targets, as needed especially for people with BPD. When treating BPD, these behaviors are some of the most important to focus on:
- Therapy-interfering behaviors include coming late to sessions, making excuses as to why one cannot come to a one-on-one session or group or being non-collaborative during sessions
- Quality of life behaviors are very important to focus on, as these can affect a person’s financial security, relationship problems and other mental health disorders
- Skills acquisition is simply the need for clients to be able to learn new skillful behaviors to replace ineffective behaviors to help them achieve their goals.
Personality disorders can often worsen if left untreated, leading to further danger and damage to the individual. If you or a loved one would like more information on BPD or treatment for BPD or other mental health disorder, you can call the Mental Health Helpline at 855-653-8178.