Borderline Personality Disorder

Key Symptoms of Borderline Personality Disorder

Emotional instability: Intense and rapidly changing emotions, including feelings of emptiness, irritability, or anger.

Impulsive behaviors: Risk-taking actions such as spending sprees, reckless driving, or unsafe sexual practices.

Unstable relationships: Extreme shifts between idealizing and devaluing others, often leading to turbulent personal connections.

Distorted self-image: A fluctuating or unclear sense of identity, causing individuals to feel disconnected from themselves.

Fear of abandonment: An overwhelming fear of being left or rejected, leading to frantic efforts to avoid abandonment, even in situations where there is no real threat.

Treatment Methods for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT): A form of cognitive-behavioral therapy (CBT) that focuses on teaching skills to manage emotions, reduce self-destructive behaviors, and improve interpersonal relationships. DBT includes individual therapy, group skills training, and phone coaching.

Mentalization-Based Treatment (MBT): A form of psychotherapy that helps individuals understand and interpret their own and others' thoughts, feelings, and intentions. This approach aims to improve emotional regulation and interpersonal functioning.

Schema-Focused Therapy (SFT): Combines elements of CBT with a focus on identifying and changing deeply held patterns or "schemas" about oneself and others that can contribute to emotional instability and dysfunctional behavior.

Transference-Focused Therapy (TFT): A psychodynamic approach that focuses on the therapeutic relationship to explore and understand the patient's interpersonal difficulties, aiming to transform maladaptive patterns.

Cognitive Behavioral Therapy (CBT): A structured, goal-oriented therapy that helps individuals identify and challenge negative thought patterns and behaviors that contribute to emotional distress and dysfunctional relationships.

Acceptance and Commitment Therapy (ACT): Focuses on helping individuals accept difficult emotions rather than trying to avoid or control them, and encourages them to commit to values-based actions that align with a meaningful life.

Good Psychiatric Management (GPM): A structured, evidence-based approach focusing on psychoeducation, managing the patient’s symptoms, and improving functioning through supportive therapy and medication management.

Medications (for symptom management): While no medication specifically treats BPD, medications such as antidepressants, mood stabilizers, and antipsychotics can help manage symptoms like depression, mood swings, and anxiety.

The most effective treatment often includes a combination of these approaches.

Services include assessment and treatment for mild to moderate Borderline Personality Disorder [BPD]. Borderline Personality Disorder services include management and treatment- with management focusing on reducing symptoms and behaviors and treatment focusing on reducing or eliminating traits associated with Borderline personality. Assessment includes identifying the severity of the disorder, which often affects one’s ability for management or treatment. The assessment process for BPD can take up to three sessions. Following assessment, severity will be identified, and based upon this, a referral to a DBT program clinic may be made prior to starting individual services for BPD. The referral is made based upon the clinical opinion of what type of treatment the client may benefit most from. Dialectical Behavior Therapy programs focus on management skills and include individual and group therapy at a more frequent, structured rate. Borderline Personality Disorder services would fall under psychotherapy, with treatment being longer term. A commitment is needed to begin BPD services and there are expectations of one’s participation to include a dedication to completing homework, using skills, and applying concepts outside of therapy sessions. Treatment for BPD is recommended at a frequency of twice weekly.

Participation in Borderline Personality Disorder services requires the following workbooks:
- DBT Skills Training Handouts and Worksheets, second edition by Marsha M. Linehan
- The Borderline Personality Disorder Workbook: An Integrative Program to Understand and Manage Your BPD by Daniel J. Fox PhD