At the Borderline: Borderline Personality Disorder (BPD) Insights, Causes & Treatment
- Ellie Daly
- Jun 4, 2020
- 7 min read
Borderline Personality Disorder (BPD) is a personality disorder that affects around 0.7%- 2% of the general population. The main characterization of this condition is mood instability. This also affects how an individual interacts with others. People with BPD feel everything very intensely, this can have both positive and negative consequences. There is a lot of stigma surrounding this condition. It can be difficult for the person themselves, as well as the people around them. However, BPD is treatable, and a full recovery is possible!
What is life really like for someone with BPD?
My wonderful friend Rose has been open enough to share some of her thoughts. For more about Rose and her life visit her Instagram, here she discusses her day to day thoughts also speaks about her mental health: _roseandshine_
If you would like to get in touch her email is: roserbobby@gmail.com
When were you diagnosed with BPD?
I was diagnosed with BPD at the end of January this year.
What had led you to seek treatment?
I had a couple of incidents. However, on New Years Eve I got extremely drunk, violent and suicidal - I later discovered this was an explosion of BPD rage. However, I knew there was something wrong as my moods were flipping frequently and abnormally.
What is a typical week like for you currently?
A typical week for me right now in lockdown has been studying and working. I have been quite introverted as I am sometimes scared to let my anger out on other people. I also have the tendency to drink a lot. The week can go differently depending on my mood, if I have a low week, I do not want to do anything, not even move really.
What sort of symptoms do you experience most?
The symptoms I experience the most is explosive anger and extreme chronic sadness.
What sort of support do you receive for your diagnosis?
I am a patient at a private clinic - the blue tree clinic. I have an incredible doctor, Dr Mark Silvert MBBS MSc MRCPsych (Consultant Psychiatrist) who diagnosed me with BPD. He really is incredible and has offered me so much support. I have weekly therapy sessions with my psychologist too.
My mother is also incredibly supportive and is studying how to handle and control my moods without angering me further. She is my rock.
I also have bought and researched some books which I have found incredibly useful. It is important with a BPD diagnosis to do your own research - self-help reads. I also actively read blogs and watch YouTube videos on BPD.
Is there something you would say to someone who thinks they may suffer with BPD?
To anyone that thinks they may suffer from BPD, I suggest they get an assessment from a doctor to see as I had no clue what BPD was before I was diagnosed. Please also do not self-diagnose as that is incredibly unhealthy and it is important, we move away from the stigma BPD creates. If anyone does think they may suffer, please seek help and advice from a professional and read up about BPD more.
Also, please remember there are positives to feeling so deeply and that you are incredibly loved and have the ability to love incredibly too!
Diagnosis & Criteria Information…
The DSM requires an individual to meet 5 or more of the listed criteria to be diagnosed:
· Frantic efforts to avoid real or imagined abandonment
· A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. For example, putting a relationship up on a pedestal or completely throwing someone under the bus.
· Identity disturbance: marked and persistent unstable sense of self. This can be linked to eating disorders. Suffering from body dysmorphia and having a distorted view of ourselves. This could alter eating behaviours.
· Impulsivity in two areas that are potentially self-damaging. For example, reckless spending, sexual behaviours, substance abuse, binge eating, driving.
· Recurrent suicidal behaviours, gestures or threats. Self-mutilating behaviour. This can relate to the fear of abandonment, using this to get people back into our lives.
· Affective instability det to a marked reactivity of mood. The mood can change every couple of hours.
· Chronic feelings of emptiness.
Someone with BPD may not experience all these symptoms but needs to be at least 5 for a diagnosis.
What causes BPD?
Genetics play a major role. If you have a 1st degree relative (a parent or sibling) with the condition you are 10x more likely to have it.
However, you could question whether developing the disorder is due to spending a lot of time around a 1st degree relative. To explain such a correlation. Twin studies have been conducted to see whether spending time in a different environment makes a difference. Twin studies can tease apart environment and biological makeup. One study found 42%-69% of BPD can be explained by genetics. Despite being brought up in separate and different environments, if one twin has BPD the other twin is likely to also develop BPD.
Irregularities in control areas of the brain; limbic system is evident in people with BPD. As well as this, mood regulating neurochemicals behave different in people with BPD. Levels of dopamine (related to impulsivity) and serotonin (related to low mood if too low) are unbalanced in BPD cases.
Neural Plasticity & BPD
Neural plasticity is a term used to describe the flexibility of brain structure. The brain and its activity can change continuously throughout a person’s lifetime. This is a survival technique that we have evolved. We get better at the things we do most often in our day to day lives. We anticipate our experiences based on the experiences we have had. Therefore, if we experience lots of hostility, rejection, criticism etc. we anticipate this in our future. Another contributing factor to the development of BPD is trauma or intense stress during childhood. It could be experiences such as living in an abusive home, being abandoned, consistent stress i.e. bullying.
Imagine the development of a brain that has experienced warm, safe, predictable and loving experiences.
Our repeated experiences of physical and or emotional danger trace out pathways of fear and avoidance or defensive aggression or perhaps dissociation that we get more practiced at, skills that we anticipate we will need in a future our brain anticipates will be similarly dangerous.
We can train new, more positive brain pathways. This explains how people can make a full recovery from BPD.
Relationships and BPD
Being in a relationship with someone who suffers with BPD can be challenging. The individual can be intense (impulsive, sensitive and reactive) and unstable. It is beneficial to keep home life relaxed and predictable.
The ‘emotion mind’ describes how people with BPD will view life emotionally. Be short, simple and direct when communicating with the individual. You need to help restore their self-esteem, show that you care, encourage their wonderful traits.
But also put in place boundaries in a kind yet assertive manner. Call their bluff. Challenge the irrational thinking.
Whilst it is common for suicidal gestures and threats to be made. Always take them seriously. 10% of individuals with BPD die from suicide. It is better to be safe than sorry.
How can BPD be treated?
There is a stigma surrounding BPD, with the notion that this is difficult to treat. Therapists often discuss burn out with clients suffering from this condition and referring the client on. This is not helpful when the client already suffers with feelings of abandonment.
Marsha Linehan developed a treatment method after her own experience of BPD. Linehan in 1993 combined traditional cognitive behavioural therapy (CBT) methods with Buddhist principles and mindfulness to create Dialectical Behavioural Therapy. DBT is one of the most effective forms of treatment for this condition and was designed specifically.
Dialectical Behavioural Therapy
Treatment for BPD will be regularly scheduled and long term. The term “dialectical” means the interaction of conflicting ideas. Within DBT, “dialectical” refers to the integration of both acceptance and change as essentials for improvement. Dialectical behavior therapy aims to address the symptoms of BPD by replacing maladaptive behaviors with healthier coping skills, such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
It is currently the only empirically supported treatment for BPD as proven by the Cochrane Collaborative Review.
Traditional DBT consists of 4 components: skills training group, individual psychotherapy, telephone consultation, and therapist consultation team.
Skills Training Group
Skills training group is in place to target behavioral skill deficits that are common to patients with BPD. This includes an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity.
The group focuses on teaching psychosocial skills that target these deficits through 4 skills training modules: core mindfulness (stay in the present, learn not to devalue and then idealize themselves and others) interpersonal effectiveness (The interpersonal strategies teach patients how to ask for what they need, say “no” to inappropriate demands, and cope with interpersonal conflict), emotion regulation (identify and label emotions, learn how to change them), and distress tolerance (The crisis survival skills teach patients techniques for distracting, self-soothing, and adjusting their thoughts in the moment). The group typically meets weekly for approximately 2 hours, and it takes about 6 months to complete all the modules.
Patients are encouraged to remain in the group for 1 year. Patients are assigned homework to reinforce skills and given diary cards to keep track of how they are using the skills outside of the group. This is then discussed with individual therapists.
Individual Psychotherapy
Individual therapy is there to supplement the group therapy. Parasuicidal behaviors are explored in detail, and emphasis is also placed on problem-solving behaviors, engaging in active coping, and using short-term distress management techniques. Previous trauma may need to be addressed if posttraumatic stress behaviors occur, as it can influence parasuicidal behaviors. However, the focus should initially be on current parasuicidal behaviors.
Telephone Consultation
Telephone consultation allows the patient to contact the individual therapist for in-the-moment guidance. Phone calls are designed to teach patients how to ask for help effectively and to apply skills learned in therapy to everyday life, especially during times of crisis.
Therapist Consultation Team
The therapist consultation team is a weekly meeting of all individual and group therapists who are currently providing DBT. This is to maintain motivation and commitment. It can also be used to promote empathy within the therapist, focusing on accepting the patient rather than forcing change upon the patient.
There is a lot of support for people with BPD and you are not alone.
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