Borderline Personality Disorder is an often misunderstood and frightening diagnosis for both the individual and their loved ones. \u00a0It is not the \u201ctherapeutic death sentence\u201d that it is often circulated to be! \u00a0Much of the information presented is applicable to other \u201cCluster-B\u201d personality disorders, which are typified by emotional dysregulation, impulsivity, hypersensitivity, identity confusion, and relational challenges; Histrionic Personality Disorder, Narcissistic Personality Disorder, and Anti-Social \u00a0\u00a0This article will explore what constitutes BPD, its prognosis, and effective methods for Borderline Personality Disorder treatment.<\/p>\n
The Diagnostic and Statistic Manual-V (DSM-V) lists the features of BPD as \u201ca pervasive pattern of unstable interpersonal relationships, self-image disturbance, affect dysregulation, and marked impulsivity beginning in adolescence and present in a variety of contexts\u201d (APA, 2013). \u00a0BPD has a prevalence rate of 1.6%-5%, but persons with BPD account for 20% of those in inpatient facilities, that\u2019s a glaring disproportion and foretells the severity of impact to mental health and well-being (2013). \u00a0An independent study found that persons with BPD account for the largest percentage of those with a personality disorder; 20%-25% (Newhill et al, 2009). \u00a0Furthermore, 75% of those diagnosed with BPD are female (2013). \u00a0However, a study conducted in 2012 found that rates of BPD were congruent between the sexes and attributed this to better diagnostic measures and increased understanding of how BPD behaviors manifest slightly different in men than women (Burke & Stepps).<\/p>\n
One of most prominent and destructive features of BPD is the presence of extremely volatile and unstable interpersonal relationships, which often leads to alienation from one\u2019s nuclear family, friends and a great deal of intra-psychic distress (Burke & Stepps, 2012). \u00a0Another main feature of BPD is an inability to regulate one\u2019s affect, and subsequently self-harm behaviors such as cutting, substance abuse<\/a>, sexual promiscuity, violence towards others, and suicide (Newhill et al, 2009). \u00a0Suicidal tendencies are a behavior that clinicians must very carefully screen for when assessing a person with other BPD features, it is a very real risk and included in the DSM as diagnostic criterion (APA, 2013) Finally, as the name implies, persons with BPD are unable to form and maintain a stable sense of self-image and identity, which contributes to difficulty regulating emotion<\/a> and unstable relationships (2009).<\/p>\n A newly emerging feature that I learned of in my research for this post, and a possible etiological factor, is impulsivity; there is a growing connection between ADHD in children<\/a> and BPD in adolescents and adults (Burke & Stepps, 2012). \u00a0Oppositional Defiant Disorder (ODD)<\/a> has also been shown to be predictive of possibly developing into BPD (2012). As I conceptualize BPD, these behaviors exist in interdependent feedback loops in a sort of chicken and egg coming first paradox. \u00a0\u00a0No matter the mechanism or point of intervention, emotional dysregulation, interpersonal<\/a> volatility, intrapersonal suffering, the outcome is most often extreme distress for the person with BPD. \u00a0BPD is very challenging for those who struggle with it, and for their family members too; my sister in-law has BPD and it has taken a significant toll on my in-law family\u2019s well-being. \u00a0Having a family member or child with BPD takes a tall toll on the entire family system resulting in systemic challenges and crippling despair. \u00a0What are we to do?<\/p>\n An effective treatment strategy used to remediate the symptoms and underlying causes of BPD was devised by University of Washington researcher Marsha Linehan, and is called Dialectic Behavioral Therapy<\/a> (DBT) (Soler et al, 2008). \u00a0DBT\u2019s main tenets are to condition emotional regulation through the use of dialectical exercises and tasks during instances in which there are two seemingly opposing forces and a \u201cmiddle road\u201d is synthesized to bridge the gap. \u00a0Also, conditioning to better manage high levels of stress successfully via mindfulness<\/a> exercises, healthy emotional coping strategies like journaling and exercising, and helping to develop problem-solving skills (Linehan, 1993b). \u00a0There are other modalities with proven effectiveness, but they can be accurately and efficiently summarized as being more general cognitive behavioral strategies (CBT) (Linehan, 1993a). \u00a0DBT is a specific form of CBT<\/a>. \u00a0Also, these treatment strategies are more effective when done both in group settings, and in individual counseling sessions (Linehan et al, 2006). \u00a0I would posit that the Corrective Emotional Experience, or an experience that corrects one\u2019s emotional response by replacing it with a healthy one as experienced in a real-time group setting that emulates most of our other social associations including the family, as coined by Irvin Yalom as one of the main cruxes to change in group therapy, is also one of the main reasons why group therapy is effective for persons with BPD (2005). \u00a0This is why our DBT skills<\/a> curriculum is taught via therapy and includes a second weekly DBT group to process how well clients are applying their skill based modes of coping.<\/p>\n Something not explicitly mentioned in the literature reviewed for this post, but that would seem to be an integral aspect of successful therapy in treating BPD tendencies, is for a therapist to be unconditionally respectful and warm, consistent, and model appropriate behaviors. \u00a0At Sunrise we can respond to clients with BPD<\/a> tendencies as no one else has been able to in a consistent and sustainable manner, and we can help create the spacing necessary for parents and other loved ones to do the same. \u00a0Trust me, I absolutely know that you have given your best for your dear daughter, this is not a criticism in the least but rather an accurate acknowledgment of the limitation of parental roles and family<\/a>. \u00a0The hallmarks of BPD are identity disturbances, emotional dysregulation, and interpersonal instability. \u00a0So, by modeling appropriate affect, simply being consistent in general, and providing unconditional positive regard a client can more readily do the same. \u00a0The most predictive measure of successful<\/a> outcomes is the strength of the therapeutic relationship and not the strength of the intervention itself. \u00a0\u00a0The strength of the therapeutic alliance also serves as the gauge for how far we can \u201cpush\u201d a BPD client, which is critical when utilizing an intervention like Distress Tolerance<\/a> training and exercises (Linehan et al, 2006). \u00a0These principles are universal to any therapeutic alliance, but they are especially vital when working with those with BPD tendencies. Borderline Personality Disorder is an often misunderstood and frightening diagnosis for both the individual and […]<\/p>\n","protected":false},"author":1,"featured_media":4283,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[75,76,117,118,119],"_links":{"self":[{"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/posts\/4280"}],"collection":[{"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/comments?post=4280"}],"version-history":[{"count":6,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/posts\/4280\/revisions"}],"predecessor-version":[{"id":7829,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/posts\/4280\/revisions\/7829"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/media?parent=4280"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/categories?post=4280"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sunrisertc.com\/wp-json\/wp\/v2\/tags?post=4280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}BPD’s Connection With Other Disorders<\/span><\/h2>\n
Treatment Strategies for BPD<\/span><\/h2>\n
Relationship Based Treatment for BPD<\/span><\/h2>\n
\nTo conclude this exploration, BPD is a very distressing but not damning disorder for those with it, and for their family and friends, but it can be effectively remediated to a high degree of functioning with which all of the previously mentioned individuals mentioned \u00a0are pleased with. \u00a0DBT, psychoanalysis, and CBT\u2019s in general have been proven to effectively reduce the intensity and prevalence of negative emotions, which in turn improves identity and interpersonal relationships<\/a>. \u00a0How we treat those with BPD tendencies can create a negative bias that may negatively affect successful therapy and our relationships. \u00a0A strong therapeutic alliance is vital to successful treatment, clients, family members, and therapists working as equal team members helps to create this alliance. \u00a0\u00a0Finally, there is hope, please don\u2019t forget or let wither our most precious intervention for ourselves and our loved one struggling with BPD tendencies; hope!
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\nby Allen Richards, CSW, Therapist at Sunrise Residential Treatment Center<\/p>\nReferences<\/span><\/h3>\n
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\nSymptoms in Young Adult Men. Journal Of Abnormal Child Psychology, 40(1), 35-44. doi:10.1007\/s10802-011-9558-7<\/li>\n