Borderline Personality Disorder: 1 Personality Disorder with a Successful Treatment

A short reminder: if you have been diagnosed with Borderline Personality Disorder, please do not read further. It is important you work with your medical team to ensure you the best possible outcome.  This information is provided for the general population and writers in particular, to provide a base of knowledge and understanding.

As discussed in an earlier post, Borderline Personality Disorder (BPD) is confusing, hard to treat and hard to live with – for both its victims and their families.  BPD is an illness of ‘extremes’, all or nothing and/or black and white thinking, and because it is a personality disorder, that is, it affects how a person sees the world, it is hard to treat.  Many forms of therapy can help this client, but the single greatest predictor of success in the therapist/client relationship is trust. That is hard to build with a BPD patient and it’s hard to sustain over time.  But a stalwart therapist can go a long way in helping these clients.

Many psychiatrists prescribe drugs to alleviate the symptoms of this disorder.  For example, anti-depressant drugs (Cylexa and Zoloft), mood stabilizers (Depakote), and/or anti-psychotics (Zyprexa and Resperidol) are samples of the many drugs that may be prescribed.  Each one usually has some success (many would say limited success), but on their own, none of them work to give the BPD patient a rich and rewarding life.  At best they decrease symptoms so that the patient has time for psychotherapy to work.

Several models of talk therapy have been used in treating BPD, each with varying degrees of success.  The two most well known models are:

  1. Cognitive Behavior Therapy, which helps people to identify and change their core beliefs and behaviors that are at the root of their inaccurate self-perceptions and their problems interacting with others. Because CBT is known to reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors, it is a great aid in treating Borderline Personality Disorder.
  2. Dialectic Behavior Therapy grew out of CBT and was developed by Marsha Lineham who ‘came out’ as a survivor of mental illness in 2011.  Her story can be read here. http://www.nytimes.com/2011/06/23/health/23lives.html?pagewanted=all

This treatment model is an evolving growing method of helping BPD patients and is a beacon of hope for so many.

According to GoodTherapy, Dialectic Behavior Therapy (DBT) is founded on the belief that undetermined causes (likely environmental and biological) cause some people to respond to emotional states more quickly, and they remain in this aroused emotional state for extended periods of time before returning to normal. This is logical since BPD includes symptoms of lives peppered with crises and drama – both highs and lows.  DBT teaches these people coping techniques that they did not receive in their invalidated childhoods.

According to Lineham, therapy must accomplish five goals:

1) Expand and sustain the motivation the client possess to facilitate transformation

2) Provide opportunity for skill-development in the client

3) Assimilate the client’s new skill set so that it can be applied across a broad cross-section of situations and circumstances

4) Develop the therapist’s own abilities and desire to effectively and willingly treat people

5) Provide a nonjudgmental and secure environment in which healing can occur

DBT is always provided in a team environment and includes individual and group therapy, coaching and ‘homework’. Because of the difficulty and long timelines of this work, it is imperative a team approach is adopted, ensuring the therapist receives the support, encouragement and direction needed to effectively continue providing psychotherapy.

In the 1993 training manual, Lineham says that DBT is taught as a series of skills in four modules: mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. The first of these modules makes this treatment very different from any other for mindfulness is based in Eastern Zen philosophy, and it includes Western contemplative practices. Mindfulness is an awareness of thoughts, feelings, behaviors, and behavioral urges. By learning mindfulness, we are empowered to be in charge of ourselves in a different way. It has been proven that awareness assists in emotional regulation. As we understand ourselves, we accept ourselves and change ourselves. It is a practice of attention and intention.

In DBT, core mindfulness begins with the concept of states of mind. According to the theory, there are three states of mind that everyone is in at varying times: wise mind, logical mind, and emotional mind. Wise mind is the ideal state of mind that we strive to reach to make good decisions. The other two states of mind combine to form wise mind. Logical mind is used when doing math, reading a map, and a wide variety of concrete tasks. Last is emotional mind. which is the state in which we feel emotions and then act from that emotional state. For example, we’re in this state of mind when we react out of anger without regard to consequences. This is considered the “hot” state of mind.

For people who live life out of the ever-changing kaleidoscope of emotions, living in mindfulness is the first step in overcoming BPD.  By accomplishing this goal, the other three develop and evolve and result in a rich and productive life.

Dialectic Behavior Therapy is not simple to explain, but it works. It is interesting to me that it combines successful, disciplined therapy with meditation to achieve results.

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About Louise Behiel

Author, coach, therapist, mother and grandmother. I'm on a spiritual journey and consciously work to grow every day.
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20 Responses to Borderline Personality Disorder: 1 Personality Disorder with a Successful Treatment

  1. iamnotshe says:

    This is an interesting phenom to me. There is a Bears football player, Brandon Marshall, who was diagnosed with BPD. We just acquired him from the Dolphins i think. Anyway, he DOES seem like a case of pure BPD. However, as you said before, how does BPD differentiate itself from other disorders, or how is it distinguished specifically? I have seen alcoholics who act as if they have BPD, and once they are sober the BPD seems to have “gone away”? … Can BPD exist on its own, and why would you not diagnose the person as a Narcissist?

    • The challenge with personality disorders is that the ‘edges’ of the diagnosis are murky. It’s about quantity and frequency of certain key elements. BPD exists on its own but can also occur with other disorders, like Bipolar, for example. The thing that makes Borderline unique is the lack of a firm sense of self. Narcissists know who they are and know they are the most important person around – everything is for their betterment. not so with BPD who have no sense of themselves and are usually cutting and harming. suicide is a huge risk with BPD but not with Narcissists.

      • iamnotshe says:

        Yea, you know Narcissists are a really nasty bunch. Sorry Narcissists. However, BPD seems to be a really misunderstood and maligned diagnosis. I remember when Princess Di was diagnosed as BPD. Actually she may have had BPD, but she admitted to bulimia and suicide attempts … once again, the lines of diagnosis are blurry/murky … and hell, the media may have diagnosed Princess Di themselves. Who knows! AND, all of this is supposedly to pose a treatment to a diagnosis. My issue is that MUCH of what a diagnosis does is provide a nasty label for people who are struggling already. I hate labels! Stigma … all crazy stuff. However, i like learning about the disorders/treatments … ‘specially the treatments and the extraordinary outcomes for people who struggle with drugs, food, booze, trauma, abuse, etc. Interesting journeys ahead … 🙂

        • I hear you about the labels, but unfortunately medicine works on the theory that you can’t fix something until you know what it is. I find it ironic that Dialectic Behavior therapy works so well on this, a most serious and difficult to treat disorder, but hasn’t had much success elsewhere. I have to wonder why.

          • iamnotshe says:

            Exactly! A hard to diagnose, and somewhat RISKY disorder to diagnose … and the treatment is quite baffling … or not? It seems that mindfulness or meditation would go against the grain of a fragmented personality.

            • mindfulness, along with a focused treatment plan with other components is the necessary key to recovery. It teaches them (and me) to stay in this moment and to hold my emotions in check so that I can see what’s really happening. It’s a fascinating approach to a difficult illness but it is working for many, many people.

            • iamnotshe says:

              This is a diagnosis that troubles me (i am a psych MA, I/O psych) and a “citizen” of reading Diagnostic manuals … constantly picking out everything i have (haha) … and the fact that this is considered a neurotic and borderline psychotic illness befuddles me. Maybe it’s because i’m not a BPD that i don’t see that this illness can be psychotic. Are there psychotic features? What are the extremes. How does an illness have both features, and yet is treated with pragmatic solutions. What constitutes the psychotic features??

              • I have been told that BPD is not an exlusion to psychosis, but it’s not common. So in the one-offs, there are likely a few people who will use and benefit from psychotics. But I doubt very many and since I don’t work with many of these folks, I couldn’t say. I do know that psychiatrists will often try a variety of drugs and varying combinations to see if anything helps.

                • iamnotshe says:

                  I sometimes wonder if the Diagnostic Book DSM (whatever it is now) … is always helpful or correct. Remember when being gay was considered an illness.

                  Listen, Louise, obviously i am bored, or i wouldn’t be going on and on … just ignore me. haaaaaaaaa. I need to come up with something to blog about that doesn’t include labels and mislabels … i’m stretching here!!!!! xo

  2. Heidi says:

    I don’t know enough about this to comment, except to say that I’m interested in learning about all of this and thanks for helping open the book a bit for me. Good stuff.

  3. Stacy Green says:

    All very fascinating. I find it especially interesting that there are so many different ways to treat. Is there any kind of success rate for the BPD individual who takes their meds and attends therapy? I assume the battle is getting them to stay on their meds, once you find one that works.

    • The key seems to be the relationship with the therapist and her/his ability to deal with the rejection and challenges of this type of patient. The meds soothe emotions and settle things down, but they aren’t a long term fix. Dialectic behavior therapy seems to give clients the tools to live well over the long haul. so yes, there is success for these clients and that makes them a big unusual for people with a personality disorder.

  4. Jenny Hansen says:

    Very interesting read, Louise! I have known a few with BPD in my time, and they wore me out.

    p.s. Just finished reading Family Ties – what a lovely story. 🙂

  5. Thank you for explaining something that is very hard to understand. 🙂

  6. K-lee Klein says:

    Hi there. I just discovered this entry by chance but it interested me because I’m from Calgary – like you – and I have BPD. I actually prefer the term Emotional Dysregulation because it defines the disorder so much better. I had a therapist who once told me borderlines have “no skin on their grape” referring to the amygdala being super sensitive and easy to hurt. I always liked that definition.

    I’ve been through years of DBT and various other programs, plus an array of meds (I’ve also had clinical depression for over twenty years) and I can tell you that in my experience doctors and therapists suggest meds more for the depression symptoms of BPD than the behavioural issues. Unfortunately, BPD is a disorder of learned behaviour and emotional upheaval so meds may mask the behaviours but it’s learning and honing the skills that is the real goal.

    As for mindfulness, I don’t believe we are trying to achieve a life lived inside mindfulness but the ability to use it when it’s needed and to know when that need arises. Of course mindfulness is one of the main skills in DBT, along with the even tougher Radical Acceptance – this is the one that helped turn me around and it was also one of the hardest to understand and learn, at least for me. Support groups, specifically ones for BPD or DBT, can be one of the best things for a borderline because knowing others feel and react in the same way as you or even remotely similar, can be the first step to recovery.

    Being a borderline is a long hard road and in my opinion it’s one that is never “cured” but can be manageable with the use of skills and a little compassion from those around you. I say that because there is a stigma attached to the BPD label and it’s one I’ve dealt with in hospitals and with medical professionals. All I can say to that is not everyone with the same disorder or the same anything acts and reacts the in the exact same way, yet that’s the way we are often treated. I’m just rambling now so I’ll cut this off. I hope at least some of this made sense and I’m not being too presumptuous in commenting at all.

    K-lee

    • K-lee Klein says:

      Sorry. Just as a side note, I’m wondering why you chose the word victims to define those with BPD. I’ve never considered myself a victim in that respect and I’m curious as to whether you’d refer to people with other illnesses in the same way – like depression or even diabetes? Just a pondering of mine. Cheers.

      • that’s a fair question. when I read it, I had to give it some thought. I use the word whenever I think of someone with a serious illness which they didn’t cause. there are cancer victims, schizophrenia victims, and so on. But I have to admit I don’t use that word with depression. so I’ll have to think this over some more. thanks

    • thanks for sharing your experience. it’s always interesting to learn more about any of these illnesses, and this is one I find fascinating for some reasons of my own.

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