What is Borderline Personality Disorder (BPD)?
Borderline personality disorder (BPD) is a devastating
psychiatric illness. The diagnosis encompasses patients with a pervasive
pattern of affective instability, severe difficulties in interpersonal
relationships, problems with behavioral or impulse control (including
suicidal behaviors), and disrupted cognitive processes. The estimated
prevalence of BPD in the general population is about 2%. It has also
been estimated that 11% of outpatients and 20% of psychiatric inpatients
presenting for treatment meet the criteria for the disorder.
Borderline Personality Disorder Patients Comprise:
2% of the general population
11% of all mental health
20% of psychiatric inpatients
75-90% of those diagnosed are
Borderline Personality Disorder Resource Center
As summarized from the
Statistics Manual of Mental Disorders 4th Edition as used by the
American Psychiatric Association):
"A person who suffers
from this disorder has labile interpersonal relationships characterized
by instability. This pattern of interacting with others has persisted
for years and is usually closely related to the person's self-image and
early social interactions. The pattern is present in a variety of
settings (e.g., not just at work or home) and often is accompanied by a
similar liability (fluctuating back and forth, sometimes in a quick
manner) in a person's affect [mood], or feelings. Relationships and the
person's affect may often be characterized as being shallow. A person
with this disorder may also exhibit impulsive behaviors and exhibit a
majority of the following symptoms:
DSM IV Diagnostic
Criteria for BPD:
- Frantic efforts to avoid real or
imagined abandonment. Note: Do not include suicidal or
self-mutilating behavior covered in (5).
A pattern of unstable and intense
interpersonal relationships characterized by alternating between
extremes of idealization and devaluation. This is called
Identity disturbance: markedly and
persistently unstable self-image or sense of self.
Impulsivity in at least two areas
that are potentially self-damaging (e.g., spending, sex, substance
abuse, reckless driving, binge eating). Note: Do not include
suicidal or self-mutilating behavior covered in (5).
Recurrent suicidal behavior,
gestures, or threats, or self-mutilating behavior.
Affective instability due to a
marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely
more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or
difficulty controlling anger (e.g., frequent displays of temper,
constant anger, recurrent physical fights).
Transient, stress-related paranoid
ideation or severe dissociative symptoms.
with 6 or more of the above traits and symptoms may be diagnosed with
Borderline Personality Disorder. However, the traits must be
long-standing (pervasive) and there must be no better explanation for
them (for example a physical illness, another mental illness or
Treatments for BPD have improved in recent years. Group and individual
psychotherapy are at least partially effective for many patients. Within
the past 15 years, a new psychosocial treatment termed dialectical
behavior therapy (DBT) was developed specifically to treat BPD, and this
technique has looked promising in treatment studies.6
Pharmacological treatments are often prescribed based on
specific target symptoms shown by the individual patient. Antidepressant
drugs and mood stabilizers may be helpful for depressed and/or labile
mood. Antipsychotic drugs may also be used when there are distortions in
K, Linehan MM. Research on dialectical behavior therapy for patients
with borderline personality disorder. Psychiatric Clinics of North
America, 2000; 23(1): 151-67
Koenigsberg HW. The frustrating no-mans-land of borderline personality
Cerebrum, The Dana Forum on Brain Science,
NIMH National Institute of Mental health
What is Dialectical Behavior
Dialectical Behavior Therapy (DBT) is a treatment
designed specifically for individuals with self-harm behaviors, such as
self-cutting, suicide thoughts, urges to suicide, and suicide attempts.
Many clients with these behaviors meet criteria for a disorder called
borderline personality (BPD). It is unusual for individuals diagnosed
with BPD to also struggle with other problems – depression, bipolar
disorder, post-traumatic stress disorder (PTSD), anxiety, eating
disorders, or alcohol and drug problems. DBT is a modification of
cognitive behavioral therapy (CBT). In developing DBT, Marsha Linehan,
Ph.D. (1993a) first tried applying standard CBT to people who engaged in
self-injury, made suicide attempts, and struggled with out-of-control
emotions. When CBT did not work as well as she thought it would, Dr.
Linehan and her research team added other types of techniques until they
developed a treatment that worked better. It’s important to note that
DBT is an “empirically-supported treatment.” That means it has been
researched in clinical trials, just as new medications should be
researched to determine whether or not they work better than a placebo
(sugar pill). While the research on DBT was conducted initially with
women who were diagnosed with BPD, DBT is now being used for women who
binge-eat, teenagers who are depressed and suicidal, and older clients
who become depressed again and again.
Excerpt taken from Dialectical Behavior Therapy
Frequently Asked Questions Behavioral Tech, LLC
DBT my perspective:
DBT - is a cognitive/behavioral therapy -
is a treatment designed specifically for individuals with
self-harm behaviors, such as self-cutting, suicide thoughts,
urges to suicide, and suicide attempts. MANY clients with these
behaviors meet criteria for borderline personality (BPD). It
works around the use of a "Skills Training Manual" - and focuses
on 4 Modules called - Core Mindfulness Skills / Interpersonal
Effectiveness Skills / Emotion Regulation Skills / Distress
Tolerance Skills. Basically you would have a group therapy
session for approx 1.5 hours a week and meet with your
individual therapist once a week. Your therapist may or may not
be a group leader in the group session which has 2 therapists
leading the group. 1 of the rules are - If you drop out of group
you lose the therapist you have been working with. I HATE this
rule as it is a means to "force" you to stay in DBT, in my mind.
The therapist and group leaders meet as a "consultation group"
along with a Doc once a week. Part of DBT also allows the client
to have direct phone contact with their therapist 7 days a week
for support to help you get grounded back down with use of a
skill. This phone call must happen PRIOR to any self harming
behaviors. I have been in a rigid program as exactly laid out by
M Linehan and I have been in a modified version. Both were
consistent with change of therapists after leaving the group. I
had been told once by a group leader that if I do NOT "get" DBT
I am most likely going to die from suicide. I did NOT take that
as a very positive result and that it was a scare tactic to keep
me in DBT. My current treatment team does NOT view DBT as the
end all option for me. At this point in my life I refuse to ever
do DBT again. Not saying that some of the skills are not used
during my therapy as they are useful standing out on their own.
For me a strong stance on Behavioral therapies does not work
because I just comply to "advance" versus "punishment".
Compliance isn't change. For a long time I had the assumption
that I was only going to be temporarily be out of group and
that's why my therapy with X never ended. I feel the whole No
group then new therapist application "plays" on the abandonment
fears that I have myself and on others with the Dx of BPD.
I will add that for some persons DBT works wonders from what I
have been told and to not be discouraged because it didn't work
for me. For me the Dx of BPD fits me like a glove.
Personally I think DBT sucks!
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consumers and families, the skills of a mental health professional and
experience of a consumer.
Mental Health Association
Fact sheet on Borderline personality disorder