Living with Borderline Personality Disorder (BPD)
Borderline Personality Disorder (BPD) is a mood disorder that affects how you view yourself and others. BPD Symptoms can include difficulties in accepting positive self-image and managing emotions and behaviors, as well as engaging in unstable relationships repeatedly. BPD is characterized by an intense fear of abandonment, instability, and sometimes difficulty tolerating being alone. At the same time, people with BPD tend to display anger in inappropriate contexts, act impulsively or experience frequent mood swings, despite wanting loving and lasting relationships. BPD tends to begin to emerge in early adulthood.
Symptoms may include:
Consistent efforts to avoid abandonment, either real or imagined. One may go to extreme measures to prevent such abandonment.
Intense episodes of anger, anxiety, and depression lasting between a few hours to a few days
Distortions in thoughts regarding one’s sense of self and self-identity. One’s sense of self may rapidly change within a short time span.
Recurrent suicidal behavior and/or self-harm.
Stress-related paranoia that can result in dissociative behaviors.
Frequent disassociation.
Engaging in risky or impulsive behaviors regularly, such as spending sprees, frequent substance use, binge eating, gambling, reckless driving, unsafe sex, or self-sabotaging behaviors.
Pattern of unstable and intense relationships. For example, someone with BPD may go from over-idealizing someone to having extreme distaste for them in a short period of time, usually triggered by separation of any kind
Persistent feelings of emptiness.
Stigma around BPD
Unfortunately, BPD can often be stigmatized. BPD is regularly misunderstood, even by healthcare professionals. This can lead to frequent misdiagnosis. For example, BPD is often misdiagnosed as Bipolar Disorder or Major Depressive Disorder. This can cause barriers to accessing the right treatment for you.
If you are a clinician, consider pursuing some specialized training around BPD. For example, studies by Shanks et al (2011), Klein et al (2022), and Keuroghlian et al (2016) indicate that after attending training or educational workshops about BPD, clinicians had a more positive attitude toward clients diagnosed with BPD.
Managing BPD
There are many ways to manage BPD. The type of treatment or coping mechanisms will vary from person to person.
Psychotherapy is considered the most fundamental treatment for managing BPD. There are a few modalities that have been shown to be clinically effective at treating BPD. Some of these modalities include:
Dialectical Behavioral Therapy (DBT)
DBT is a highly structured approach focused on changing undesired behaviors. DBT consists of one-on-one sessions with a trained therapist and co-occurring group therapy or a DBT “skills group.” The purpose of the group is to teach clients emotional regulation skills that can be used in real-life contexts. One-on-one sessions provide extra support and allow clients to work on behaviors that bring them distress in more depth.
Cognitive Behavioral Therapy (CBT)
CBT focuses on recognizing distorted thoughts and negative self-talk and finding ways to cope with them or counter them. CBT can help BPD clients with negative thought patterns and a sense of self. CBT can be done in individual or group therapy.
Mentalization Based Therapy (MBT)
MBT is centered on teaching clients to become more conscious of their own internal states and to develop empathy for others’ experiences. It can also be used to explore emotions and create alternative explanations for negative interactions with others.
Many people manage BPD with medication in addition to therapy. A trusted psychiatrist can help you manage BPD effectively.
Apart from clinical interventions, BPD can be managed by establishing a healthy diet and sleep schedule, as well as a consistent daily routine. Developing a mindfulness practice and finding self-soothing activities is also helpful for regulating emotions and coping with other BPS symptoms.
Finding the right clinician
It is important to find a therapist and/or psychiatrist with a solid understanding of BPD and experience treating clients with this diagnosis.
When looking for the right clinician, you should always check their credentials. For example, are they trained in modalities associated with treating clients with BPD, such as the ones mentioned above? Keep in mind that modalities like DBT require very specific and specialized training. Some clinicians may be certified DBT clinicians, while others may simply use some techniques from DBT with their clients. Make sure to ask them what training and/or certifications they have received for treating BPD.
Don’t be afraid to ask potential therapists or psychiatrists questions. Here are some questions that can help you gauge if a clinician will be a good fit for you:
-What is your experience treating clients diagnosed with BPD?
-What is your experience with diagnosing BPD?
-What formal training around BPD have you received?
-Have you participated in any educational initiatives around BPD?
-How do you manage stigma around BPD?
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