borderline personality disorder

There tends to be much confusion about how BPD should be treated.

The term ‘borderline’ derives from an assessment in the 1940s, which found that the disorder was on the border between psychosis and neurosis. This is no longer considered an accurate description. Today borderline personality disorder refers to a disorder of the mood and interpersonal function.

In some cases BPD symptoms improve with age. However, most of the time the condition affects sufferers throughout their whole life. There is treatment available to help get mood swings under control and promote healthier behaviour. This can allow sufferers to lead more fulfilling lives.

Dialetical behaviour therapy (DBT)

Dialetical behaviour therapy is specially designed to treat BPD sufferers. This approach addresses two important factors that can contribute to the development of the condition: emotional vulnerability and a person’s environment. The goal of DBT is to help clients believe that their emotions are acceptable, valid and real. It also teaches them to be open about their opinions and ideas, rather than thinking in a solely black and white mindset. These concepts are used to promote positive behavioural changes and help sufferers of BPD to perceive the world in a way that is not rigid or limiting.

DBT is recommended by NICE as a leading borderline personality disorder treatment option. It can be provided in group or individual sessions. However, in severe cases it is rarely sufficient as a stand alone treatment.

Mentalisation-based therapy (MBT)

This is an additional long-term form of borderline personality disorder treatment. It’s based on the idea that people with the condition are unable to effectively examine their own thoughts and beliefs, or assess whether they are realistic. For example some people with BPD may have an urge to self-harm and will do so without questioning their behaviour. They lack the ability to take a step back and consider their actions.

Another aspect of this inability to ‘mentalise’ is failure to understand and recognise that other people have their own thoughts, feelings and needs. BPD also means sufferers will not see how their actions impact on other people’s emotional states. This can further complicate their relationships. The goal of MBT is to address these issues and help clients to see themselves and others in a more realistic light. It does require a committment on the part of the Borderline and the therapist over a period of time.

While there has traditionally been skepticism about the psychological treatment of personality disorders, several specific types of psychotherapy for borderline personality disorder have developed in recent years and psychotherapy now appears to be a key part of the treatment of borderline personality disorder.  Psychotherapy may be individual or group-based, and may involve sessions over several months or, particularly for severe personality disorders, even several years.

A combination of medication, psychotherapy and a contract based therapy regime is, in my experience a pretty good combination.