Borderline Personality Disorder Questions and Treatment Approaches

When the phone rings in our Admissions Department, it may be a call from someone wanting information about or admittance to our Optimum Performance Institute. But in the case of our OPI Intensive program for men and women with BPD, that call is often made by someone seeking answers to our most frequently asked borderline personality disorder questions.

Because May is National Borderline Personality Disorder Awareness Month, today we present a few of the most common questions we get concerning BPD in young adults, and how we answer them. We hope you find this information valuable and helpful.

What Is Borderline Personality Disorder (BPD)?

There is an ongoing debate about the terminology since the word “borderline” was coined by early diagnosticians to mean “borderline psychosis,” which has stigmatized the diagnosis. More accurately, the International Classification of Diseases (ICD) 10th Revision refers to BPD as “Emotionally Unstable Personality Disorder.”

What Are The Symptoms Of BPD?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), BPD’s main symptoms are impulsive behavior and instability of emotions, self-image, and relationships. Symptoms can be grouped by areas of dysregulation including:

• Emotions: People with BPD feel emotions more deeply and easily than others and emotions are more prolonged and changeable. On the “plus” side, they can be exceptionally loving and idealistic. But negative emotions can be so overwhelming that, if coping mechanisms are not learned, they can lead to self-injury or suicidal behavior, two core diagnostic criteria for BPD in the DSM IV.
• Behavior: Impulsive behavior is common. It provides quick relief but can result in loss of jobs, friends or educational goals. This is followed by shame and guilt that causes renewed pain. Substance or alcohol abuse and eating disorders are common co-occurring conditions.
• Interpersonal relationships: Feelings about others can shift from positive to negative based on perceived threats, abandonment or loss of self-esteem. Black-and-white thinking can lead to a shift from idealizing someone to devaluing them, and also limits the ability of young adults to see more than one solution to conflicts. This overwhelmingly singular approach is a disincentive to compromise and discover a mutual conflict resolution where both parties feel heard.
• Cognition: Intense emotions can make it difficult to concentrate.

Co-occurring conditions and BPD:  Co-occurring conditions with BPD can include eating disorders, post-traumatic stress disorder, addictive disorders and disassociation disorders.

What Causes BPD?

Continuing research suggests diverse causes, ranging from environmental factors to genetics, childhood trauma to brain abnormalities and neurobiological factors.

Blaise Aguirre, MD, director of the Adolescent DBT center at McLean Hospital, suggests our understanding is “progressing from a strictly psychodynamically- based construct to a neurodevelopmental disorder with roots in the genetics of the child, the child’s temperament and the environment.” (Psychiatric Times, May 2012)

Can BPD Be Cured?

Contrary to popular belief, recovery from BPD is very possible depending on patient personality and quality of treatment. A longitudinal study tracking symptoms of people with BPD found that 34.5% achieved remission within two years from the beginning of the study, 49.4% in four years and 68.6% in six years. In 10 years, 86% had sustained recovery.

How Do You Treat BPD?

Psychotherapy is the primary treatment. A number of evidence-based psychotherapeutic approaches exist which, according to recent literature, are equally effective. Two of the most prominent are Dialectical Behavior Therapy (DBT) and Mentalization.

We chose DBT as our foundation because:

• It is effective in decreasing suicidal and self-harm behaviors.
• It provides an easy-to-understand format for developing skills that assist with emotion self-regulation and mindfulness.

What Is DBT?

Marsha Linehan, Ph.D., professor of psychology and adjunct professor of psychiatry and behavioral science at the University of Washington, and a BPD sufferer herself, originally developed DBT to treat suicidal behaviors. She then expanded it to treat BPD and other severe and complex mental disorders, particularly those that involve serious emotional dysregulation.

What Is The Philosophy Behind the OPI Intensive Program?

Our program helps young men and women reach their goals while simultaneously learning to deal with their BPD. Individuals and families grow to appreciate each other within the context of the limitations of all parties. In a “family” or “village” setting, participants are supported to experience, express and share something creative or inspiring.

Through this approach, we are able to help young adults develop renewed faith in themselves by:

• Creating bridges (experiential opportunities) that enable each person to discover their creative self or “beginners mind.”
• Helping each participant learn to express their creativity and share it with others.

At OPI Intensive, medications are used to treat co-occurring conditions such as depression and anxiety.

How Long Does BPD Treatment Take?

Just as it took a long time to develop BPD and related traits, it takes a long time to cure. Unfortunately, there are no shortcuts.

Can Families Help?

Absolutely. But consider:

• It is hard for parents to realize their gifted child sees the world through the eyes of a younger person who believes goals are achieved by magic.
• It is hard to realize your young adult is frightened to accept the responsibility of moving forward in a world that is imperfect and ever-changing.
• For years, the pattern at home has been one of responding to polarizing options in an atmosphere of fear and obsessive control, which is why a respite is required.
• Everyone needs time to pull back in order to start accepting each family member’s limitations and begin appreciating each other again.
• Everyone must focus on compromise.  There is no absolute winner or loser when a family member is recovering from BPD.

Do Men As Well As Women Suffer From BPD?

Yes. Research shows that within the BPD population the gender split is not 75% females/25% males as stated in the DSM-IV, but closer to 50/50. We know little about BPD and its effect on men because:

• Men are less likely to seek professional help than women.
• Many men see it as “unmanly” to express feelings.
• Clinical bias: A study found that when 52 professionals in a mental health agency assessed patient vignettes, they were unable to diagnose the presence of BPD in males, even though symptoms were identical to those in vignettes of females.
• Anger is interpreted differently: Men are seen as aggressive or having anger management issues. Women are seen as irrational, frenzied or emotional.
• Many men find it difficult to expose a fear of abandonment or emotional vulnerability, hallmarks of BPD.

OPI Intensive, named by Psychology Today magazine as BEST IN TREATMENT for Borderline Personality Disorder two years running, is one of the only BPD programs nationwide which offers BPD treatment for men.

For additional information about how families can address BPD and BPD Traits with a young adult, I urge you to read my article series on Working With Families & Young Adults With Borderline Personality Disorder (BPD).