Borderline Personality Disorder Therapy
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Borderline personality disorder is characterized by impulsivity and instability. The phrase derives from being on the “border” of psychosis—those suffering from the condition appear to have a distorted perception of reality.
Relationships, emotions, and self-concept are all affected by instability. People with BPD, who are afraid of abandonment, cling to those close to them, want reassurance and reinforcement, and are agitated by seemingly minor changes. Emotion outbursts, severe mood swings, hopelessness, paranoia, self-harm, and suicidality can accompany emotional and self-concept turmoil; 10% of persons with the condition commit suicide.
BPD is most commonly diagnosed in youth or early adulthood. According to the NIMH, it affects approximately 1.6 percent of U.S. people, however other estimates bring the frequency closer to 6 percent.
Individuals and their loved ones can navigate the condition if they commit to treatment with patience and perseverance. Different types of therapy, including dialectical behavior therapy, and drugs to manage symptoms can help people with BPD live a more fulfilling life.
In BPD, instability is a defining feature, whether in mood or in relationships. The individual may experience extreme emotional fluctuations, ranging from lavish praise and affection to harsh criticism and blame. In a fit of anger, they may scream at you in public, attack you, or damage themselves—things that ordinary people would not do in the same situation. A fear of desertion might emerge as clinginess or manipulating a relationship you have with another person. If the person exhibits these behaviours on a regular basis, they may have BPD.
Splitting is the black-and-white thinking that can envelop persons suffering from BPD. In times of happiness, they may fawn over a friend or lover, labeling them “perfect,” whereas little setbacks or miscommunications may cause them to become terrified or enraged, labeling the person “awful” or “never trustworthy.” Splitting’s extreme perspectives might manifest in how persons with BPD see themselves.
The causes of borderline personality disorder are largely unknown. It appears to be produced by intricate connections between one’s biology and environment, as is the case with many mental health issues.
According to the DSM-5, the disorder has a strong hereditary component, since it is five times more likely in those with BPD who have first-degree relatives who have BPD. In persons with BPD, the balance of activity in important brain areas, including the prefrontal cortex and the amygdala, may be disrupted. Life events also play a role, since BPD is more likely in people who suffered early hardship, such as abuse or abandonment.
The exaggerated way people with BPD see the world may be the result of a fault in brain dynamics. The limbic system, an evolutionarily primitive network of brain areas that create primordial emotions such as fear, is typically governed by the prefrontal cortex, the portion of the forebrain responsible for self-control and decision-making. However, patients with BPD appear to have less prefrontal cortex-to-amygdala input. This results in a hyperactive amygdala, which perceives threat and rejection when others do not.
Historically, borderline personality disorder was regarded to be virtually hard to cure. However, specialists now understand that the condition is manageable with therapy dedication, considerably improving the lives of persons with borderline.
Dialectical behavior therapy is the first-line treatment for BPD, and it teaches patients to accept emotional ambiguity and suffering while also teaching them coping strategies to manage their emotions and develop stable relationships.
Other types of therapy can also be useful. Cognitive behavior therapy focuses on faulty cognitive patterns. Transference-focused psychotherapy assists patients in overcoming the emotional obstacles that lead to borderline behavior. Furthermore, mentalization-based treatment assists patients with regaining curiosity about the mental states of others in order to get a different viewpoint.
Medication, in addition to therapy, may be recommended to aid with symptoms such as anxiety or sadness.
Dialectical behavior therapy (DBT) has long been the go-to treatment for BPD, an intensive program of group skills training in mindfulness, distress tolerance, conflict management, and emotion regulation, reinforced with psychotherapy and phone coaching.
DBT, which was developed by University of Washington psychologist Marsha Linehan, herself a BPD patient, focuses on managing the disorder’s behaviors. Clients utilize mindfulness and distress tolerance strategies to cope with difficult emotions rather than acting out through cutting, suicide attempts, risky sex, substance misuse, or disordered food.
Even people who recover from BPD are unlikely to be low-maintenance lovers or companions in the future. Loved ones must learn stress management, self-care, and boundary setting so that they can look out for themselves while still assisting their partner.
The following suggestions can assist a loved one suffering from BPD and aid to establishing bonds:
• Avoid discussing your relationship’s difficulties until your spouse feels calm and protected.
• Maintain your curiosity and inquire as to how your loved one is feeling.
• Stress that it’s alright for neither of you to be flawless.
• People suffering from BPD may threaten suicide or self-harm in order to keep you near. If you’re remaining with a partner or a friend just because you’re afraid he won’t be able to survive without you, it’s time to get professional treatment. Couples therapy can provide a secure space for you to communicate the impact of the other person’s behavior on your life.
Having a solid existence outside of a love relationship is essential for recovery. Prioritizing work, particularly modest, recurrent encounters with coworkers might assist persons suffering from BPD in establishing a consistent pattern, both professionally and socially. Building relationships with neighbors and friends can follow the same path. People with BPD may be ready to get into an intimate relationship once they have established a solid foundation.
A person would be diagnosed with BPD if they have at least five of the following symptoms, as judged by a mental health professional using the DSM-5.
- Frantic efforts to avert abandonment, real or imagined
- A pattern of unstable and intense relationships characterised by oscillations between idealisation and depreciation.
- Identity disruption is defined as a significantly and persistently unstable self-image or sense of self.
- At least two potentially self-harming domains of impulsivity (spending, sex, substance abuse, reckless driving, or binge eating).
- Suicidal ideation or threats, as well as self-harming behaviour, on a regular basis.
- Mood instability (dysphoria, irritability, or anxiety).
- Feelings of emptiness that persist.
- Anger that is inappropriate, intense, or difficult to control.
- Stress-related paranoid thoughts or acute dissociative symptoms.
Yes, it appears that BPD manifests differently in men and women. In terms of impulsive behavior, men are more likely to engage in substance abuse, antisocial behavior, and intermittent explosive disorder, whereas women are more likely to engage in eating disorders. Men may self-harm in a variety of ways, including bruising, head-banging, and biting, in addition to cutting.
In terms of treatment, women are more likely to seek therapy and medication, whereas men are more likely to seek substance abuse treatment. Both men and women attend treatment in the same emotional state.
Quiet BPD and high-functioning BPD are non-diagnostic words that refer to people who do not exhibit traditional BPD symptoms such as angry outbursts or self-harming activities. Rather, symptoms and feelings are frequently turned inward or only emerge in “pockets,” such as when the person is triggered by certain people or events. These people may appear calm and collected on the outside, yet they are suffering from intense loneliness, shame, and self-criticism.
Previous study has indicated that BPD affects women three times more than males. However, subsequent evidence shows that the rates may be comparable. Previous disparities might be attributed to the condition manifesting differently in men and women, diagnostic prejudice, and more women seeking treatment. As a result, it’s critical to note that BPD affects both men and women, as well as people of all ethnicities.
Among the most prominent risk factors for BPD include childhood experiences of parental neglect and emotional, physical, or sexual abuse. These situations may cause children to keep up and modify techniques in order to handle the unpredictability of parents and caregivers, fostering rejection and distrust in the context of relationships.
Long-term treatment is required for recovery; 10-year research indicated that 85 percent of patients with BPD were in remission by the conclusion of the trial. These individuals also demonstrated enhanced social abilities, despite the fact that they still encountered challenges.
Borderline personality disorder patients obsessively test the stability of relationships. If therapists give in to this temptation, therapy aiming at personality change will come out as withholding; if therapists resist the urge to prove they care, therapy will come across as a rejection. Therapists must not feed or starve the patient’s abandonment anxieties in order to involve the patient in altering how they connect to others.
Close friendships, romance, and familial relationships are frequently what people on the borderline seek the most, and they frequently move in a flurry to win others over. However, maintaining connection is a monumental effort since the disorder epitomizes a profound paradox: Sufferers need closeness, but their overwhelming insecurity drives away people closest to them. Despite their self-defeating behaviors, it is not difficult for them to get through the histrionics and retain closeness—indeed the sheer stability of a relationship is sometimes restorative.
Relationships with borderline people are characterized by instability, volatility, and drama. When the individual is in excellent spirits, you may feel terrific; when they are not, you may feel crushed. People with borderline personality disorder respond to abandonment worries with neediness, which can manifest as clinging text messages or stalker activities, or with anger and rage. They may be on the lookout for actual or imagined symptoms of rejection or desertion if you are late, cancel an appointment, or chat to someone they perceive as competition. A persistent sense of distrust can lead to a skewed perception of reality and paranoia.
What is the next step?
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