Understanding Borderline Personality Disorder

 By: Brian Murray, LMHC, NCC

Borderline Personality Disorder (BPD) is a mental disorder characterized by difficulty with interpersonal relationships. Common symptoms include conflict, addictions, self-harm, impulsive and reckless behavior, and they frequently feel suicidal. Most individuals experience a rapid shift in mood ranging from good to bad to angry to fear of abandonment and rejections from others. The feelings experienced in BPD are usually caused by a tendency to see things in terms of black and white thinking while contributing to conflicting views of the self-known as dichotomous thinking. They are highly sensitive people and dependent on how others view and treat them in their relationships.

People with BPD struggle to manage their emotions and lose functionality when feeling upset, sometimes with explosive anger. People with BPD can be seemingly high functioning and educated in the workplace and social settings. However, it is their personal life where they struggle to function in interpersonal relationships due to fear of rejection and abandonment. Interpersonal relationships can be marriage, dating, friendships and family.

What causes a person to develop BPD?

The exact cause of BPD is unknown and the consensus of how it develops is still open to debate in the psychological community. BPD is part of a family of personality disorders that all share some basic causations. This includes biological, psychological, and social factors. Between these factors it appears that some people with BPD have early influences in life that are a major contributor to a person developing the disorder. This is especially true of those with childhood sexual abuse. Here are some statistics regarding BPD.

1. Approximately 75% of people diagnosed with BPD have a history of sexual abuse. Some estimates place that percentage higher.
2. Approximately 75% of those diagnosed are women.
3. About 10% of people diagnosed with BPD commit suicide.
4. 2-3% of the general population has BPD or approximately 6.6 million people in the United States.  

How is BPD Treated?

Treatment usually involves psychotherapy and at times medication. Dialectical Behavioral Therapy (DBT) is considered the most effective form of treatment for BPD, however other forms such as Person Centered, and Existential approaches have shown to be effective as well. It’s important to find a therapist who is trained in DBT which is a specific type of therapy that was developed for the disorder by psychologist Marsha Linehan.

DBT treatment usually consists of weekly sessions with a counselor and possibly group therapy to learn specific skills. Group therapy is not recommended until a client with BPD is well established in treatment under the guidance of a counselor. Individual counseling includes interpersonal and relationship skills (needed for group therapy), distress tolerance, radical acceptance, emotional regulation, and mindfulness skills. Expect counseling for BPD to last anywhere from 6 months to 2 years depending on severity. Lifelong maintenance counseling, every 1-2 months, is not uncommon after 2 years of therapy. 

Due to the chronic feelings of emptiness, lack of personal identity and difficulty managing associated symptoms such as anxiety and depression, other types of therapy are helpful as well. For example, existential therapy is useful for helping the sufferer establish a sense of meaning and purpose in life. This can help them to not be dependent on others for their feelings.

BPD sufferers often dictate feelings on what they think others might be thinking about them. For this reason, they can be confused with someone who has social anxiety. This anxiousness causes the BPD sufferer to avoid social situations. By avoiding they learn to avoid the powerful emotions and so they tend to socially isolate themselves. This isolation gives them a sense of helplessness which validates and reinforces their emotions. This cycle becomes reciprocal over time and any attempt to pull them out of isolation is usually met with fierce anger. It is in this isolation mode they will often refer to self-destructive behaviors such as cutting, heavy drugs and alcohol, eating disorders and unfortunately suicide.

A counselor who specializes in BPD will recognize these patterns and will be able to guide the client toward healing. As previously stated, it typically takes anywhere from 6 months to 2 years to recover and learn how to manage BPD depending on severity. Most people with BPD want to get healed. They want to love and have good relationships just like anyone else. At some point in their lives, they do recognize that something is not right, and they make efforts to get counseling. Therefore, another pattern they have is counselor hopping. They tend to go from one therapist to another trying to find an ideal one who can pinpoint their problem. Another symptom plays into this is they will idealize a therapist until the therapist does something they do not like and then the BPD client will devalue them. This is the result of psychological splitting going from all good to all bad.

If you or someone you know has BPD understand that it can be very difficult to live with both for the sufferer and the family or partner. Finding the right therapist is important so do some research and find the one who has spent some time with the disorder. Not all counselors work with BPD so it’s important to ask the counselor if they do, how much experience they have working with them and any special training to treat BPD.  

 

To schedule an appointment with Brian Murray,
Please call our office at 407-647-7005.
www.lifeworksgroup.org