As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.
Borderline Personality Disorder, commonly referred to as BPD, is a condition that affects less than 2% percent of the American population in any given year. It is a condition marked by a general instability of mood and in personal relationships, and most often a negative self-image. Borderline Personality Disorder can make interpersonal relationships difficult to maintain as the symptoms often exacerbate social isolation and disconnection. Additionally, some people living with Borderline Personality Disorder may also experience disruptions in performance at school, work, and other social environments.
In addition, many who live with Borderline Personality Disorder (BPD) also face challenges with engaging in self-destructive or impulsive behavior. However, this may not be the case in all who live with the condition.
Symptoms
Typically, those diagnosed with BPD may start to experience symptoms in adolescence or early adulthood. These symptoms consist of the following:
- An ongoing pattern of intense and unstable interpersonal relationships. This may often include cycling through periods of extremely high evaluation (idolizing) of others and subsequent devaluation.
- An ongoing fear of abandonment
- The person may engage in behaviors that hope to stave off interpersonal abandonment or isolation
- Persistent feelings of emptiness or unworthiness
- Intense bouts of anger or frustration which may or may not manifest in physical altercations
- An ongoing sense of particularly intense, yet moderately short, emotional experiences such as severe anxiety that resolves after hours or a day, or extreme agitation which may lift in a similar manner
- A person with BPD might engage in highly impulsive, self-destructive risky behavior such as risky sexual behavior, illogical spending, driving recklessly, substance misuse
- Recurring self-mutilation (such as, but not limited to, cutting), and/or suicidal gestures, behaviors or feelings (with or without plans)
In addition, some individuals living with Borderline Personality Disorder may also experience periods of moderate to severe stress-related paranoia or momentary experiences of feeling disconnected from one’s self and body.
Treatment for Borderline Personality Disorder
Medication
Medication can be a powerful tool in the treatment of symptoms associated with Borderline Personality Disorder. Those who live with the condition may experience a mixture of emotions that they find disruptive in their day to day lives. For some, this may primarily include anxiety and depression. For others, they may experience stress-related paranoia or dissociation (feeling disconnected from one’s body).
Mood stabilizers are sometimes recommended by psychiatrists in the treatment of Borderline Personality Disorder, and medications like Topamax (generic name topiramate) and Lamictal (generic name lamotrigine), which are anti-seizure medications have been particularly effective in managing the mood-related symptoms of Borderline Personality Disorder.
A category of medications called antipsychotics, which target paranoia or dissociation, may be recommended as indicated by each individual case. Some of the most prescribed anti-psychotic medications for Borderline Personality Disorder are Risperdal (generic name risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine), and Clozaril (clozapine).
Psychotherapy (Talk Therapy)
Dialectal Behavioral Therapy, or DBT, is the most well-known and researched type of therapy treatment for Borderline Personality Disorder. This model for treatment is an offshoot of Cognitive Behavioral Therapy (CBT) and was developed in the 1980s by psychologist Marsha M. Linehan. In fact, DBT was developed with the specific intention to treat those living with Borderline Personality Disorder.
DBT helps support those living with Borderline Personality Disorder by focusing on three main areas: collaboration, support, and working through distorted thought patterns.
Typically, in DBT you meet with an individual therapist once weekly for individually focused sessions. In these sessions, you will learn the skills to identify and challenge distorted thoughts related to self and others, as well as tangible skills to cope with those thoughts. Your therapist may include mindfulness-based strategies as helpful ways to cope with particularly intense feelings. As many living with Borderline Personality Disorder might indicate, the emotional experiences and instability can feel quite intense, leaving a person to experience a heightened emotional experience. By using mindfulness strategies and other tools, you and your therapist can work together to make you better equipped to cope with future life events or intense emotional surges.
In addition, DBT very highly values the idea of collaboration between therapist and client. As mentioned above, this means that you and your therapist will work closely to figure out the best ways to manage your symptoms. Sometimes, the relationship between you and your therapist (and those dynamics between you) will be used in an effort to work through and develop the skills necessary to foster and maintain interpersonal relationships. This work can be challenging, yet very forwarding in the long run.
Other treatments recommended for Borderline Personality Disorder are more uncommon and may include Transference Focused Psychotherapy (TFP), Schema-Focused Therapy (SFT), and General Psychiatric Management. Due to the rarity of training programs for these therapies, it is less common to find mental health providers who use these models to treat Borderline Personality Disorder.
Group Therapy
As indicated in individual therapy, collaboration is a big part of treatment for BPD. As such, your therapist may recommend that you consider joining a therapy group or support group for those living with Borderline Personality Disorder. In therapy groups, a DBT-trained therapist will work with the group on improving interpersonal relationships, how to regulate your emotional experience more effectively, how to tolerate distress and accept reality, and teach mindfulness-based skills. In the group you will learn about these various skills and practice them together. Group members are encouraged to also practice those skills outside of group and report back in a follow session. DBT-therapy groups often meet weekly for about 2.5 hours.
Support groups, by contrast, will focus on providing a source of social support for those living with Borderline Personality Disorder and may or may not lead by a trained therapist. Most often support groups are run by peers who have experience living with, and recovering from, the condition.
Therapeutic Note
Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.
Questions You Might Have For Your Talkspace Therapist
- How can I have meaningful relationships when I don’t feel like people want to be close to me?
- What are some alternatives to self-harm?
- Sometimes I feel as if I’m not even of this world because I am so isolated, could that be due to BPD?
- People always tell me that I am pushing them away, why would I do that when I really want to have people in my life?
- If I have paranoid feelings or disassociate, does that mean I have Schizophrenia too?
Sources
An Overview of Dialectical Behavior Therapy. (2016, July 17). Retrieved June 14, 2017
Borderline Personality Disorder. (2017, April 19). Retrieved June 14, 2017
Borderline Personality Disorder. (n.d.). Retrieved June 14, 2017
Friedel, R. O., MD. (n.d.). Medications. Retrieved June 14, 2017
Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., … Ruan, W. J. (2008). Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 69(4), 533–545.
Medications for Borderline Personality Disorder. (2013, September 07). Retrieved June 14, 2017