There are many different ways individuals with Borderline Personality Disorder (BPD) experience symptoms. Some have a difficult time distinguishing reality from their own view of the world and environment. This occurs because the individual’s emotions becoming overwhelming to their regular cognitive functioning.

Another way individuals with the disorder see others is in black-and-white terms. They may see someone as caring and loving (white) and when something goes wrong they are suddenly bad (black). Therapists must be aware of the “all-or-nothing” lability that individuals with this disorder exhibit and not give it validation. It is important for the therapist to be stable to contrast the individual’s lability of emotion and thinking. It is hard on the clinician to treat this disorder because of the individual’s constant suicidal gestures, thoughts, and behaviors, and the possibility of self-mutilation.

This article on How to Treat Borderline Personality Disorder will briefly discuss the DSM IV diagnostic criteria. It will further explain treatments, such as psychotherapy, hospitalizations, medications, self-help, and outcomes. For more information on this disorder, please read How to Diagnose Borderline Personality Disorder. For other interesting reading, please see How to Diagnose Clinical Depression, How to Treat Clinical Depression, How to Diagnose Anxiety Disorders, and How to Treat Anxiety Disorders.

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment
2. Unstable and intense interpersonal relationships fluctuating between idealization and devaluation
3. Unstable self-image or sense of self
4. Compulsivity in areas that could be self-damaging
5. Suicidal gestures or behavior, threats, or self-mutilating behavior
6. Mood instability
7. Constant feeling of emptiness
8. Inappropriate, intense anger and difficulty in controlling anger
9. Brief periods of stress-related paranoid ideation or severe dissociative symptoms.http://psychcentral.com/lib/2007/borderline-personality-disorder-treatment/

Other factors

These criteria can be present in different combinations which makes the disorder present differently from one individual to another. These different combinations make the diagnosis difficult for clinicians who are not familiar with the disorder. This disorder seldom occurs alone. It often occurs with other disorders such as:

• Major Depressive Disorder (60%)
• Chronic moderate to mild depression (70%)
• Eating disorders (25%)
• Substance abuse (35%)
• Bipolar disorder (15%)
• Antisocial personality disorder (25%)
• Narcissistic personality disorder (25%)

One to two percent of the population is affected by this disorder. The two percent includes individuals with schizophrenia and bipolar disorder.

Approximately 10% of outpatients and 20% of inpatients being treated have BPD.

Three times more females than males have BPD.

Self-injury is present in approximately 75% of individual with BPD.

Approximately 10% of individuals commit suicide.

• Prognosis is good when treated properly with medications, psychotherapy, education, and support groups. Medications may be necessary for co-occurring illnesses.

• Dialectical behavior therapy (DBT) is a more recent treatment that at this time is the best-studied intervention for BPD.

• With proper treatment many patients do get better.http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=44780

When starting psychotherapy, it is important to make a contract with the individual to make sure they do not commit suicide. The potential for suicide needs to be carefully assessed and monitored throughout the entire course of treatment. If suicidal feelings are severe, medication and hospitalization should be seriously considered.http://psychcentral.com/lib/2007/borderline-personality-disorder-treatment/

For the individual with BPD, therapy ordinarily consists of two or three sessions a week, which may last a period of years. The therapist helps the individual understand the meanings and motives of their behavior, and helps them with their ability to endure frustration, loneliness, and anger, and not act impulsively on those feelings. Consistent focus on their “black and white” thinking is important. The family also needs to learn to set limits with the individual and not give in to their threats or unreasonable demands.http://www.borderlinedisorders.com/public.php

The most successful and effective treatment is Dialectical Behavior Therapy (DBT). It teaches the individual how to take control of their life, emotions and themselves, through self-knowledge, emotion regulation, and cognitive restructuring. It is most often conducted in a group setting. If the individual has difficulty learning new concepts, however, it may not be appropriate.http://psychcentral.com/lib/2007/borderline-personality-disorder-treatment/

Group modalities like DBT and CBT are like classes with instruction by the group leader and homework between sessions. It has a manual that if followed each week which puts the lectures and exercises together. This type of interpersonal group allows the individuals with BPD to share experiences, along with the lessons, which enhances their treatment.http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=44780

When a family member has BPD, by the time they are diagnosed everyone has been affected by the stress that has been created in the family. It is helpful for the family to seek out a family-friendly organization that will educate them and help them understand the disorder. All too often, psychiatrists do not value input from the family. This situation can be frustrating for family members, who may be the sole moral and financial support for their loved one, but receive little or no response from the treating professionals.http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=44780

Individuals with BPD often go to the emergency or local mental health center when they are in a crisis. This can be very costly and the individual should be encouraged to find social support within the community, contact a crisis hotline, or seek help from their own therapist. Treatment that a hospital may give may conflict with treatment the individual is already receiving from their own therapist or another facility. For this reason, it is important that the emergency facility contact the individual’s therapist immediately. http://psychcentral.com/lib/2007/borderline-personality-disorder-treatment/

Hospitalization is sometimes an option when the person is experiencing extreme difficulties with their daily living. It is seldom used in the U.S. because is very expensive and is seldom appropriate. The average length of stay is three to four weeks. It may help stabilize the individual, but is not enough time to make the changes that are needed in the individual’s personality makeup.http://psychcentral.com/lib/2007/borderline-personality-disorder-treatment/

If the individual is not progressing in therapy or has frequent suicide attempts that interrupt their life or others’ lives, the individual and his/her family may seek a facility that specializes in BPD. After a thorough assessment more treatment options may be suggested.http://www.borderlinedisorders.com/public.php

A good specialty facility should consist of a highly structured environment which will expand the individual’s independence. The goals of the treatment should include the reduction of the individual acting out, identification and work on inappropriate behaviors and feelings, both the therapist and the individual accepting the magnitude of therapy involved, learning how to have more effective interpersonal relationships, and working with transference and real relationships within the hospital setting.http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=476

“Partial hospitalization or a day treatment program is often all that’s needed for people who suffer from borderline personality disorder. This allows the individual to gain support and structure from a safe environment for a short time, or during the day, and returning home in the evening. In times of increased stress or difficulty coping with specific situations, this type of treatment is more appropriate and healthier for most people than full inpatient hospitalization.”http://psychcentral.com/lib/2007/borderline-personality-disorder-treatment/

“Day hospital treatment is helpful both in enabling patients to understand their problems and how they affect others, and also in bringing patients into close daily contact with others who are working on similar problems. Borderline patients tend to support each other—sometimes in a negative way, to be sure, but more often in a very positive way. Articulate, candid and forthright, peers are often extremely effective in cutting through the denials and excuses and the blaming of others that so hamper a person's ability to see his or her own problems. Recognition of the illness and the determination to overcome it has everything to do with successful treatment.”http://www.borderlinedisorders.com/public.php

Medications

Sometimes medications are necessary in outpatient treatment. For individuals with large mood swings may be treated with Depakote or Tegretol, which are often used for epilepsy. For those individuals with severe depression or eating disorders may be given antidepressants. Sometimes BPD causes severe stress, and a small dose of a neuroleptic drug often used for schizophrenia, may be given. Lithium may help and may allow for a decrease in the dosage of other drugs. Tranquilizers can be habit forming, so drugs like Valium or Dalmane should be used carefully.http://www.borderlinedisorders.com/public.php

Side Effects of Medications

1. Antidepressants – dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, weight gain, weight loss.
2. MAOIs – strict food restrictions because blood pressure elevates.
3. SSRIs – nausea, nervousness, insomnia, diarrhea, rash, agitation, sexual problems, weight gain, weight loss.
4. Mood stabilizers – nausea, drowsiness, dizziness, possible tremors.
5. Some drugs require liver function tests and blood cell counts.
6. Neuroleptics – tardive dyskinesia (involuntary movements)
7. Atypical antipsychotics – weight gain, drowsiness, insomnia, breast engorgement and discomfort, lactation, restlessness.http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=44780

Self-Help

The medical profession often overlooks self-help methods, but treatment does encourage getting additional social support. There are many support groups in the communities throughout the world that devote their time to helping others to share their common experiences and feelings. The individual should also be encouraged to try new coping skills and regulate their emotions with other support group members. It can help them increase their skills and develop new and healthier social relationships.http://psychcentral.com/lib/2007/borderline-personality-disorder-treatment/

Outcome

After a study of 500 people, the Columbia Psychiatric Institute reported that four out of ten were clinically recovered 10-20 years after their point of entry into the study. In addition, seventy-five percent were doing reasonably well and were self-supporting. At 16 years post admission, 7% had committed suicide. Those that tended to recover were those that continued psychotherapy for many years.http://www.borderlinedisorders.com/public.php

The content on this page is for information purposes only and is not a substitute for professional medical advice. Speak with a qualified heath care professional to ensure that you have the most accurate information regarding any mental health diagnosis.