Borderline personality disorder (BPD) is a mental health disorder characterized by impulsive behaviours, challenging or volatile relationships, and fluctuating moods.
Studies show that BPD affects approximately 1.6% of American citizens. Moreover, 20% of the general population receiving inpatient treatment in a psychiatric hospital are borderline personality disorder patients.
What is a borderline personality disorder, and how is it treated?
A borderline personality disorder is a ‘’cluster b’’ personality disorder. Like other personality disorders in this cluster (i.e., narcissistic personality disorder), BPD is marked by overly emotional, erratic or dramatic behaviours.
Treating BPD can be complex due to the nature of the disorder.
People with a borderline personality disorder may find it challenging to build trust and rapport with a therapist since many BPD patients have a history of trauma or other co-occurring mental health disorders that can prevent or disrupt treatment.
Treatment
Borderline personality disorder is typically treated with psychotherapy. BPD treatment aims to improve functioning and reduce symptoms, allowing the individual to enjoy a better quality of life.
The medical literature states that there are no FDA-approved medications for borderline personality disorder as it currently stands. Moreover, every BPD patient responds differently to treatment. Thus there are no absolutes when it comes to treating the condition.
The good news is that people with BPD usually have high remission rates. In addition, research shows that with proper treatment and persistence, many people with borderline personality disorder typically lead happy, functional lives.
Risk factors and causes
Like most mental health disorders, BPD is usually caused by a mixture of environmental and biological factors.
Emotional trauma is usually a significant risk factor for developing BPD, with many patients reporting a history of child abuse, neglect or abandonment.
Risk factors
However, there are various other risk factors, such as:
- Brain structure: Although it is unclear whether specific brain changes cause borderline personality disorder, scientific studies illustrate that those with BPD show functional and structural brain changes that control certain impulses, such as emotional regulation (How Borderline Personality Disorder Is Treated, Michelle Pugle, Verywell Health, April 10th, 2021).
- Social, environmental, and cultural factors: Many people with borderline personality disorder have traumatic histories – particularly traumatic events from childhood – such experiences include child abuse and neglect, abandonment, or other adverse events. Equally, many with BPD report having exposure to unpredictable or unstable home environments, conflicts, and invalidating relationships.
- Family history: People with a family history of BPD are at a higher risk for developing the condition, for instance, if a person’s mother, father, or other close family member has the disorder.
Prevalence rates
Although receiving a BPD diagnosis can be overwhelming and scary, the condition is more common than you might think.
For example, over four million people in the United States have a borderline personality disorder. In addition, research shows that BPD is more prevalent than some mental disorders, such as schizophrenia.
Gender differences and borderline personality disorder
Studies show that women are more likely to be diagnosed with BPD than men (Borderline Personality Disorder Statistics, Verywell Mind, Kristalyn Salters – Pedneault, Ph.D., November 25th, 2020).
Additionally, around 75% of people diagnosed with borderline personality disorder are women. So if you look at it this way, that’s three women to one man with the condition (Borderline Personality Disorder Statistics, Verywell Mind, Kristalyn Salters – Pedneault, Ph.D., November 25th, 2020).
There are various explanations as to why more women are diagnosed with BPD. One reason is that women are more likely to seek treatment than men, or men with BPD are far more likely to get misdiagnosed with other conditions like depression or post-traumatic stress disorder.
The literature states that gender bias may be to blame for men receiving inaccurate mental health diagnoses (Borderline Personality Disorder Statistics, Verywell Mind, Kristalyn Salters – Pedneault, Ph.D., November 25th, 2020).
Suicidal thoughts and behaviours
Unfortunately, one of the main features of borderline personality disorder is the prevalence rates of suicidality.
The researchers explored the suicide rates in patients diagnosed with BPD and found that around 70% of BPD patients will make at least one suicide attempt throughout their life (Borderline Personality Disorder Statistics, Verywell Mind, Kristalyn Salters – Pedneault, Ph.D., November 25th, 2020).
The suicide rates of BPD patients are higher than the general population. Many experts believe this could be due to people being misdiagnosed or not receiving proper treatment and support for their condition.
Treatment options for borderline personality disorder
A multifaceted approach to treating borderline personality disorder usually works best since many people with this disorder also have co-occurring conditions.
Prevalent mental health disorders that co-occur with BPD include:
- Mood disorders (i.e., anxiety disorders or bipolar disorder)
- Eating disorders
- Post-traumatic stress disorder
- Substance abuse
Treatment for co-occurring disorders must be multifaceted and take a holistic approach. For instance, mental health professionals must treat the two conditions simultaneously (i.e., substance abuse and borderline personality disorder).
Addressing the root cause of borderline personality disorder (and the concurrent condition) is imperative for people to experience better treatment outcomes.
Dialectical behaviour therapy
Dialectical behaviour therapy, sometimes called DBT, is an effective treatment for BPD since it addresses any conflicting ideas that a person may have. DBT aims to resolve the apparent contradictions that are often the building blocks of the disorder.
For instance, many people with BPD have conflicting ideas about a person, situation, or event that continue to plague them – DBT seeks to remedy any conflicting views without invalidating the person’s experience.
DBT therapists help patients to integrate acceptance and change as the core components that facilitate recovery.
Like cognitive behavioural therapy, DBT tackles a person’s symptoms by replacing unhealthy, maladaptive thoughts and behaviours with healthy coping skills.
Skills training
Dialectical behaviour therapy is facilitated as part of a skills training group; the group aims to address (and resolve) behavioural problems and maladaptive ideas and perceptions that are common issues for BPD patients.
Such issues may include:
- Fear of abandonment
- Emotional dysregulation and a lack of impulse control
- Chaotic or volatile relationships
- Unstable sense of self
The four core principles of dialectical behaviour therapy
Four primary principles of DBT are used to improve function and reduce symptoms in BPD patients. They include:
- Interpersonal effectiveness
- Core mindfulness
- Emotional regulation
- Distress tolerance
Effectiveness
Studies show how effective DBT is for treating people with a borderline personality disorder.
Some reports show that those receiving DBT treatment experience more positive clinical outcomes; for example, DBT is proven effective for reducing suicide attempts and self-harming behaviours.
Moreover, the researchers noted a reduction in the number of days BPD patients spent in the hospital after receiving dialectical behaviour therapy.
Cognitive behavioural therapy
Trust issues can be a challenge for people with a borderline personality disorder.
Thus, one of the objectives is for therapists to build mutual trust and provide a safe space for patients to express themselves and discuss their issues.
Cognitive behavioural therapy (CBT) is talk therapy (and a form of psychotherapy) that addresses maladaptive thoughts and behaviours; CBT aims to bring unhelpful and destructive thoughts and behaviours into a patient’s awareness so they can be addressed.
Various forms of CBT have been specially designed to treat borderline personality disorder.
Psychodynamic therapy
The psychodynamic approach focuses on the unconscious motivations and forces that drive specific behaviours. Unfortunately, some of these thoughts and beliefs are often unhealthy or destructive.
Psychodynamic therapy aims to bring a patient’s thoughts into conscious awareness – discussing and exploring emotions are integral components of this type of therapy, including thoughts and beliefs that are threatening, contradictory or far from the patient’s awareness.
Understanding unconscious motivations or unhealthy ideas are integral to the patient developing emotional and intellectual insight into the self.
Psychodynamic principles
There are a few ways that psychodynamic therapy can help increase self-awareness and improve symptoms for BPD patients. They include:
- Recognizing specific patterns: Unpacking and exploring past attachments and relationships can help increase understanding and awareness of the person’s current emotional problems.
- Identifying avoidance: BPD patients often use avoidance behaviours to avoid distressing thoughts and emotions. Psychodynamic therapy helps people develop better coping skills by recognizing and identifying unhelpful coping strategies.
Additional techniques that psychodynamic therapists may use include:
- Free association.
- Improving personal relationships.
- Creating an understanding of how people with BPD relate to others.
- Reworking relationship patterns.
Transference-based therapy
Another symptom of borderline personality disorder is black-and-white thinking.
Many people with BPD tend to see people or situations as ‘’all good’’ or ‘’all bad’’; transference-based therapy focuses primarily on targeting black -and-white-thinking, a core feature of borderline personality disorder.
Essentially, all -or-nothing-thinking is the inability to integrate positive or negative images of the self and others, sometimes called splitting (How Borderline Personality Disorder Is Treated, Michelle Pugle, Verywell Health, April 10th, 2021).
Transference based-therapy addresses this component of BPD by helping people to see the various other shades in their black-and-white views of themselves and others (How Borderline Personality Disorder Is Treated, Michelle Pugle, Verywell Health, April 10th, 2021).
Studies have illustrated the effectiveness of transference-based therapy on BPD patients, where people have noticed an improvement in their symptoms and functioning.
Other effective treatments
The research literature included other helpful treatment options for borderline personality disorder. They include:
- Mentalization-based therapy
- Dynamic deconstructive psychotherapy
- Schema-focused therapy
- Specific medications such as antidepressants, mood stabilizers, and antipsychotics
- STEPPS program (Systems Training for Emotional Predictability and Problem Solving)
Looking ahead to the future
Treatment outcomes for BPD are much more positive nowadays than previously; studies show that some of the most debilitating symptoms of BPD improve during the first few years after the condition develops.
Many researchers believe that BPD can have a positive trajectory, with some experts observing increasing remission rates each year after treatment intervention.
Statistics show a significant reduction in relapse rates the longer a person’s remission lasts – with some studies showing that relapse rates dropped to 10% after eight years.
Contact us
If you want more information about this article or are concerned about your mental health – the Centre for Health and Healing team is always here to listen. Contact our friendly team today.
Useful resources
- Borderline Personality Disorder Statistics: Verywell Mind, Kristalyn Salters -Pedneault, Ph.D., November 25th, 2020
- How Borderline Personality Disorder Is Treated: Verywell Health, Michelle Pugle, April 10th, 2021
