Treatment of Borderline Personality Disorder

As persons with Borderline Personality Disorder (BPD) may be aware, many mental health professionals are reticent about providing treatment to persons with this diagnosis due to the often incorrect belief that these clients are either impossible to treat or will behave in ways that are disruptive to their practices.  BPD is a treatable disorder if clients are motivated to take their issues seriously and if they will commit to remaining in treatment during times of comparative emotional calm.  BPD is a disorder stemming from multiple variables including possible inherited temperment, history of family chaos and/or abuse, and a failure of healthy adults to intervene effectively with the person during important developmental stages.


BPD is at its core the result of the person's failure to develop critical psychological functions, causing the individual to present with a personal history of "stable instability."  Central to this disorder is a tendency to easily become highly emotionally aroused and then to have difficulty regulating the intensity of their emotions.  This emotional rollercoaster can then lead to impulsive, poorly considered actions, causing further chaos or self-destructive behaviors.  Interpersonal instability is another key characteristic of people with this disorder.   Often the early life experiences of these clients lead them to expect harsh and devaluing treatment by others which, in turn, causes them to misread social cues or to even behave in ways that cause others to get angry or reject them.  Their relationships are often marked by extreme closeness followed by intense conflict which never gets fully resolved.  They are terrified of abandonment, yet their behavior invites others to leave.


Treatment for BPD involves moderately long term therapy which includes the therapist acting as a teacher and coach who teaches new skills so they can learn to better anticipate consequences of their behaviors, to modulate and regulate their emotions, and to be more effective in their relationships.  Therapy often involves getting an understanding of the factors that have contributed to the development of this disorder, but insight alone is definitely insufficient: these patients need to learn to better observe themselves, to check out their assumptions about other peoples' motives, and to develop an understanding of how healthy relationships function.  This kind of therapy can be difficult because looking carefully at the debris of one's emotional life can be painful.  And it requires the motivation to make "changes for good," not solely to seek temporary relief during periods of crisis.


My experience as a therapist who has worked her entire career with persons diagnosed with BPD is that the diagnosis is not a "life sentence."  I have worked with many clients who, at the end of treatment, no longer meet clinical criteria for the disorder.  They have become well-functioning adults who can maintain a stable work life and can develop and keep close relationships without intermittently destroying the things in their lives that matters most.  Recovery takes determination and a willingness to put one's mental health as the highest priority in one's life.  This is necessary because a failure to address the BPD and its symptoms can result in the loss of jobs and relationships, can lead to various addictions and other self-destructive behaviors, and can leave the person in a state of unrelenting unhappiness.  Getting good treatment for the disorder is critical and can change the course of a person's life.