Burn it to the ground. Then burn it again just to make sure. Then walk away with a cold detachment that quickly slides into shame, regret and self doubt. The flames now burn differently. Self doubt ravages into self-hate. And instead of suffering silently, it's time for big actions against yourself. You left them this time. It's different. Nope. They would have left you anyway - you're completely unlovable. Aggressively rubbing your forearm isn't enough pain. Stop it. No, keep going - you're worthless. Go get the nail file. Cut a little. Just to let it out. You deserve it. The pain will leave. It will all leave. No it won't. You deserve this. I can't do this. I'm a failure. Somebody has to help me. Rescue me. Please. I just want it to all be over.

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If the imagery of that paragraph left you scared, dizzy, exhausted or in all too familiar place, imagine how crippling living with BPD can be. If you ever experienced an episode of intense emotions, mood instability, impulsive behaviors exploding into suicidal thoughts and/or self-harm then it's possible you've encountered an episode of Borderline Personality Disorder. We've come a long way in identifying the BPD experience of folks who are suffering from them regularly. This post is not intended as an extensive dive into all components of BPD. Rather, today's post is going to dig into the components of a bpd episode, distinguishing characteristics of personality disorders from other types of mental health conditions and review effective treatments of BPD.

Before we jump into episodes and symptoms of bpd, we will first define it. According to the American Psychological Association, BPD is a personality disorder characterized by a long-standing pattern of instability in mood, interpersonal relationships, and self-image that is severe enough to cause extreme distress or interfere with social and occupational functioning. Also, symptoms of Borderline Personality Disorder include:

self-damaging behavior (e.g., gambling, overeating, substance abuse)
intense but unstable relationships
uncontrollable temper outbursts
uncertainty about self-image, sense of self, gender, goals, and loyalties
shifting and intense mood swings: Emotional Regulation Deficits
self-defeating behavior, such as fights, suicidal gestures, reckless driving or self-harming behavior
chronic feelings of emptiness and boredom

An important note in this definition is that BPD is a long-standing pattern. Like all personality disorders, BPD is a lifelong mental health disorder that doesn't disappear suddenly when life gets easier. HARD STOP. This does NOT mean that those with BPD are doomed. Borderline Personality Disorder is Treatable & Manageable. You can learn ways to take back your calm body and wise mind! We'll go further into effective treatment modalities like Dialectical Behavior Therapy (DBT) in the final section of today's post. Often folks are confused between BPD and other mental health disorders. Bipolar Disorder is often mischaracterized in movies, #socials and well meaning family members. While these disorders may have several symptom crossover, the diagnostic criteria is specifically differentiated. Another distinguishing feature of BPD is the intense fear of abandonment. This could be real or perceived and doesn't need to be rooted in logical explanations. Often BPD triggers connect back to traumatic memories or attachment disturbances during the early years of childhood. Post-Traumatic Stress Disorder is often present in folks with BPD, which can be a barrier to differentiating what drives reactivity to triggering events. History of trauma or PTSD does NOT perfectly correlate with BPD, rather folks with BPD often have traumatic pasts. Substance Use Disorder is often experienced by folks with BPD & is categorized in the self-damaging/self-defeating behaviors.

The prevalence of BPD is fairly low compared to other mental health diagnoses. Most sources report 1.6% of the general population meet criteria for BPD. Many clinicians & researchers suggest that BPD (like many personality disorders) is often misunderstood & misdiagnosed by health care providers. Many believe that a more accurate representation may be 5-8% of the general population. An amazing stat is that up to 20% of people admitted to inpatient psychiatric facilities may be those with BPD. These are incredibly compelling reasons to keep encouraging seeking out effective treatment of BPD.

Most Effective Treatment of BPD

Dialectical Behavioral Therapy (DBT)

DBT is the the gold standard treatment for BPD. Developed by Marsha Linnehan in the late 70's, DBT shifts the focus of responsibility back to the individual with masterful persistence. Being able more effectively manage emotions is the name of the game here. There are countless coping skills taught by licensed mental health professionals practicing DBT. Next, DBT is based on the idea that 2 important factors contribute towards BPD:

you are particularly emotionally vulnerable – for example, low levels of stress make you feel extremely anxious
you grew up in an environment where your emotions were dismissed by those around you – for example, a parent may have told you that you had no right to feel sad or you were just "being silly" if you complained of feelings of anxiety or stress

These 2 factors may cause you to fall into a negative cycle – you experience intense and upsetting emotions, yet feel guilty and worthless for having these emotions. Because of your upbringing, you think having these emotions makes you a bad person. These thoughts then lead to further upsetting emotions. The goal of DBT is to break this cycle by introducing 2 important concepts:

validation: accepting your emotions are valid, real and acceptable
dialectics: a school of philosophy that says most things in life are rarely "black or white" and that it's important to be open to ideas and opinions that contradict your own

Christin is DBT Trained! Contact her directly

There are specific Certified DBT Programs - including in the KC area! - although, most clinicians providing DBT are not affiliated with these teams. It's always best to ask potential therapists about their trainings and/or certifications in such a specialized treatment like DBT. Any therapist worth their weight will answer honestly and not take offense if you keep searching for someone equipped (& highly trained) to help you!

Cognitive Behavioral Therapy (CBT)

CBT is heavily utilized within the helping field & is where most therapists borrow from in supporting all their clients. It's interesting to note that some cognitive-behavioral therapists incorporate certain elements of the DBT model into their treatment sessions. Also, other forms of CBT have developed that use the elements of DBT. For instance, mindfulness-based cognitive therapy utilizes traditional cognitive-behavioral techniques with mindfulness to treat depression. CBT may not be as effective at eliminating impulsive actions or self-destructive behavior to the extent DBT can. Where CBT can really shine is in helping folks connect motivation and ramification of our behaviors. And to build awareness of the differences of acting from a thought/belief versus an emotional reactive state. Acting out of emotion rarely helps us. But it does feel nice every now and then!

Transference-Focused Psychotherapy (TFP)

According to John F. Clarkin; Eve Caligor & Julia Sowislo's article TFP Extended: Development & Recent Advances, Transference-focused therapy (TFP) for BPD is a type of treatment when folks focus on using their relationship with their therapist to change how they relate to other people in their world. This may help folks identify problematic thoughts, develop healthier behaviors, and improve social interactions. TFP is more focused on the “here and now” experience of the therapist and patient than on the patient’s past. Because of this, the therapist is more active than would be expected in traditional psychoanalytic treatment. Though transference-focused psychotherapy has roots in psychoanalytic theory, its delivery is different. Unlike traditional psychoanalytic treatment, patients meet with a TFP therapist twice per week instead of several days per week. In addition, TFP requires a detailed treatment contract and clearly defined personal and treatment goals. TFP treatments often last a year or more. This style of interaction is really helpful because it's more focused on the right now in therapy & allows folks to practice articulating how one is being perceived, experienced & regarded. All while practicing safe ways to communicate this - it's in therapy after all.

Schema-focused therapy

Schema-focused therapy can be done individually or in a group. It can help you identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival, but as an adult are hurtful in many areas of your life. Therapy focuses on helping you get your needs met in a healthy manner to promote positive life patterns.

Mentalization-based therapy (MBT)

MBT is a type of talk therapy that helps you identify your own thoughts and feelings at any given moment and create an alternate perspective on the situation. MBT emphasizes thinking before reacting. People living with borderline personality disorder experience emotional dysregulation more frequently than others and may find it difficult to mentalize with these intense emotions or reactions. They can also struggle with feelings of paranoia and suspicion about the intentions of other people. As a result of impaired mentalization skills, individuals living with BPD may experience instability in their relationships and self-image.

Systems training for emotional predictability and problem-solving (STEPPS)

STEPPS is a 20-week treatment that involves working in groups that incorporate your family members, caregivers, friends or significant others into treatment. STEPPS is used in addition to other types of psychotherapy. The program’s goal is to educate people with Borderline Personality Disorder about their diagnosis and to help them acquire skills to deal with different aspects of the disorder. The content is taught to people in a group format that is much like a seminar or workshop. The STEPPS program consists of a 20-week basic skills group program that meets once a week for 2 hours, and an additional program after that, which meets twice a month for about a year. The groups are typically lead by two trainers for about 6-10 participants.

There’s always Hope

Taking responsibility for one's emotional regulation is the foundation of treatment for most folks with BPD. I have helped several folks with BPD who have needed entire therapy sessions to rinse, wash and repeat coping skills around emotional regulation. It's hard. And courageous. And I'm continually impressed by folks who continue to work on themselves to live a better life. As I mentioned before, BPD has so many effective treatment options! If you want a new way to manage yourself and make healthy relationships, you can level up your life in the best way. You can find a path toward health relationships built on trust, calm & balanced. Keep going!

Authored by Aaron Shore, LPC

I’m a Licensed Professional Counselor since 2010 with over 20 years working in community mental health, non-profits & senior leadership roles. I have established mastery in trauma therapies, men’s issues, nature therapy & Severe and Persistent Mental Illness. I also love mentorship, clinical supervision & the development of young therapists.

Disclaimer: The information in this blog is intended for educational resourcing. It is not medical advice or meant to replace directives by mental health professionals. Please continue to seek supportive services from qualified health professionals in your community. The most courageous thing you can do is admit to yourself you need help. And go get that help. We trust you will find your courage and find your way through. You will thrive. Keep going!

Borderline Personality Disorder: How to Cope with BPD