Guide to Borderline Personality Disorder (BPD)

In this guide, you'll hear from people who are experiencing BPD symptoms, people who have been formally diagnosed with BPD, as well as BPD experts. You'll learn what having BPD is like from the inside out, and what the latest treatment methods are for overcoming it.

What is borderline personality disorder?


The official definition of Borderline Personality Disorder comes to us from the National Institute of Mental Health, which states that "Borderline personality disorder is a mental illness marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships."


people in recovery from BPD share...

We asked members of the Learn DBT Group by Mentally Fit who identified as having BPD what they thought about this subject. Some of their answers are below. Are there any that sound relatable to you? 

Please note: that these are the personal opinions of everyday people who have BPD, not medical professionals. You may or may not relate to or agree with what they say--and that's okay! Everyone is entitled to their own experience.

Michael: Before finding out about emotional based psychotherapy A fragmented personality. Now I believe someone who had more of an attachment disorder than most. We all have multiple personalities.

Prog: That is a question not easily answered as borderline is complex. Its a personality disorder. But I have issues with unstable relationship, a not so solid sense of self, I used to have problems with explosive anger and while I don't think I have abandonment issues it is in the criteria for the illness. May I suggest looking up the DSM-5 for the actual criteria? Its a good read.

Katie: I know it's a cluster of 9 different traits but I can't remember them off by heart. the biggest one seems to be fear of abandoned. I don't actually have bpd but my cptsd and adhd traits overlap with it bpd critiera, so dbt is extremely helpful!

Catherine: For me its intense emotions that are nearly impossible to cope with. Switching between extremes in every area of my life.. In relationships, I switch between hating them and loving them. My self image, one day I love myself the next day I hate myself and am suicidal. The way i feel about situation ls switches often. And intensely. Intense mood swings. I can go from extreme emotions to almost sociopathic lack of emotion almost instantly. Insane compulsive urges/behaviors. Addiction/self harm. Social anxiety/paranoid thoughts. "Chronic feelings of emptiness" a feeling that something is missing and nothing in the world can fix it, absolutely restless. Daily dissociation, derealization. Quick attachment to people, to the point of obsession. Unclear sense of self. Hard for me to form clear opinions, values, originality. I'm very easily swayed by others.

Erica: I was taught by a leading psychologist that it stems from abuse, which makes it similar to ptsd in that it is psychological injury and not mental illness. I think even a severe lack of attachment parenting early on can cause it. I also have been told i don't have it but share some features....turns out ALL ALONG that I was freaking just on the spectrum and had a TBI....and of course CPTSD. This shoe fits, no pill helps but I am extremely self-aware and glad for it. Be careful how you identify, symptoms can mean MANY different things, and remember that doctors aren't Gods and that you are not crazy, folks! You should SEE the misdiagnosed I got 20 years ago that were all just Aspergers!

Holly: Borderline Personality Disorder (BPD) is a condition characterized by difficulties regulating emotion. This means that people who experience BPD feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event.

Bruce: It is a byproduct of PTSD, and it is different for each person that has it, It has also been proclaimed by some as the gateway to being a sociopath( which I disclaim/ but my spouse agrees with)

bpd experts share the best treatments for borderline personality disorder (BPD)

Támara Hill, MS, NCC, CCTP, LPC

I am a licensed mental health therapist specializing in child and adolescent counseling. I am nationally certified as a trauma therapist. Most of my work with teens and their families involve BPD. I would love to contribute to your project. I included some thoughts below.

Treating adolescents with BPD is complicated because of the developing brain, hormonal shifts, and the ups and downs of the adolescent years. But according to Dr. Blaise Aguirre, adolescents should be evaluated and treated for BPD. I agree. It is important, before any treatments or interventions are used, that the entire family be involved in the treatment process. Research suggests that BPD is often the result of genes and the environment. Most noted is the invalidating environment often created by invalidating parents.

My treatments, when I do see teens with traits of BPD, involves psychoeducation (educating the family to what the disorder is and how it impacts lives over time), family counseling (helping the family sort through challenges and make sense of family dynamics), and trauma-informed individual counseling, especially if the teens has been abused or has suffered a trauma. Trauma-informed principles seek to explore and resolve fears and traumas that may be negatively impacting the individual and preventing them from having healthy relationships. Although dialectical behavior therapy (DBT) is considered the "standard" treatment for BPD, trauma-informed counseling, as well as family counseling, can be just as beneficial.

DR. David Flomenhaft, LCSW, PhD

Borderline Personality Disorder (BPD) is often the psychological consequence of early life trauma, typically sexual abuse.

The symptoms included impaired interpersonal relationship, self-harming behaviors (i.e. cutting) , instability of mood and often patterns of substance use behaviors. Symptoms surface in adolescence and can endure throughout adulthood if one does not seek competent care.

The research on BPD suggests interventions that teach these individuals skills to manage unstable moods, enhance interpersonal relationship capabilities and mindfulness practices. An integrated approach of psychotherapy, emotional management skill building, psychiatric medication management, substance abuse interventions (if necessary) are typically offered in a coordinated treatment called Dialectical Behavior Therapy (DBT). DBT was developed by psychologist Marsha Linehan, PhD in the 1980s and has been adopted at the treatment of choice for BPD. This is offered at hospital based psychiatric programs, clinic and at private clinical practices (which are not typically covered by insurance plans).

A new intervention called Dynamic Deconstructive Psychotherapy, which was developed at SUNY Upstate Medical Center by Robert Gregory, MD to treat borderline personality disorder and other complex behavior problems, such as alcohol or drug dependence, self-harm, eating disorders, and recurrent suicide attempts.”

Lynn R. Zakeri, LCSW

I am a clinical therapist in private practice in the Chicago area.

I did not go into practice thinking I would be an expert on BPD, however, because of my success with my clients I can't ever say no to this diagnosis either and find they are some of my most enjoyable clients to work with.

I will start by saying I am not officially DBT trained and I do not follow a DBT program. I do, however, believe that DBT skills are necessary for success, and when my clients don't come to me with a baseline knowledge of how to use the skills, I will partner with another therapist, a local male therapist, who does the straight-up skill teaching, and I do my thing and together we see progress. Many of my clients, though, do not go to him as they are able to use my suggestions and education to help themselves react and live more satisfying lives.

It is a combination of intuitiveness, validation, education and suggestions that I use and oftentimes it is the first time that my clients understand what is causing their reactivity and fears of abandonment and their escalations that empowers them to not be as reactive "next time". With our trusted relationship-sometimes it is the first time they have had a trusted relationship in therapy with me- I can say things like "don't go back to bed when you leave here" and they don't hear it as a judgment but more as a "you get me".

Kathleen Payne, PhD

I am a licensed clinical psychologist in private practice. I work have worked in various settings and provide treatment for a range of mental health disorders.

The number one evidence based treatment for borderline personality disorder is dialectical behavior therapy (developed by Marsha Linehan). DBT works to help individuals with borderline personality disorder learn emotion regulation skills, as one of the primary traits of borderline personality disorder is emotional dysregulation.

A second helpful evidence based treatment is cognitive behavioral therapy which teaches individuals how their thoughts, feelings, and behaviors are connected and works to help them challenge their thoughts for accuracy.

Amer Nabil,
PMHNP-BC

As a psychiatric nurse practitioner who works at an acute inpatient hospital with psychiatric clients, as well as clients at my private practice (Half Full Psychiatry), here are some thoughts:

- There is good evidence for DBT based therapy for borderline personality patients founded by Marsha Linehan.

- Medication is not a treatment for borderline personality. In fact medication does not address any form of personality.

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