As you may have experienced, people always ask the type of clients you want to work with. For me, since before my practicum even started, my answer has been “clients with Borderline Personality Disorder (BPD) and those who self-harm.” Thankfully, my practicum experience solidified my passion. So, as I wait patiently, I am focusing my efforts on trainings and readings to increase my knowledge of BPD and Dialectical Behavior Therapy (DBT), a popular treatment model.
I am writing this post to share with you some basic definitions and treatment options for BPD. I am currently reading “The Essential Family Guide to Borderline Personality Disorder” by Randi Kreger, and I will be using that as my main reference.
BPD is a mental illness that affects approximately 4 million Americans (2% of the population), and approximately 75% of the sufferers are women. (It is believed the number of men with BPD is higher, but it is difficult to distinguish from cultural expectations.) BPD is a complex mental illness. It is more about thought processes and schemas versus brain chemicals, such as bipolar disorder. BPs, the abbreviation for those who have BPD, tend to be all or nothing. For example, they may idolize someone but as soon as that person makes a mistake, like we all do, the person falls very far off the BP’s pedestal. The BP, however, can portray two sides of themselves, as well. They may gloat and praise themselves, but deep down they are empty, yet full of self-loathing. A main characteristic of a BP is the intense fear of being abandoned. What I like most about this book is that it speaks specifically to the loved ones of a BP: the spouse, friend, parent, child and even siblings. In the situation of being abandoned, the spouse may constantly need to reaffirm their love, and even then it may not be enough. The BP as a child may be unusually clingy, even beyond the typical clingy stage. Then once they become adult children, the parent-child relationship becomes even more strained due to expected independence. Maybe as a parent, the BP may hover (even more than the typical new generation parent) and have a difficult time with natural child rebellion. Anger is a very noted characteristic of a BP, as well, that all relationships may experience. “People with BPD repeatedly pull people toward them – often desperately – and then brusquely shove them away through bitter criticism, unappeasable rages, and fits of irrational blaming,” (Kreger, 32, Scribd digital version).
One thing that stood out to me was rapid mood swings. Have you ever spoken with someone who didn’t know the true definition of bipolar and they describe someone as bipolar because they are up or down in an instant? Well, if you know bipolar, you know that the person may experience the ups or downs for days at a time, not minutes. BPs, however, can fluctuate that quickly. “Two key differences between what is ‘normal’ and what veers into personality disorder territory are extremity and frequency,” (Kreger, 45, Scribd digital version).
Having BP is very overwhelming. It results in relationship troubles, job instability, substance abuse and/or other impulsive actions. In fact, 10% commit suicide because it’s too much for them to handle. Suicide attempts and self-harm are also be associated with BPD; therefore, it’s important to seek help.
There aren’t any medicines that cure BPD; it’s considered a life-long disorder. However, some anti-depressants or anti-anxiety medications can help reduce many of the symptoms of BPD. Unfortunately, just taking this route won’t get to the root of the problem. Therapy, if the client is willing to put forth the effort, will significantly help the BP. Most therapies help the BP reframe their thought processes. An eclectic approach would be a mix of psychodynamic (discovering childhood or suppressed thoughts that influence the client) and CBT. This could be used by most therapists, and because it uses empirically-proven CBT, it will be beneficial. Dialectical Behavior Therapy, however, was developed by Marsha Linehan specifically for BPD. Dialectical, roughly meaning opposing arguments, is used to help the client accept their negatives but make changes in a positive direction. There are several resources, including workbooks, available to help the clinician guide the client through the therapeutic process.
This is a very brief overview of a BP. If any of this sounds familiar, please consult this book! The very beginning even has questions to help better define a BP in your life, or even yourself.
Next, I’ll review the “power tools” the book provides for BPs.