Understanding Borderline Personality Disorder

DSM-V Criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines specific criteria for diagnosing Borderline Personality Disorder (BPD). According to the DSM-5, a diagnosis of BPD requires the presence of at least five of the following nine criteria:

  1. Frantic efforts to avoid real or imagined abandonment (not including suicidal or self-mutilating behavior covered in Criterion 5).
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation (also known as “splitting”).
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: This does not include suicidal or self-mutilating behavior covered in Criterion 5.
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

The symptoms must be pervasive, causing significant distress or impairment in social, occupational, or other important areas of functioning, and stable across time and various situations.

DBT for Treatment of BPD

Dialectical Behavior Therapy (DBT) is considered one of the most effective treatments for Borderline Personality Disorder (BPD). Developed by Dr. Marsha Linehan in the late 1980s, DBT combines cognitive-behavioral techniques with concepts from mindfulness and acceptance. Here’s how DBT is helpful in treating BPD:

  1. Emotion Regulation:
    • DBT teaches skills to help individuals understand and manage intense emotions. Patients learn to identify their emotions and the triggers for them, as well as techniques to reduce the intensity and duration of emotional reactions.
  2. Distress Tolerance:
    • This module helps individuals develop the ability to tolerate and survive crises without resorting to self-destructive behaviors. Skills taught include self-soothing techniques, distraction, and finding meaning in difficult situations.
  3. Interpersonal Effectiveness:
    • DBT helps individuals improve their relationships by teaching them how to communicate more effectively, set boundaries, and maintain self-respect in interactions with others. Skills focus on assertiveness, negotiation, and conflict resolution.
  4. Mindfulness:
    • Mindfulness practices are central to DBT, helping individuals become more aware of their thoughts, feelings, and bodily sensations in the present moment without judgment. This awareness can reduce impulsivity and enhance emotional regulation.
  5. Behavioral Chain Analysis:
    • DBT involves analyzing behaviors to understand the chain of events leading to problematic behaviors. This helps in identifying triggers and developing strategies to interrupt the chain and choose healthier responses.
  6. Validation and Acceptance:
    • DBT emphasizes validating the patient’s feelings and experiences, which can help build a therapeutic alliance and enhance the patient’s self-acceptance. This validation is balanced with teaching change strategies, which can help patients feel understood and supported while also motivating them to make positive changes.
  7. Skills Training:
    • DBT includes group skills training sessions where individuals learn and practice new coping strategies. These sessions are structured and provide a supportive environment for learning and applying new skills.

Studies have shown that DBT can significantly reduce the frequency and severity of self-harm, suicidal behaviors, and other symptoms of BPD. It also improves emotional regulation, interpersonal functioning, and overall quality of life for individuals with BPD.

Medication Management

Medication management is a component of a comprehensive treatment plan for Borderline Personality Disorder (BPD). While no medications are specifically approved for BPD, certain medications can help manage specific symptoms or co-occurring conditions. Here is an overview of medication management, including the use of antipsychotics, mood stabilizers, antidepressants, and other relevant medications:

  1. Antidepressants:
    • Selective Serotonin Reuptake Inhibitors (SSRIs): Medications like fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro) can be effective in treating symptoms of depression and anxiety, which are often present in individuals with BPD.
    • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Medications such as venlafaxine (Effexor) and duloxetine (Cymbalta) may be used to address both depression and anxiety symptoms.
  2. Mood Stabilizers:
    • Lithium: Although primarily used for bipolar disorder, lithium can help stabilize mood swings and reduce impulsivity in some individuals with BPD.
    • Anticonvulsants: Medications like valproate (Depakote), lamotrigine (Lamictal), and carbamazepine (Tegretol) can help regulate mood and reduce impulsive behaviors.
  3. Antipsychotics:
    • Atypical Antipsychotics: Medications such as quetiapine (Seroquel), olanzapine (Zyprexa), aripiprazole (Abilify), and risperidone (Risperdal) may be used to manage symptoms of mood instability, impulsivity, and transient psychotic episodes. Lower doses of antipsychotics can be beneficial for managing severe anxiety and dysregulated mood.

Helpful Tips and Strategies for Support

Supporting someone in treatment for Borderline Personality Disorder (BPD) involves a combination of empathy, practical assistance, and encouraging adherence to their treatment plan. Here are some helpful strategies:

  1. Educate Yourself:
    • Understand BPD: Learn about BPD, its symptoms, and its treatment. Knowledge can reduce misconceptions and help you provide informed support.
    • Resources: Utilize books, reputable websites, and support groups to gather accurate information.
  2. Maintain Clear Boundaries
    • Clear Limits: Establish and maintain clear boundaries to protect your own well-being. Communicate these boundaries calmly and consistently.
    • Consistent Support: Provide consistent support within the limits of your boundaries to avoid enabling harmful behaviors.
  3. Validate Feelings Rather than Content
    • Listen Actively: Be a non-judgmental listener. Validate their feelings without necessarily agreeing with their perspective.
    • Empathy and Patience: Show understanding and patience, recognizing that their emotions and behaviors are part of the disorder.
  4. Focus on Skills Use When in Distress
    • DBT Skills: If they are in Dialectical Behavior Therapy (DBT), encourage the use of DBT skills such as mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
    • Practice Together: Engage in mindfulness exercises or other DBT skills together to provide mutual support.

By combining these strategies, you can provide meaningful and effective support to someone undergoing treatment for BPD, helping them to feel understood, valued, and motivated to continue their path to recovery.