Therapists often avoid working with Borderline Personality Disorder (BPD) due to stigma, fear of challenging behaviors (like self-harm, emotional outbursts, lashing out), the intensity of emotional distress, difficulties managing strong transference/countertransference, lack of specific training, and perceived untreatability or long-term commitment needed, creating high stress and boundary challenges, though specialized therapies like DBT are effective.
Fear of Patients Lashing Out. Individuals with symptoms of BPD are particularly sensitive to perceived criticism. This increases the likelihood that they will feel attacked when a therapist attempts to offer suggestions or insights. This often leads to lashing out.
4. STOP
Dialectical behaviour therapy has the most supporting evidence compared with other psychotherapy techniques for the treatment of borderline personality disorder.
People with Borderline Personality Disorder (BPD) "split" (use black-and-white thinking) as a defense mechanism to manage overwhelming, conflicting emotions, especially fear of abandonment, by seeing people or situations as entirely "good" or "bad" rather than integrating complex realities, providing temporary relief from intense anxiety and emotional pain. It's a way to simplify a confusing world and protect themselves from perceived threats, but it often leads to unstable relationships and self-image.
Why BPD Symptoms Peak in Early Adulthood. In the 20s, identity formation and independence conflict with emotional vulnerability. Research shows impulsivity and mood swings occur most frequently between the ages of 18-25.
Some common types of delusions that may occur in individuals with BPD include: Persecutory delusions: Believing that one is being mistreated, harassed, or conspired against by others.
The 24-hour rule is meant to encourage patients to seek help from the therapist at earlier stages of a crisis while the therapist can still offer assistance and not after the patient has already chosen maladaptive behaviors.
Psychotherapy in the form of dialectical behavior therapy (DBT) is considered a gold standard to treat BPD. This cognitive-based therapy combines acceptance and change strategies to help individuals recognize their behaviors and mood swings, and process negative thoughts and feelings.
The "3 C's of BPD" typically refer to advice for loved ones of someone with Borderline Personality Disorder, reminding them: "I didn't cause it, I can't cure it, I can't control it," to help set boundaries and avoid taking on undue responsibility for the person's actions or illness. Another set of "C's" describes core BPD traits for individuals: Clinginess (fear of abandonment), Conflict (intense relationships/moods), and Confusion (unstable self-image).
How can I help myself in the longer term?
Some common warning signs include intense and rapidly changing emotions, often triggered by seemingly minor events. Individuals with BPD may exhibit impulsive behaviors such as substance abuse, binge eating, or reckless driving.
People with BPD may experience rage when they perceive rejection, neglect, or abandonment in a relationship. During rage, a person may say or do things that they later regret. This could lead to ending the relationship in the heat of the moment. BPD rage is often followed by significant regret and shame.
It is called 'borderline' because doctors previously thought that it was on the border between two different disorders: neurosis and psychosis. But these terms are no longer used to describe mental illness. It is sometimes called emotionally unstable personality disorder (EUPD).
Dialectical behavior therapy (DBT).
DBT includes group and individual therapy designed to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, handle distress and understand relationships better.
People with Borderline Personality Disorder (BPD) are triggered by intense emotions, particularly fear of abandonment, rejection, and invalidation, often stemming from past trauma, leading to reactions like sudden anger or self-harm when feeling criticized, alone, or facing instability, sudden changes, or perceived neglect, according to sources like Borderline in the ACT. Common triggers include relationship conflicts, cancelled plans, perceived or real abandonment, reminders of trauma, or unmet needs like sleep, disrupting their fragile sense of self and emotional regulation.
Overview. Common BPD medications include antidepressants (Prozac, Zoloft, Effexor, Wellbutrin), antipsychotics (Abilify, Seroquel, Risperdal, Zyprexa), mood stabilizers/anticonvulsants (Lithobid, Depakote, Lamictal, Tegretol), and anti-anxiety drugs (Ativan, Xanax, Klonopin, Buspar).
But there are lots of positive things you can do to support them:
First, people with BPD are characterized by a biological vulnerability to experience intense emotions (i.e., affective instability), which includes (a) greater reactivity to internal and external stimuli, (b) stronger emotional intensity, and (c) slower return to a baseline level of emotional arousal.
For someone with borderline personality disorder (BPD), change is less consciously determined. Transformation for such a person is more reflexive, less rehearsed. The borderline chameleon changes depending on the environment and who is present, constantly struggling to fit in.
BPD limerence is when borderline personality traits (BPD) meet with obsessive romantic attachment. It creates an emotionally intense experience where fear of abandonment meets desperate longing.
Don't…
Common symptoms of BPD psychosis include: Visual hallucinations. Gustatory hallucinations (strange or unpleasant tastes) Olfactory hallucinations (smells and aromas that aren't actually present) Tactile hallucinations (feeling someone or something touching a person's skin or beneath the skin)
Individuals with borderline personality disorder (BPD) exhibit extreme distress and confusion in social environments and display behaviors that indicate impairments in appraising others' trustworthiness.
Curiosity – Being extra sensitive and connection emotions, senses and surroundings allows for greater curiosity in the minds of those with BPD. Bold – Impulsivity is a BPD trait that can be positively linked to being bold, courageous and having the ability to speak one's mind.