Imagine that you’ve just been diagnosed with Borderline Personality Disorder. Although you familiarize it with Bipolar Disorder, you’re corrected and told that they are indeed different disorders. As a kid, you were diagnosed with Conduct Disorder and now as an adult, you have Borderline Personality Disorder. Among the research that you do, treatments are the main objective that you focus on. There are so many options, but which one is the best for you?
Borderline Personality Disorder (BPD) is a cluster B disorder. It is described as “an extreme sensitivity to perceived interpersonal slights, an unstable sense of self, intense and volatile emotions and impulsive behaviours” (Gunderson et al., 2018). BPD is fairly prevalent in society, but more so in the psychiatric community and it can be difficult to diagnose (Bryne et al., 2018). Borderline Personality Disorder is commonly developed during childhood and proceeds into adulthood. There are four categories of symptoms of Borderline Personality Disorder: interpersonal instability, behavioral dysregulation, cognitive and affective. Interpersonal instability is described as an individual having profoundly unstable relationships as well as avoidance behaviors pertaining to abandonment (Gunderson et al., 2018). Behavioral dysregulation as described by Gunderson and colleagues is characterized by an individual being impulsive and susceptible to harm (2018). Cognitive symptoms are described as the individual being paranoid or having identity disturbance, and affective symptoms are described as the individual having feelings of anger, emptiness, or instability of mood (Gunderson et al., 2018). In each sub-category of Borderline Personality Disorder, the symptoms are usually extreme and are harmful to the individual.
There are many treatments for Borderline Personality Disorder. Most treatments align with Cognitive therapy due to the fact that Borderline Personality Disorder is a pattern of thoughts and behavior. One of these treatments is Schema Therapy, which is characterized as the integration of “elements from cognitive behavioral therapy, attachment theory, and a number of other approaches, [to explore] emotions, maladaptive coping methods, and the origin of mental health concerns” (Santangelo et al., 2017). The basis of Schema Therapy is to target events and thoughts that cause the individual to perform harmful actions and to replace them with good thoughts and actions. The role of the therapist is to be an almost parental-like figure and to provide emotional stability and validation. Schema therapy can include imagery, chair work, flash-cards and diaries. The effectiveness of Schema therapy is thought to be well supported and is backed by several articles. One study lasted 30 weeks and out of the 16 participants in the experimental group, 15 reached Borderline Personality Disorder remission compared to the 75% of participants in the control group. Another study comparing Transference Focused Psychotherapy (TFP) and Schema Therapy concluded that Schema therapy worked better with an average of 29% more participants in remission.
Mentalization-based therapy (MBT) is another treatment. It is based on the attachment theory, which suggests that there is a critical time period in an individual’s life to make attachments and if not made, it can negatively affect that individual’s life and development such as by reducing intelligence and increasing anger. MBT focuses on creating diverse meaningful perspectives along with the individual’s own perspectives to create a coherent self that is reimagined through these techniques (Bryne et al., 2018). A study found that MBT compared to general treatments was effective in improving depression and anxiety, and decreasing self harm in individuals.
Lastly, there is no way to automatically know which treatment will work best, rather it operates on a case-by-case basis, but knowing available options tends to ease the obscurity of an unknown future for those with Borderline Personality Disorder.
Byrne, G. & Egan, J. (2018) Clinical Social Work Journal, 46, 174. https://doi.org/10.1007/s10615-018-0652-y
Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S., & Zanarini, M. C. (2018, May 24). Borderline personality disorder. Retrieved from https://www.nature.com/articles/nrdp201829#management
McLeod, S. A. (2017, Feb 05). Attachment theory. Retrieved from https://www.simplypsychology.org/attachment.html
Santangelo, P.S., Koenig, J., Funke, V. Parzar, P., Resch, F., Ebner-Priemer, U., & Kaess, M. (2017). Journal of Abnormal Child Psychology, 45, 1429. https://doi.org/10.1007/s10802-016-0249-2