Guide to borderline personality disorder (BPD)

We all have particular characteristics and responses to events in our relationships and environments, but sometimes, these responses can work to our disadvantage. Dr Matina Sotrilli is a psychologist whose repertoire of expertise includes borderline personality disorder (BPD) and its treatment, including dialectical behavioural therapy (DPT). Here, she shares her expertise with you.

What is borderline personality disorder (BPD)?

All humans have personality traits. These are well-ingrained ways in which individuals experience, interact with and think about everything that goes on around them.

Personality disorders are collections of traits that have become rigid and work to individuals’ disadvantage. That is, to the point that they impair functioning or cause distress. These traits create patterns of behaviour and thinking that have been present since early adult life and have been recognisable in the person for a long time.

People with borderline personality disorder sustain a pattern of instability throughout their adult lives. They often appear to be in a crisis of mood or interpersonal relationships, they feel empty and bored, they attach themselves strongly to others and become intensely angry when they believe they are ignored or mistreated by those they depend on.

What are the criteria for borderline personality disorder?

People qualify for a diagnosis of BPD by having at least five of the following nine traits:

• unstable, intense personal relationships
• identity disturbance
• quick changes in mood (clinically referred to as affective lability)
• inappropriate intense anger
• frantic efforts to avoid abandonment
• impulsivity
• suicidal or self-harming behaviour
• chronic feelings of emptiness
• transient paranoid thinking or dissociative symptoms

These features are not independent of each other and they may exist between varying degrees (Padesky cognitive workshops, 2005)

What causes it?

There is uncertain evidence that the occurrence of BPD relates to social factors such as poverty, instability, family violence and lack of traditional structures. There is, on the other hand, abundant evidence to associate BPD with extremes of childhood deprivation and sexual or physical abuse.

There are associated factors that could make someone more susceptible to BPD.

• Gender: Borderline personality disorder is considerably more common in women.
• Neurotransmitter dysfunctions: Neurotransmitters are responsible for sending chemicals messages to targeted cells in the body. BPD has been associated with dysfunctional transmissions that cause impulsivity and rapid changes in mood.(Gurvits et al. 2000)
• Other biological factors: There is some evidence that brain structure and neuroendocrine function may be damaged by persistent stress (silk 2000)
• Genetics: Genes have been linked to BPD although this is still unclear (Torgersen 2000)

What treatments exist for BPD?

• Medication: Different drugs may be effective in diminishing the severity of cognitive-perceptual, affective and impulsive symptoms.
• Cognitive behavioural therapy (CBT): The CPT approach to treating personality disorders (C.A.Padesky 2005) helps clients with BPD to conceptualise their old personality system in a compassionate way. It also helps them construct a new system that is more functional and desirable for them. It helps clients build new beliefs and interpersonal skills that strengthen the new personality system.
• Cognitive Analytic Therapy (CAT): This is very useful for the treatment of BPD as it focuses on three forms of linked damage like harsh reciprocal role patterns, dissociation and impaired self-reflection
• Mentalisation based treatment: MPT can be helpful to BPD clients because it derives from traditional psychoanalytic concepts and new discoveries from attachment and social cognition research.
• Dialectical Behavioural Model: This model of therapy is an evidence-based model for treating BPD.

How can dialectical behaviour therapy help a patient with BPD?

Dialectical behaviour therapy (DBT) emphasizes the psychosocial aspects of treatment, meaning how a person interacts with others in different environments and relationships. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships.

DBT differs in practice from other therapies in one important way. In addition to individual, weekly psychotherapy sessions, most DBT treatment also features weekly group therapy. In these group sessions, people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills. A group setting is an ideal place to learn and practice these skills because it offers a safe and supportive environment.

Dr Matina Sotrilli provides the upmost quality counselling and therapy to clients with a variety of mental health issues. Click here to see her profile, learn how she can help you and to get in touch.