Understanding Borderline Personality Disorder

By Nancy Hall, MA, NCC, LPC

This article was first published in Nancy’s blog, "All Shapes and Sizes," on January 23, 2015. Nancy is facilitating a workshop on BPD at The Awakening Center Sunday July 26. For more info, email at nancyhalltac@gmail.com.

For many, getting the diagnosis of Borderline Personality Disorder (BPD) comes as a relief. Finally, something to explain the mood swings, constant fear of abandonment, and relationship challenges. For others, it becomes an obstacle to treatment. Understandably, working with someone with BPD can be quite challenging, and often therapists allow only a few in their caseload. But new treatment approaches and an improved understanding of the disorder are giving sufferers and family members hope.

            According to National Education Alliance: Borderline Personality Disorder, 14 million adults are struggling with BPD. Traits or symptoms include:

·                  Intense fear of abandonment

·                  A pattern of unstable and intense relationships

·                  Unstable self-image

·                  Self-destructive impulsivity

·                  Recurrent suicidal behavior or non-suicidal self-injury

·                  Chronic feelings of emptiness

            Emotions are often intense, and anger can seem explosive and reactive at times. Those with BPD tend to function in the extremes, especially in relationships. He or she might struggle to see gradations in people; a friend or partner will be idolized one day and hated the next. At the core is an intense fear of rejection and abandonment.

            Diagnosis is difficult, especially since BPD tends to co-occur with other conditions, such as substance abuse, eating disorders, or anxiety disorders. And often the individual is consumed with shame, self-hatred, and hopelessness, so seeking help does not feel like a viable option. Additionally, the chaos and drama is often so engrained that it feels like his or her identity. The BPD sufferer cannot imagine who he or she is without those traits or behaviors.

            It has been difficult to pinpoint the cause of BPD. It does seem to run in families, but it’s unclear if that means it has a genetic component or if it is related to attachment issues. Trauma also seems to be a key factor, as 70% of those diagnosed with BPD report a history of physical or sexual abuse. Ultimately, the biological-based temperament + invalidating environment + trauma can all come together to trigger BPD.

            Treatment options are available and are showing quite a bit of success. If you or a loved one is looking for help with BPD, look for someone with training in:

·                  Dialectical behavior therapy (DBT): This form of therapy combines cognitive-based practices with a person-centered approach. Clients are led through a skills-based curriculum where they learn (1) mindfulness, (2) emotional regulation, (3) distress tolerance, and (4) walking the middle path.

·                  Mentalization-based therapy (MPD): The therapists helps clients tell the difference between their feelings or thoughts and other people’s. Folks with BPD tend to see their feelings as “the truth,” and MPD helps them find alternatives to this.

·                  Transference-based psychotherapy: This psychodynamic therapy explores the relationship between the client and the therapist to help work through the emotional instability.

          Families and individuals can find relief from and help for this stressful and emotionally draining disorder. But we all have to work to remove the shame and stigma around BPD. For more information, visit NEA: BPD.

Nancy Hall, MA, NCC, LPC is a staff therapist and the intake coordinator at The Awakening Center. In addition to seeing clients for individual therapy, she leads the weekly meditation group and DBT group. Check and subscribe out her blog, “All Shapes and Sizes,” which appears on Chicago Tribune’s media partner ChicagoNow.com.