Borderline Personality Disorder Treatment: How To Navigate The Disorder

Borderline personality disorder (BPD) is one of several cluster B personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is generally considered to be a mental health disorder that often begins in early adulthood. It can be characterized by an unstable or poorly developed self-image, rapidly changing personal goals, intense but unstable relationships colored with neediness due to real or imagined fear of abandonment and an impaired ability to recognize the needs and feelings of others.

Many may find that there are several different ways to treat borderline personality disorder, which can involve therapy, medications, hospitalization, or a combination of two or three.

Doing so can have significant positive effects on your life and the lives of those you love.

Read on to learn more about borderline personality disorder and supportive strategies that can positively impact your quality of life.

Experiencing the effects of borderline personality disorder?

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Signs and symptoms of borderline personality disorder

When five (5) or more of the following symptoms are present in an individual in different environments, clinicians may evaluate the individual for borderline personality disorder:

• Tremendous efforts to avoid true or imagined abandonment

• Patterns of strong interpersonal bonds, possibly described as alternating from extreme idealization to devaluation

• Identity interruption, which can result in a significantly and persistently unstable image of self or sense of self

• Impulsive behavior in at least two areas that could possibly be self-damaging (e.g., overspending, substance use disorders, sex, binge eating, or reckless driving)

• Experiencing recurrent suicidal patterns, threats, or self-destructing behavior

• Affective instability resulting from a distinct reactivity of moods (e.g., extreme episodic profound state of dissatisfaction or restlessness, nervousness that lasts for hours and more than a day, although seldom), or irritability

• Long-standing feelings of emptiness

• Trouble controlling anger (e.g., persistent anger, recurring physical fights, or frequent displays of temper)

As an individual living with borderline personality disorder gets older, some of the symptoms might begin to wane. These individuals may also retain some other symptoms such as intense emotional response, impulsivity, and intensity in relationships.

People experiencing borderline personality disorder who opt for treatments, such as borderline personality disorder online therapy, may show marked improvement in their lifestyle, vocation, and relationships.

Treatment for borderline personality disorder

Many may find that there are three main psychotherapeutic treatments for borderline personality disorder: cognitive behavioral therapy, dialectic behavioral therapy, and other forms of psychotherapy. We’ve summarized each type below: 

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) generally focuses on what is currently causing the symptoms of the disorder to create changes in both cognition and behavior directly. Features of CBT can include:

• The patient remains an active partner in the treatment

• Socratic questioning, through which thoughts can be challenged with gentle questions

• Special attention to provoking and maintaining factors, such as when the patient records in a journal what happens before the symptoms begin, what happened after the symptom, and how both might relate to the disease

• Special attention to the patient’s way of thinking in an effort to promote eventual change

Dialectic behavioral therapy

Dialectic behavioral therapy (DBT) can be considered an expanded form of CBT, which is understood to have been designed by Marsha Linehan for people living with borderline personality disorder. DBT tends to have three major components.

• Individual sessions

• Skills training sessions

• Communication sessions (generally done via a therapist in between other session types)

Individual sessions

The focus in these sessions may primarily include topics such as:

• Cognitive-behavioral techniques

• Dialectical methods of thinking, i.e., showing that the world may not be binary and that there can be more than one side or solution to a problem

• Mindfulness, in which a person can be taught to view problems in a more detached or less intense manner

Skills training sessions

These sessions can last about two hours or more. They can be scheduled weekly, and they may be conducted in groups. People diagnosed with borderline personality disorder can be taught how to control their anger and other strong emotions in these sessions and may learn valuable skills that can impact how they cope with distress, establish interpersonal skills, and build habits of mindfulness.

Communication with therapists in between sessions

This ongoing line of communication can help patients navigate a crisis by using the skills learned during the individual and skills training sessions. It can be done either in person or by telephone.

Schema focused therapy

This is considered by many to be another form of expanded CBT that was developed by Jeffrey Young. It is generally based on the assumption that people with borderline personality disorder may have four basic maladaptive schemas:

• Abandoned/abused child

• Angry/impulsive child

• Detached

• Punitive parent

Schemas can be defined as the ways we think of and categorize the world. Schema-focused therapy, in this sense, generally aims to replace the maladaptive schemas with adaptive new ones. The therapist can do this by using techniques such as guided imagery, assertiveness training, and role-playing to help the patient face and confront past traumatic events. The therapist might also directly target the emotions associated with the events. 

Dynamic psychotherapy

This is a type of psychotherapy that is generally based on psychoanalysis. Unlike CBT, it can instead focus on the origin of a mental health condition rather than what may be currently maintaining it.

The general premise of dynamic psychotherapy is that unconscious mental processes that begin in childhood can influence the way we function in adulthood. The forms of dynamic psychotherapy relevant to borderline personality disorder may include:

• Mentalization-based treatment

• Transference focused psychotherapy

• Cognitive analytic therapy

Mentalization-based treatment

Mentalization is generally defined as the ability to understand intuitively how the thoughts, feelings and motivations of others can relate to one’s thoughts, feelings, and emotions overall. 

The mentalization-based treatment, which was developed by Peter Fonagy and Antony Bateman, is thought to be based on the assumption that people with borderline personality disorder can have a conflict of parental attachment which might have developed in early childhood. 

This attachment problem can then possibly lead to deficits in mentalization. The treatment generally aims to resolve the problem of mentalization by developing self-control capacity through a dynamic psychoanalytical approach which can involve:

• Group psychotherapy

• Individual psychotherapy

• Community therapy

• Partial hospitalization

• Outpatient treatment

Transference-focused therapy

Otto Kernberg is thought to have developed this method of dynamic psychotherapy for people living with borderline personality disorder. It is generally based on the idea that BPD can develop due to identity diffusion, i.e., an inability to notice that people are not wholly good or bad. 

According to Kernberg, people living with borderline personality disorder might be unable to realize from childhood that people can be both “good” and “bad” at the same time—possibly leading to internal conflict or confusion.

Transference-focused therapy generally aims to correct this identity diffusion by focusing on the past relationships of the person living with borderline personality disorder, and evaluating how they may be currently affecting the life of the individual.

Cognitive analytic therapy

Tony Ryle is generally attributed to the development of cognitive analytic therapy. In this modality, a therapist may ask the person living with borderline personality disorder to record a list of problems, moods, and maladaptive behaviors in a diary for later processing. Some of the behaviors may then be identified for further analysis and correction. 

Medications

Medications might also be used as adjuncts to psychotherapy. Studies have, however, called into question their effectiveness. Despite these findings, however, some medications could be used to treat co-morbidities that might arise with borderline personality disorder. Please consult with a medical professional before making any medically related decisions. 

Examples can include:

• Antidepressants

• Mood stabilizers

• Antipsychotics

Self-care

Although this is not a formal, clinical mode of treatment, it can add to the general well-being of anyone with borderline personality disorder. Self-care habits are highly encouraged anyway, as they can elevate the quality of one’s life. Examples of self-care habits can be individual but can include consistent sleeping routines, regular exercise, a nutritious diet, proper stress management, and so on.

How can online therapy support those living with borderline personality disorder? 

Many people living with borderline personality disorder may gravitate toward online therapy as a treatment option. They may feel overwhelmed by the prospect of having to meet with someone face-to-face to discuss such sensitive topics, or they may not believe they have time to dedicate to ongoing in-person therapy. 

With online therapy platforms like BetterHelp, many can participate in therapy in a convenient way. Online therapy generally only requires a stable internet connection. You can even attend with a support partner, like a friend, family member, or significant other, if you believe that would help you successfully experience an initial session.

Is online therapy effective? 

While personality disorders can be some of the most challenging mental health conditions to treat, many of the treatment methods detailed above have been successful in helping people with borderline personality disorder manage their symptoms. Additionally, these treatment modes can be and have been conducted online. 

For example: In a 2022 randomized controlled trial, researchers created two groups consisting of people living with a DSM-5 diagnosis of borderline personality disorder or another personality disorder with four or more BPD traits: a waitlist control arm with patients who would keep a sleep diary for six weeks, and an experimental arm that utilized guided internet-based CBT for five to eight weeks followed by a standard BPD treatment. 

Outcomes were evaluated using clinical interviews, questionnaires, the sleep diary and EEG headband twice; both at two months and eight months post-intervention. Researchers concluded that iCBT can be an effective way to treat patients experiencing both borderline personality disorder and sleep problems.

Online therapy may also help with comorbid mental health conditions, such as bipolar disorder, substance use disorder, and eating disorders. A therapist may use dialectical behavioral therapy (DBT) to help with problems related to emotional control.