Borderline Personality Disorder
Borderline personality disorder (BPD) refers to personality dysfunction characterized by a disturbance in the individual's sense of self. The disorder typically involves unusual levels of instability in mood, "black and white" thinking (splitting), chaotic and unstable interpersonal relationships, self-image, identity, and behavior. Since Borderline Personality Disorder contains many aspects of several personality disorders, it has been referred to as "the personality disorder that decided not to specialize." In extreme cases, this disturbance in the sense of self can lead to periods of dissociation. These disturbances can have a pervasive negative impact on many or all of the psychosocial facets of life. This includes difficulties maintaining relationships in work, home and social settings. Attempted suicide and completed suicide are possible outcomes, especially without proper care and effective therapy.
Borderline personality disorder was once classified as a subset of schizophrenia (describing patients with borderline schizophrenic tendencies). Today BPD is considered a relatively stable personality disorder and is used more generally to describe non-psychotic individuals who display emotional dysregulation, splitting and an unstable self-image. Individuals with BPD are at high risk of developing other psychological disorders such as anxiety and depression. Other symptoms of BPD, such as dissociation, are frequently linked to severely traumatic childhood experiences, which some put forth as one of the many root causes of the borderline personality. BPD has many similar characteristics to emotionally unstable personality disorder, subtype borderline and complex post-traumatic stress disorder.
How is a Borderline Personality Disorder diagnosed?
A person with Borderline Personality Disorder usually has wide-ranging problems with social relationships and significant mood dysregulation. People suffering from borderline personality disorder (and their families) often feel their hardships are compounded by a lack of clear diagnoses, effective treatments, and accurate information. Personality disorders are very difficult to correctly diagnose, and are often misdiagnosed because they are not sharply defined and lack a clear set of diagnostic criteria. Furthermore, the diagnostic categories are not mutually exclusive. Often, people will show characteristics of more than one personality disorder. Finally, the dimensionality of personality characteristics (i.e., ranging from normal expressions of an emotion to pathological exaggerations) make diagnosis difficult, as the same emotional issues can be found on a smaller and less intense scale in many normal individuals. Therefore, Borderline Personality Disorder should be diagnosed by a mental health professional with expertise in Axis II (personality) disorders.
What causes Borderline Personality Disorder?
The complexity of personality disorders makes it difficult to firmly establish a genetic predispostion. There are qualities of Borderline Personality Disorder such as hypersensitivity to environmental stimuli or impulsive aggression which may be related to temperament and thus hereditary factors. Recent research indicates there may be disruption in the functioning of the brain's limbic system, which regulates emotion. Commonly accepted environmental causes of BPD are psychological trauma including physical or sexual abuse, an unstable family life as a child, or severe loss (such as death of parents or siblings). Marsha Linehan, the developer of Dialectical Behavior Therapy (DBT), believes that BPD is caused by an interplay between biological factors and an "emotionally invalidating" childhood environment (where the child's emotional needs are not met). Exposure to high levels of stress, substance abuse, self-medication, medical problems, and difficulties with family or other interpersonal relationships can all contribute to decreased functioning in someone with BPD or onset of a crisis period.
What is the Prognosis for Borderline Personality Disorder?
Borderline Personality Disorder is generally a life-long disturbance with periods of remission and exacerbation (worsening) dependent on life circumstances. Research shows that medication when indicated, coupled with effective psychotherapy, sleep and stress management and psycho-education can significantly improve the quality of life of someone with Borderline Personality Disorder. A newer treatment modality, Dialectical Behavioral Therapy (DBT), has produced excellent results in helping persons with BPD. DBT teaches the client how to learn to take control of their life, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. In conjuction with psychotherapy, and medication when necessary, persons with BPD can show a significant improvement in their overall happiness and quality of life.
What factors can slow recovery?
Persons with Borderline Personality Disorder may lack insight or blame others for their problems making them resistant or afraid to seek treatment. Identifying the proper diagnosis and setting the appropriate treatment plan tends to be difficult for this population, and many persons with BPD are misdiagnosed. Depression, eating disorders, and substance abuse (especially alcohol, marijuana or cocaine) is also prevalent among persons with Borderline Personality Disorder. Concurrent substance abuse dramatically interferes with effective psychological and medical treatment. Persons with Borderline Personality Disorder may have severe problems with family or loved ones, lacking social support that is important to help with their recovery. Effective treatment is extremely important, as approximately 80% of hospitalized of persons with Borderline Personality Disorder attempt suicide at some point during treatment, and about 5% succeed in committing suicide.
How Can Friends and Family Help?
Family members and friends are often caught in the web of Borderline Personality Disorder, dealing with frequent conflicts and outbursts of anger or rage. The stress of living with someone with BPD can be overwhelming. While it is important to try to keep a calm home environment and avoid triggering the person with BPD, their mood dysregulation inevitably leads to problems or crises necessitating intervention and availability of outside resources. It is important for family members and loved ones to realize there are treatment options for BPD, and they can help the affected person reach a treatment facility. Accordingly, it is extremely important to find a mental health care provider or treatment facility that has specific experience with Borderline Personality Disorder. Family and friends can provide emotional and financial support once a family member with BPD enters treatment.
When Should a Client enter a treatment center?
When a person with Borderline Personality Disorder is having serious problems that are negatively impacting their daily school or work life and personal and family relationships, an intensive treatment program is an appropriate option. Uncontrolled anger or rage, self-injurious behavior, or substance abuse are red flags requiring intervention. Once per week psychotherapy or medication is often ineffective at managing serious consequences of Borderline Personality Disorder. A treatment facility, like PCH Treatment Center, can be a powerful option, especially when the person with a personality disorder is not cooperating or is resistant to their current therapy.
How does PCH Treatment Center treat Borderline Personality Disorder?
When a Client arrives at PCH Borderline Personality Treatment Center, they are assigned a doctoral level therapist who performs a complete initial assessment. If a previous diagnosis of Borderline Personality Disorder has been made, this will be carefully evaluated. Improper diagnoses and stigmatizing labels are discarded at PCH Treatment Center. In conjunction with Dr. Jeff Ball, the Executive and Clinical Director, a treatment plan is designed. Each week the clinical team, comprised of multiple doctoral level psychologists, meets to review each Client's progress. Psychotherapy is the cornerstone to treatment along with Dialectical Behavioral Therapy and Somatic Experiencing. Anger management, process group, sleep management, psycho-education, and neurofeedback further enhance each Client's treatment experience. Holistic therapies including yoga, mindfulness meditation, acupuncture and massage therapy are also important for recovery and healing. Family therapy groups are also available which integrate family members or significant others into the Client’s treatment environment. Each Client also receives an evaluation by our Staff Psychiatrist, Dr. William Wirshing, who is an expert on psychopharmacology. He reviews each Client's medication regimen and adjusts it accordingly. Our philosophy at PCH Treatment Center is to focus on holistic healing with the minimal amount of medication necessary, and Dr. Wirshing complements this philosophy well. Clients may select our Intensive, Day or Evening Treatment Programs, depending on their severity of symptoms, time constraints and responsibilities, and living arrangements.
