By Rob Greene, MA, LLP
What is BPD? Borderline Personality Disorder (BPD) shows itself as a chronic pattern of instability and chaos in relationships, self-image, and in frequent impulsivity and unusual emotional responses. It usually begins by early adulthood and can be noticed in any number of settings and environments (i.e., school, home, work and the community). There are signs of frantic efforts to avoid real or imagined abandonment, unstable and intense relationships in which the individual alternates between extreme idealization and devaluation of others when they perceive injustice, betrayal, manipulation or loss of interest and love. People with BPD struggle with an unstable self-image and sense of self. There is a pattern of suicidal behavior and/or self-injury.
What is most rewarding about treating BPD? When I began my career in mental health in the early 1990s, most of my professional colleagues avoided working with BPD because there were very few techniques and interventions that proved helpful. With time and experience I began to learn that there were at least a few ways we could help these people who suffer incredibly. I liked the challenges presented by these types of cases, and when I was successful, I felt I'd achieved something very meaningful and fulfilling. I immediately found Dialectical Behavioral Therapy (DBT) to be effective and my interest in working with this grew. I found that I could help people that my more experienced professional colleagues argued could not be helped. I was hooked. I have an affinity for people that "fall through the cracks," and I haven't looked backed in my career.
What are common myths about BPD? There’s a myth here is that if you assign such diagnosis as BPD it will frighten the individual and forever stigmatize them. I say provide the right diagnosis and treatment and nobody will be concerned about the mental health history after their recovery. Nobody knows what's on my college transcripts and my work today is based on results not my grade point average. People with BPD often are diagnosed with other mental illnesses and sometimes the major focus of treatment becomes finding the "right" combination of medications instead of teaching cognitive-behavioral coping skills. I’m not against the use of medication, but my concern is that I've met many people that have not been diagnosed properly and most of these people seem confused. Some don't even know what diagnosis they have been given.
How does BPD affect family members and friends of those suffering? Untreated BPD can be debilitating to everyone in a support system surrounding an individual with BPD. Before and during treatment, associated behaviors can be disruptive, confusing and stressful. It is not uncommon to work with individuals who’ve lost their entire support system. Unfortunately we still have limited resources for families and loved ones to access, however, this is beginning to change. At AFBHS we are including the family in the treatment of adolescents and children with behaviors like those mentioned above to help families find effective ways to cope and keep support systems active.
Why do you think DBT works so well in treating BPD? First and foremost, DBT is specifically designed to treat BPD - it is not a one-size-fits-all modality. DBT is evidenced-based and has a much higher rate of retaining people with BPD in treatment—much better rates of reducing and eliminating suicidal and self-harmful behavior and the system provides relief and support far more quickly than treatment as usual. Clinicians are becoming drawn to this kind of work because they've learned about DBT's success and their anxiety about working with BPD is rapidly disappearing.
When should someone know to seek help? How can they recognize when their feelings, emotions, and actions might not match those of others? It's common for individuals with this disorder to be confused about whether they have an illness, what type of illness they may have, and to be stigmatized. If you have doubt, any concerns, don’t be afraid to seek help. A phone call to AFBHS is confidential and we have the necessary resources to make appropriate recommendations no matter what the conditions and circumstances may be. Learn about our comprehensive DBT Program for children, adolescents, and adults.