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Borderline Personality Disorder

Borderline personality disorder (BPD) is associated with dysregulation in a variety of areas, including emotions, cognitions (thoughts), and behaviours. 

While the exact cause(s) of BPD are unknown, it has been conceptualized as stemming from the transactional relationship between biology (a sensitive temperament with extreme and long-lasting reactions to emotional cues) and an invalidating environment (one that responds ineffectively to the individual’s biological sensitivity)

Diagnosis

BPD may be diagnosed in individuals who present with five or more of the following symptoms:

  • Frantic efforts to avoid real or imagined abandonment 

  • A pervasive pattern of unstable and intense interpersonal relationships 

  • Unstable self-image or sense of self

  • Impulsivity that is potentially self-damaging (e.g., spending, sex, substance abuse, binge eating, etc.) 

  • Recurrent suicidal behaviour, gestures or threats, or self-injurious behaviour

  • Mood reactivity (e.g., intense emotional ‘highs and lows’, irritability, anxiety, etc.)

  • Chronic feelings of emptiness 

  • Inappropriate, intense anger or difficulty controlling anger 

  • Transient, stress-related paranoid ideation or severe dissociative symptoms 

Treatment

There is no known ‘cure’ for BPD; however, it is possible to manage the symptoms with psychotherapy, medication, or a combination of both. Whereas BPD was once thought to be an untreatable condition, specialized treatment approaches have since been developed that are effective in treating its symptoms. 

Dialectical behaviour therapy (DBT) is currently recognized as the gold standard treatment for BPD. DBT balances standard cognitive behaviour therapy (CBT) strategies and techniques with acceptance strategies that are based in Zen philosophy. There is evidence that other types of treatments may also be helpful, such as schema-focused therapy, mentalization-based therapy, systems training for emotional predictability and problem-solving (STEPPS), and transference-focused psychotherapy. Long-term treatment (over the course of several years) may be required in some cases. 

While medications may be used to manage some symptoms of BPD, they are not appropriate for everyone. Medications are often used in conjunction with psychotherapy.  

Psychologists that Specialize in BPD

Karen Lemke and Liat Habinski have significant experience treating BPD. In addition to providing individual therapy, they also run a DBT-informed Emotion Regulation Skills Group that targets many of the symptoms of BPD. 

References

Beck, A.T., Freeman, A., Davis, D.D., et al. (2007). Cognitive therapy of personality disorders (2nded.). New York, NY: Guildford Press. 

Behavioral Tech. (2017). What is dialectical behavior therapy (DBT)? Retrieved from https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/

CAMH. (2018). Borderline personality disorder. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/borderline-personality-disorder

Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York NY: Guildford Press.