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The most successful treatment for BPD appears to be dialectical behaviour therapy. A cognitive-behavioural treatment developed about 15 years ago by Marsha Linehan, a psychology professor at Seattle’s University of Washington and director of its behavioural research and therapy clinics, DBT typically involves weekly individual or group-therapy sessions (or both) that focus on managing and coping with emotions, dealing effectively with interpersonal situations, and tolerating emotional distress. It also helps people practise “mindfulness”, a way of paying full attention to the present moment.
SFU assistant professor and psychologist Alexander Chapman cofounded the Dialectical Behaviour Therapy Centre of Vancouver in 2007 with fellow registered psychologist John Wagner. The same year, Chapman coauthored The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living With BPD with Kim L. Gratz and Perry D. Hoffman.
“There was very little material for people with borderline personality disorder that was understanding,” Chapman says of the book. “People with BPD are branded as out of control, extremely angry, and manipulative. Even treatment providers turn them away because they’re deemed too difficult to work with.
“There’s a stigma attached to BPD: if you’ve got BPD, your personality must be flawed; it must be a scar on your soul that will never go away. But research shows that people do get better over time. Impulsivity and suicidality tend to decrease with age; however, fear of abandonment and rejection do not.
“When it comes to being highly emotional, there’s a positive side to that as well: some of the most compassionate people I’ve ever met are the people I’ve worked with,” Chapman adds.
The DBT centre, which treats people with BPD as well as those with suicidal thinking, eating disorders, and self-destructive behaviour, among other things, offers weekly individual therapy. It provides skills training, too, teaching people how to identify and cope with emotions, deal with stress, self-soothe, and be “in the moment”. The wait to get in is usually between three and eight weeks—not ideal for someone who’s desperate for support and change but shorter than the usual year or so it takes to see a psychiatrist.
“DBT is the well-researched therapy for BPD and related problems,” Chapman says. “The centre sees about 60 clients a week. There’s certainly high demand for treatment.”
Although DBT has shown great promise in treating borderline personality disorder, all too often people are prescribed a cocktail of pharmaceuticals that have potentially serious side effects. Experts in the field say medications are inappropriate for treating the disorder.
“The current evidence is that treatment is effective, and the primary intervention seems to be some type of psychotherapy,” Livesley says. “But that’s not how most patients are treated, especially here; most are treated with medication. American Psychiatric Association guidelines for treating BPD recognize psychotherapy as the main treatment and pharmacotherapy used as adjunctive treatment. Interestingly, the new guidelines out of the U.K. [the National Institute for Health and Clinical Excellence] don’t recognize medication at all for BPD.
“It’s a myth that we can’t treat this disorder,” he adds. “The evidence is that we can make substantial changes and improve quality of life.”
Livesley claims that government cutbacks to health care, in particular to day-treatment programs for those with mental illnesses, have made it harder for people to get help.
“We’re going backwards, in a way,” he says. “We’ve had so many cutbacks. Europe is doing more in terms of longer-term inpatient care for more severe patients. But that doesn’t fit the North American model of short-term admissions. Medications are an easy option.”
BPD is, because of it's nature, very difficult when someone close to you has it. Physical and emotional abuse, as it may lead to (intentionally or not) is not ok. I belive that a big part of recovery includes getting the disordered people to realise how others actually feel when getting exposed to some of their behaviours.
Do you at least agree on that they're responsible for taking whatever course of action needed to recover?
Frank: Nice to hear that she's getting better! Could you perhaps specify these strengths that the disorder has given her? Would be nice to hear some success stories for a change. :)
There were several psychiatrists in my journey that wanted to medicate me. I was lucky as I knew I'd had a pretty messed up childhood and had to work some stuff out. I also came across several people, psychologists and non-mental-health individuals who guided me through learning to cope with feelings and stresses and managing my quirks.
I have no time for anyone who thinks they can use any diagnosis, mental or physical, as an excuse for cruelty and messing with other people, especially their own children. In this day and age we have enough information at our fingertips to get the help we need, and we should expect as much from those around us.
I am a functional person now raising a healthy family. When I come across things that I don't know how to cope with, I seek out the answers. I took a couple of different parenting courses to get the skills I need to rewire myself to give my children the healthy upbringing that I was provided.
you might find this very helpful
Does that mean I can treat people badly with no consequences when I get bored during a staff meeting or triggered because someone in the elevator reaches into my personal space to press a floor without saying excuse me? No, because while I didn't ask for anxiety and ADHD and it's not my "fault" I have them, it is my "responsibility" to manage the symptoms and behaviors that accompany them.
I know with my mother, she refuses to accept even the most basic of responsibility for how she treats people. Up until we ceased contact a year and a half ago, she was still emotionally abusive with rages, smearing campaigns, etc.
She was very likely responsible for excluding me from most meaningful participation in my brother's wedding. Her smear campaign against me with my sister-in-law destroyed the budding relationship we had, as well as that with my brother. I have a niece born during the estrangement who I haven't met.
Sure, my mother didn't ask to have a PD and I know it was abuse and trauma that made her the way she is. But as long as she refuses to acknowledge/take any responsibility for the emotional carnage she's wrought, I want absolutely NOTHING WHATSOEVER to do with that toxic piece of work.
I kept trying to make things right and be the bigger person. I can't tell you how many sleepless nights I've spent, how many times I've walked on eggshells dealing with her. I overthink everything and constantly blame myself because I was conditioned to do that as her scapegoat.
You claim they have no control over their behavior. Well, then, why do they behave differently in public than they do in private? My mother made a big show of being the loving mother in public. Yet in private, she'd tell me I'd probably get breast cancer too if I didn't lose weight when I took 2 weeks off from work and spent airfare to care for her after a mastectomy. Btw, I'd lost 25 pounds since the last time she saw me during that incident. Yet, my golden child brother, who was in prison at the time, got a friend from the outside to send flowers to her for Mother's Day (he couldn't be told about the cancer/surgery because she didn't want to worry him). And he was the best and sweetest son ever. I was screamed and yelled out for asking the nurse to show me how to handle the drains/changing bandages, etc.
And speaking of the golden child/scapegoat dynamic, IMO that's MORE PROOF they can control themselves. I'm not saying it's easy to control behaviors. Just that they choose not too.
Get help, get meds if need be. Yes, it's great if other people can help/be supportive, but one should never use a fellow human being as a doormat or an emotional scratching post. That goes double for the ones we claim to "love"
As for public versus private actions, unfortunately we act out more towards people we trust, which is terrible and I, for one, feel horrible every single time. I feel badly for the family and friends who are hurt by all people with BPD and it isn't fair but no, actually, we can't control it, no matter how much we tell ourselves "not again" and no matter how much we despise ourselves for it. As for being a doormat, that isn't fair either, but it is then it's up to you to draw the line and take care of yourself; cut the tie until that person gets help or forever if need be. Just because that person can't control themselves doesn't mean you have to live with any abuse.
Hopefully with knowledge of the disorder, more will get diagnosed and get help so no one, BPD or otherwise, will get hurt by this disorder.
yeah, we should just walk away from the people we love because it's up to us? walk away from our kids too? our obligations?
sadly what is glossed over in this article is that most, not all BPD's are hardwired like this and therapy, if they ever admit to having a problem, which, most don't , doesn't work.
i find it offensive that they claim their therapy "works" because i have read almost all of the scholarly work on BPD and NPD, including the work quoted here in this article.
1 out of 100 BPD's will succeed in getting therapy.
1 in 1000 will succeed.
the issue here isn't that it's misunderstood. it's understood.
it's that our culture of entitlement promotes and rewards this behavior.
BPD's make bad choices and they know the difference.
they just don't care. and when you love these people, it wreaks havoc on everyone.
BPD's also trust no one. they go through a cycle: they idolize it, they demean it, they destroy it. this is all in the research.
as soon as you get close, they demolish you. then they try and destroy your friendships with others.
they don't "relearn" either. they adapt and go covert.
few get through this. it's in the research thats quoted here.
i suggest for your own "understanding " on the subject, you look it up. it's all online.
then hit a few of the BPD support groups and see what those people have to say. this isn't a BPD witch hunt.
but it is what it is. they are hardwired this way.
and that is heartbreaking.to see people with so much potential who can't see it in themselves..unless they see it in others...
hard to move a highway once it's been paved and painted.
i suggest to anyone reading these comments or this article to read up on it. do what you can to help but don't be surprised.
if you are a BPD, good luck. you have your work cut out for you and you do have my sympathies...
"As for public versus private actions, unfortunately we act out more towards people we trust, which is terrible and I, for one, feel horrible every single time. I feel badly for the family and friends who are hurt by all people with BPD and it isn't fair but no, actually, we can't control it, no matter how much we tell ourselves "not again" and no matter how much we despise ourselves for it. As for being a doormat, that isn't fair either, but it is then it's up to you to draw the line and take care of yourself; cut the tie until that person gets help or forever if need be. Just because that person can't control themselves doesn't mean you have to live with any abuse."
For adults and those in chosen relationships, it's possible to do this. For children growing up with a parent with a PD, it's quite different. Adult children who go no contact with a parent with a PD are judged more harshly than a significant other who ends the relationship.
While I agree with you that more awareness and treatment is necessary, I disagree on the public vs. private thing. If the person can control behavior in public, they can do it in private. Behaving vastly different in public also contributes to the gaslighting and crazymaking. People often don't believe the person who's been abused by someone with a PD because the person with a PD acts so differently in public. If parents with PDs can treat the child they scapegoat differently than their golden child, they're obviously capable of some control over their actions.
I have enormous respect for people like Julie who posted about her own experience. She doesn't use her illness as an excuse and makes an active and concerted effort to address the effects of it.
I suspect that most people (women) with BPD don't know they have it, will never accept that they have it, and will never get treatment. Perhaps they need interventions by family & friends, like alcoholics & drug addicts.
Relearning how to deal with emotions takes many, many years. Kudos to those who are willing to try to understand and support the afflicted.
To the people saying it's horrible, it is. It's not as controlable as people may think - I guess the only way I can explain it, is that it's like a massive tsunami. There's the initial wave of anger and hurt which boils over, and then slowly ebbs (i.e. rather than being angry/upset for days at a time, it can be minutes/hours)
It takes a lot of time to relearn and change your thinking an behaviour - and as it's often an auto response there are times and things you regret on the way to being better - but believe me, it can happen.
Nearly 3 years later I'm much happier. No more suicidal ideation, or hate or even anger. I still get the lovely parts of borderline (very emotional both for happy and sad things, very intuitive to how people are feeling, and very empathetic) but no where near as much of the bad things.
To any sufferers out there or friends and family of borderlines, there is hope.
Marushka, you are right. interventions would help but the problem with that is most times the parent are bpd as well and or think they are "bad parents". or they are just flat out in denial.
in regards to a friend of mine (former friend quite sadly ) i kept hearing about how "it's a phase" from members of her family who are all BPD's in denial. a whole cluster of cluster b's.
i would laugh but that's hardly funny.
so her family will live in LA LA land, she will never get help and go on to a sad sad life. seen it a number of times.
that is a very very sad thing. i am glad at least that she is too vain to do any harm to herself.
if you mention it to her (as her friends are starting to do ) the professional victim in her comes out, the blame wheel fires up and bang...off to find a new set of "friend" as she only travels in threes..one on the go, one for backup and one on the make being groomed.
sad sad sad ...
nice to see that half the battle is recognizing it.
hopefully there will be more success stories like the ones here.
hopefully people will see this, something will ring a bell and they will go and get themselves some help.
I'm a recovering BPDer and after several years of therapy (including DBT) am no longer suicidal, far less depressed and almost never have bouts of rage”¦ so there is definitely hope, no matter what's written "out there".
Recently I've started working on the black&white thinking and was able to make up with someone even after she badly triggered me and after I "painted her black" in my mind.
The thing is that when you think of yourself as subhuman (as I've recently realized I do) then other people look like all knowing Gods, there to protect you, and when they don't/can't and when the stay stuff you find hurtful and therefore think they want to destroy you (once your mind escalated to that point that is) – your only choices are either self destruction or devaluation of the person you idolized in order to diminish their imaginary power over you.
I hereby plan on being the only source of my own validation from now on. Other people are just plain old human beings and can't really provide me with what I need to provide for myself.
The very core of BPD is invalidation, yet, funnily enough, much of the world likes to invalidate us. It's nice to read that there are some researchers out there who actually care.
To all the BPDers out there: be strong for yourself, fight for yourself and – against our very nature – have faith in yourself.
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