Borderline personality disorder triggers turmoil and rage
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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.”