Borderline Personality Disorder (BPD) is a psychiatric condition that impacts 1.4% of the population, with two-thirds of the population being female (Borderline Personality Disorder (n.d.). According to the Diagnostic and Statistical Manual, 5th Edition (DSM 5), BPD is composed of behaviors that include patterns of personal relationships that fluctuate from idealizing a person to pushing that same person away. At the same time, the person with BPD will also react with intensity at the thought of being abandoned by others. (American Psychiatric Association, 2013)
In addition to behavioral instability with relationships, the DSM also notes a person with BPD as one with a fragile self-image where intensified emotions can result in destructive behaviors. A person with BPD might experience fits of rage, feelings of emptiness, and/or depression. Consequently, behaviors might include promiscuity, overspending, self-harm, and/or paranoia. (American Psychiatric Association, 2013, Borderline Personality Disorder, n.d.)
With that being said, it is not advisable to diagnose someone with BPD based upon DSM symptomology alone. Rather, the symptoms should have occurred over an extended period of time. We also want to consider other factors in the behaviors that might include home environment and/or medical issues. (Linehan, 2014)
Dialectical Behavioral Therapy (DBT) is considered one of the most effective forms of treatment for those diagnosed with BPD. DBT was developed in the early 1990s by Marsha Linehan and is traditionally facilitated in a group setting and in conjunction with individual therapy, and possible medication management. DBT is an evidence-based protocol that helps the person cope with the intense emotions that he or she might experience. It is based upon the principles of mindfulness (staying present-focused) and includes several modules in its structure. (Linehan, 2014)
Core mindfulness skills introduce the person to staying in the present moment. Oftentimes, emotions are driven by thoughts about the past, the future, and/or a distorted sense of self or others. Mindfulness brings to awareness the unpleasant and escalating emotions. Once there is an improved awareness of the escalating emotions, the person employs a DBT “skill.” The goal of each DBT skill is to stay “wise minded” or, in other words, not succumb to the impulse of the emotion. (Linehan, 2014)
Core mindfulness leads to Emotion Regulation skills, which are aimed to strengthen the psychological foundation of the person, making him or her less vulnerable to extreme emotions. Emotion Regulation skills focus on self-care, working towards long and short-term goals, and nurturing healthy relationships. For example, a person will feel less intense anger if he or she is eating and sleeping well. (Linehan,2014)
Along with core mindfulness and emotion regulation, DBT introduces Distress Tolerance Skills which allows the person to cope with an emotional reaction based upon an unexpected event. Distress Tolerance introduces many coping skills and it is at this point in time that those participating in DBT will develop their own, individualized coping plan. For example, radical acceptance of a moment does not mean that the person is satisfied with a situation or outcome. Rather, the person learns to accept his or her reality as it is. (Linehan,2014)
Finally, DBT also introduces communication skills and addresses the impact of relationships on emotional wellness. Because those with BPD have difficulty with interpersonal relationships, learning to communicate is key. (Linehan,2014; Borderline Personality Disorder, n.d)
BPD is a treatable condition with the right combination of, and consistency with, therapies and possibly medications. However, learning DBT skills only becomes effective when they are practiced.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Borderline Personality Disorder (n.d.). National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/
Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.