Treatment of Borderline Personality Disorder

28 October, 2020
Are you wondering what the treatments for borderline personality disorder are? Continue reading today's article to discover them.

There’s a treatment for borderline personality disorder. The main characteristic of this condition is a repertoire of non-adaptive behaviors in situations that generate frustration and discomfort. The maladaptive behavior is related to overly high expectations that become uncomfortable when unfulfilled.

Dichotomous thinking is common in people with this disorder and conditions their relationships and perception of the world. Similarly, it explains their rigid behaviors and limits their emotional, professional, and social sphere.

It’s true that emotionally stable people may react inappropriately in a situation that generates discomfort. The difference between people with optimal emotional stability and people with borderline personality disorder is that the former usually knows how far they can “let themselves get carried away” by emotion. The reactivity to the discomfort is usually greater in the latter and they have a tendency toward risky types of behaviors.

A distressed woman.

Borderline personality disorder

This disorder falls under the category of cluster B of personality disorders in the DSM-5. Its main characteristic is a pattern of emotional instability that manifests in interpersonal relationships, self-image, and emotions.

Impulsiveness is another key characteristic and it manifests in full emotional escalation in the face of unpleasant events. In the worst case, impulsivity can lead to risky behaviors such as self-harm or aggression.

What can summarize the functioning of people with borderline personality disorder in general terms is that emotional escalation is usually quite high in situations that generate unpleasant emotions. This escalation implies a high reactivity to one’s environment and the return to the baseline is slower than usual.

Treatment of borderline personality disorder

This is often associated with eating disorders, addictions, and other impulse control disorders. Therefore, psychological therapy is necessary and important in the whole treatment of borderline personality disorder.

The non-adaptive behaviors associated with borderline personality disorder are effective in the short term for the relief of discomfort, but not in the long term. In this regard, drugs can complement any form of psychotherapy for it and associated disorders sometimes require hospitalization or specific treatment.

Continue reading to discover two treatments for borderline personality disorder.

Dialectical behavior therapy

Dialectical behavior therapy was developed by Dr. Marsha Linehan. Furthermore, it links behavioral and acceptance strategies as well as changes through the dialectical model.

Thus, dialectics are part of the therapeutic program to exaggerate absolutist conclusions of dichotomous thinking. It promotes discomfort acceptance and changes in certain dysfunctional behavior patterns.

How to apply this treatment

Standard dialectical behavior therapy for borderline personality disorder is comprehensive and includes four therapy modes:

  • Individual therapy. This is the basic format. A therapist is responsible for conducting individual sessions of 50-60 minutes once a week.
  • Skills training. This corresponds to the modality of group therapy and individual therapy. The therapist must be trained in borderline personality disorder and mindfulness skills, emotional regulation, tolerance to discomfort, and interpersonal effectiveness. A session lasts 2-3 hours and takes place once per week.
  • Generalization of activities. This is about helping a patient integrate the learned skills into their natural context. They do so by making phone calls between sessions in order to put their skills into action in real situations.
  • Consultation teams. This is a form of burnout prevention in therapists. There are weekly supervision sessions in which the whole team is present.

In addition, the patient makes a commitment to attend therapy for the estimated time (usually between six months and a year) prior to entering the treatment program. Failure to attend four sessions in a row is usually grounds for termination of therapy until the end of the contract when they may renegotiate entry into therapy.

A woman with a therapist.

Iconic therapy

This type of therapy arose at the Centro Asistencial San Juan De Dios. This therapy is an integrated model that includes an explanatory guide about the lack of emotional regulation. That is a therapeutic model that gathers the various strategies to use when working on non-adaptive behavior and aspects about the vulnerability that increase the risk of unstable ones.

Characteristics of iconic therapy and its application

In short, iconic therapy is based on the treatment of borderline personality disorder through the use of icons. Furthermore, these icons are a way of verbalizing certain aspects of non-adaptive behavior in a non-judgmental way. Likewise, they encourage insight and allow for skill training such as frustration tolerance. It also promotes acceptance strategies. In addition, it works on other aspects such as the feeling of emptiness, personal identity, and self-esteem.

Thus, iconic therapy consists of 32 icons and a given individual can place them on a sort of map that allows them to move from the negative emotion to the most useful coping strategy. Moreover, this coping strategy is represented by an icon. Finally, this kind of therapy lasts approximately 12 weeks and is conducted in group, individual, and family sessions once a week.

Binks CA, Fenton M, McCarthy L, Lee T, Adams CE y Duggan C (2006b). Terapias psicológicas para personas con trastorno de la personalidad borderline. En: Biblioteca Cochrane Plus, número 2, 2008. Oxford: Update Software Ltd. Disponible en: http://www.update-software.com

Swales, M. (2009). Dialectical Behaviour Therapy: Description, Research and Future Directions. International Journal of Behavioral Consultation and Therapy, 5 (2), 164-177

Verheul, R., Van Den Bosch, L.M.C., Koeter, M.W.J., De Ridder, M.A.J., Stijnen, T & Van den Brink, W. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry, 182(2), 135- 140.