https://www.verywellmind.

com/what-is-borderline-personality-disorder-bpd-425487

Understanding Borderline
Personality Disorder (BPD)
Borderline personality disorder (BPD) is a serious psychological condition that's
characterized by unstable moods and emotions, relationships, and behavior. It's one of several
personality disorders recognized by the American Psychiatric Association (APA). Personality
disorders are psychological conditions that begin in adolescence or early adulthood, continue
over many years, and, when left untreated, can cause a great deal of distress. Thankfully, the
treatment that's targeted to BPD can help significantly.

Symptoms

BPD can often interfere with your ability to enjoy life or achieve fulfillment in relationships,
work, or school. It's associated with specific and significant problems in interpersonal
relationships, self-image, emotions, behaviors, and thinking, including:

 Relationships: People with BPD tend to have intense relationships with their friends, family,
and loved ones characterized by a lot of conflicts, arguments, and break-ups. BPD is also
associated with a strong sensitivity to abandonment, which includes an intense fear of being
abandoned by loved ones and attempts to avoid real or imagined abandonment. This usually
leads to difficulty trusting anyone and may cause significant strain on interpersonal
relationships.
 Self-image: Individuals with BPD have difficulties related to the stability of their sense of
self. They report many ups and downs in how they feel about themselves. One moment they
may feel good about themselves, but the next they may feel they are bad or even evil.
 Emotions: Emotional instability is a key feature of BPD. Individuals with BPD may say that
they feel as if they are on an emotional roller coaster with very quick shifts in mood (for
example, going from feeling okay to feeling extremely down or blue within a few minutes).
These mood changes can last from minutes to days and are often intense. Feelings of anger,
anxiety, and overwhelming emptiness are common as well.

 Behaviors: BPD is associated with a tendency to engage in risky and impulsive behaviors,
such as going on shopping sprees, drinking excessive amounts of alcohol or abusing drugs,
engaging in promiscuous or risky sex, or binge eating. Also, people with BPD are more prone
to engage in self-harming behaviors, such as cutting or burning and to attempt suicide.
 Stress-related changes in thinking: Under conditions of stress, people with BPD may
experience changes in thinking, including paranoid thoughts (for example, thoughts that
others may be trying to cause them harm), or dissociation (feeling spaced out, numb, or like
they're not really in their body).

Causes

Like most psychological disorders, the exact cause of BPD is not known. However, there is
research to suggest that some combination of nature (biology or genetics) and nurture
(environment) is at play. Contributing factors that may increase your risk include:
  Negative experiences: Research has shown that many people diagnosed with BPD have
experienced childhood abuse, trauma, or neglect or were separated from their caregivers at an
early age. However, not all people with BPD had one of these childhood experiences and,
conversely, many people who have had these experiences do not have BPD.
 Brain structure: There is also evidence of differences in brain structure and function in
individuals with BPD, especially in the parts of the brain that affect impulse control and
emotional regulation. However, it's still unclear if these differences are a result of having
BPD or if they are part of the cause.
 Family history: Having a parent or sibling with BPD also means you may be a higher risk of
developing it.

Remember that a risk factor is not the same as a cause; just because you have risk factors
doesn't mean you will develop BPD, just as many people who don't have these risk factors
develop it anyway.

Treatment

Although at one time experts believed that BPD was unlikely to respond to treatment,
research has now shown that BPD is very treatable. Getting help from a mental health
professional is critical because, with consistent treatment, you can live a better quality of life
with fewer symptoms. Since BPD is associated with risky behavior, self-harm, and suicide,
treatment can also help curb these behaviors. Find someone who specializes in BPD because
you will need treatments that are targeted specifically to BPD. If you aren't getting the right
treatment, it may not be as effective.

Treatment options include:

 Psychotherapy: This is the standard treatment for BPD. Examples of psychotherapy that are
targeted to BPD include dialectical behavior therapy (DBT) and cognitive behavioral therapy
(CBT). This may include your family, friends, or caregivers as well.
 Medication: Your mental health professional may also recommend medication to help treat
certain symptoms such as depression or mood swings.
 Other treatments: Hospitalization or more intensive treatments may be necessary as well in
times of crisis.

The symptoms of BPD can affect a variety of areas, including work, school, relationships,
legal status, and physical health, which is why treatment is so critical. Despite the obstacles
that BPD can cause, many people with BPD lead normal, fulfilling lives when they stick with
their treatment plan.

When to Get Help

If you or a loved one are having suicidal thoughts, call the National Suicide Prevention
Lifeline at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. Calls are free and your
information is kept confidential.

If you think that you or a loved one may suffer from BPD, it's imperative that you seek the
help of a licensed mental health professional, such as a mental health counselor, social
worker, psychologist, or psychiatrist. It's important to remember that many of the symptoms
of BPD are symptoms that everyone experiences from time to time. Also, some of the
 symptoms of BPD overlap with other mental and physical conditions. Only a licensed
professional can diagnose BPD.

The good news is that once a diagnosis is made, there is hope. Your therapist or doctor can
help to determine a plan of action, which may include psychotherapy, medications, or other
treatments. Research has shown that with good, consistent treatment, BPD symptoms can be
reduced significantly. Some people who were once diagnosed with BPD no longer meet
criteria for the disorder with treatment and time.

Borderline Personality Disorder

(BPD)
From dispelling the myths to finding treatment options and daily tips that work for you, here's
what you need to know about borderline personality disorder.

 Diagnosis
 Treatment
 Living With BPD
 Related Conditions

https://www.verywellmind.com/bpd-triggers-425475

Understanding Borderline Personality

Disorder Triggers
Most people with borderline personality disorder (BPD) have triggers, that is, particular
events or situations that exacerbate or intensify their symptoms. BPD triggers can vary from
person to person, but there are some types of triggers that are very common in BPD.

Defining a Trigger

You may have heard the term "trigger" before but are not sure exactly what this means.
Usually, a trigger refers to some event that brings on a major exacerbation of BPD symptoms.
This event can be external, as in something that happens outside of yourself, or internal,
meaning something that happens in your mind, like a thought or memory. Immediately
following a trigger, one or more of your BPD symptoms may intensify significantly. Triggers
are events that make you feel as if your symptoms are going off the charts.

Relationship Triggers

The most common BPD triggers are relationship triggers or interpersonal distress. Many
people with BPD experience intense fear and anger, impulsive behavior, self-harm, and
even suicidality in the wake of relationship events that make them feel either rejected,
criticized, or abandoned. This is a phenomenon called abandonment or rejection sensitivity.

For example, you may feel triggered when you leave a message for a friend and do not
receive a call back. Perhaps after placing the call, you wait a few hours, and then start having
thoughts like, "She's not calling back, she must be mad at me." These thoughts may spiral
from there into things like, "She probably hates me," or "I'll never have a friend who sticks by
my side." With these spiraling thoughts come spiraling symptoms, such as intense emotions,
anger, and urges to self-harm.

Cognitive Triggers

Sometimes you may be triggered by internal events, such as thoughts that can seemingly
come out of the blue. This is particularly true for people who have BPD related to traumatic
events like child abuse.

For example, a memory or image of a past experience, like a traumatic event or a loss, can
trigger intense emotions and other BPD symptoms. The memory does not necessarily need to
be a distressing one to trigger symptoms. Some people are triggered by memories of good
times from the past, which can sometimes be a reminder that things are not as good now.

How to Manage BPD Triggers

Triggers are highly individual, so the first step in managing triggers is to know the particular
events, situations, thoughts, or memories that trigger your outbursts of anger or
impulsiveness. To determine what your triggers are, try this exercise. It can help you identify
and deal with your worst triggers.

Once you've learned your most troubling triggers, you have a couple options. First, you can
figure out whether a particular trigger can be avoided. For example, if you know that
watching a certain movie always triggers you, you can choose to not watch that movie. Many
triggers, however, can't be avoided so easily. If you find that some of your triggers cannot be
avoided, you can make a plan for coping that includes developing an action plan, seeing a
therapist, and learning to gradually approach your triggers. A therapist can help you learn to
express your emotions in a way that doesn't push the people you love away, which leaves you
feeling abandoned or rejected, and thus triggered.
https://www.verywellmind.com/emotional-invalidation-425156

Emotional Invalidation
During Childhood May
Cause BPD
Many people with borderline personality disorder (BPD) have had experiences of emotional
invalidation. In fact, some experts believe that emotional invalidation may be one factor that
increases a child’s risk of developing BPD in adolescence or adulthood.

What Is Emotional Invalidation?

Emotional invalidation is when someone communicates to you that your emotions are not
valid, are unreasonable or irrational, or should be hidden or concealed.

For example, when a child is fearful, their parent might tell them, “Stop being such a baby,
there’s nothing to be afraid of.” This is an emotionally invalidating response; it not only
communicates to the child that their emotions are invalid but also that they are weak for
having emotions.

Alternatively, a parent might respond with, “I understand you’re feeling afraid. Tell me
what’s happening to make you scared.” This is a validating response; it tells the child that
their emotions are respected (even if the parent may not agree that there is an objective reason
to be scared).

Emotional Invalidation and Borderline Personality Disorder

Many experts believe that emotional invalidation, particularly in childhood and adolescence,
may be one factor that leads to the development of BPD.

Marsha Linehan, Ph.D., the clinical psychologist who developed Dialectical Behavior
Therapy (DBT) has proposed that an “emotionally invalidating environment,” or an
environment in which one’s emotional responses are consistently invalidated or punished,
may interact with other factors to cause BPD.

In Dr. Linehan’s model, children at risk of developing BPD later in life are born with a
biological predisposition toward strong emotional responses. Unfortunately, these strong
emotional responses can be met with invalidation (which may, but does not necessarily, take
the form of abuse or neglect).

It is important to note that in this model, there is an interaction between the child's emotions
and the environment. Because the child has such strong emotional responses to situations that
others might not react to, their emotions are more likely to be invalidated. If a parent or
caregiver interprets the child's responses as overreactions, they are likely to respond with
behaviors that discourage the emotional response.

Unfortunately, discouraging a child’s emotional responses, particularly if that child is

temperamentally predisposed to have strong emotions, probably does not work to calm the
child. Instead, it likely has the opposite effect—the child’s emotional response is heightened,
leading to an intensification of the emotion. Further, that child may miss the opportunity to
learn how to manage their emotions effectively, which may lead to more emotion
dysregulation down the road.

Does Emotional Invalidation Cause BPD?

Dr. Linehan’s model of BPD includes emotional invalidation as one risk factor, and there is
some strong evidence of a connection between childhood maltreatment and BPD (various
forms of maltreatment, such as emotional neglect and physical abuse, are inherently
invalidating of emotions). Further, research has demonstrated that BPD symptoms are
associated with reports of perceived childhood emotional invalidation.

But there is no way to know whether emotional invalidation is, in fact, a cause of BPD. This
is because most of the research on this topic is retrospective (meaning that the researcher asks
the person to report about experiences that happened earlier in their life; these reports can be
subject to bias) and correlational (meaning it demonstrates a relationship between emotional
invalidation and BPD but cannot conclude that emotional invalidation is a cause of BPD).

How Loved Ones Can Provide Emotional Validation

If you love someone with BPD and are reading this, you may have noticed that some of your
own reactions to your loved one’s emotions have been invalidating. Because a person with
BPD has such intense reactions to seemingly minor events, it can be very hard to remain
validating. However, learning some skills to increase emotionally validating responses can
actually help reduce your loved one’s reactivity.

https://www.verywellmind.com/borderline-personality-disorder-statistics-425481

Borderline Personality
Disorder Statistics
Borderline Personality Disorder Is More Common Than You Think
If you have been recently diagnosed with borderline personality disorder (BPD), you may
feel overwhelmed, scared and alone. But BPD is much more common than you probably
think. Learning the facts about the disorder, including prevalence statistics, can help you feel
more empowered to seek help through therapy and support groups. Here are some relevant
BPD facts and figures.

Borderline Personality Disorder Statistics on Prevalence

In the United States, recent research has shown that 1.6% of the population has BPD. That
number may seem small, but when you consider just how large the United States is, you may
realize that 1.6% represents quite a large number of people. That percentage means that over
four million people have BPD in America alone. Whole BPD is not as well known as other
disorders, it is actually more common that illnesses like schizophrenia.

Gender Differences in BPD

Women are far more likely to be diagnosed with BPD than men. In fact, about 75% of people
diagnosed with BPD are women; that's a ratio of 3 women to 1 man diagnosed with BPD.
Researchers do not know why there is this gender difference. It may be that women are more
prone to BPD, women may be more likely to pursue treatment or that there are gender biases
when it comes to diagnosis. For instance, men with symptoms of BPD may be more likely to
be misdiagnosed with another condition like post-traumatic stress disorder or major
depressive disorder.

BPD Suicidality Statistics

Some of the most sobering borderline personality disorder statistics come from the research
literature on BPD and suicidality. About 70% of people with BPD will make at least one
suicide attempt in their lifetimes. In addition, between 8 and 10 percent of people with BPD
will complete suicide; this rate is more than 50 times the rate of suicide in the general
population. Why these rates are so high is currently unknown. It may because people with
BPD don't know where to turn for treatment or are misdiagnosed and not treated
appropriately.

BPD and Misdiagnosis

While 1.6% is the recorded percentage of people with BPD, the actual prevalence may be
even higher. In a recent study, over 40% of people with BPD had been previously
misdiagnosed with other disorders like bipolar disorder or major depressive disorder. These
illnesses are often cited, potentially because they are more well-known and more easily
treated with medications than borderline personality disorder.

It's also common for those with BPD to have comorbidities or other illnesses along with
BPD. In fact, as many as 20% of people with BPD have also been found to have bipolar
disorder, making their diagnosis and treatment more complicated than treating one disease.

Statistics on Prognosis

Now for the good news -- while BPD is a serious mental illness, it is by no means a life
sentence. Research has shown that the prognosis for BPD is actually not as bad at once
thought. Almost half of people who are diagnosed with BPD will not meet the criteria for a
diagnosis just two years later. Ten years later, 88 percent of people who were once diagnosed
with BPD no longer meet criteria for a diagnosis.

https://www.verywellmind.com/what-is-the-sympathetic-nervous-system-425330

Your BPD and the

Sympathetic Nervous
System
When you're in distress, it triggers the fight-or-flight response

Ever wonder what gets your heart pumping while you're watching a scary movie? Or what's
responsible for your quick reaction when someone cuts you off in traffic? Or why your brain
goes blank and your palms get sweaty when you have to give a presentation to a room full of
people?

The sympathetic nervous system is what stimulates the "fight-or-flight" response when you're
presented with a threat, whether it's being chased by a wild animal or confronting your fear of
public speaking. When no threat is present, the parasympathetic nervous system allows your
body to rest, recover, and digest nutrients.

Understanding the Autonomic Nervous System

The sympathetic nervous system is one branch of the autonomic nervous system(the other
branch is the parasympathetic nervous system). The autonomic nervous system regulates the
functions of organs like your heart, stomach, bladder, and intestines that take place without
conscious effort. It also controls the muscles in your body. You usually don't notice this
system at work because it acts reflexively in response to stimuli like the aforementioned wild
animal.

In acutely stressful situations, a number of things happen in your brain. First, the amygdala,
which is responsible for detecting fear and preparing for emergency events, sends the
message to your hypothalamus that you're in danger. In turn, the hypothalamus, which links
your nervous system to your endocrine system, sends adrenaline into your bloodstream. This
sets off a number of physiological and hormonal changes, such as dilated pupils, increased
heart rate and blood pressure, increased alertness, and heightened senses. In addition, blood
sugar and fats are released into your bloodstream for energy, so you can "fight" or "flee" from
the danger.

In borderline personality disorder, this very well-orchestrated system is more easily triggered,
which can cause serious emotional conflict, within and without.

The Sympathetic Nervous System and Borderline Personality Disorder

Borderline personality disorder (BPD) is a common and disruptive mental illness that affects
millions of people within the United States. Despite its prevalence, little research has been
performed to study the neurological or physiological mechanisms behind BPD. Some
scientists have suggested that better understanding the mechanics behind BPD, such as issues
with the sympathetic nervous system, may lead to the creation of more effective treatment
options. To date, though some drugs can help manage specific symptoms of BPD, there's no
medication specifically approved to treat BPD.

According to the Diagnostic and Statistical Manual of Mental Illnesses,5th edition, a

reference healthcare professionals review when making a diagnosis, people with BPD
typically have trouble regulating their emotions. Researchers have hypothesized that this
means the sympathetic nervous system in people with BPD may be overly stimulated,
causing intense or irrational reactions. People with BPD tend to display signs of stress longer
than others; some studies have found that those with BPD remain in an emotional state 20
percent longer than other people.

For people with BPD, minor situations which wouldn't impact other people can cause an
extreme physical response. This can create extreme stress and anxiety, even if the stress is
caused by delusions. For instance, if a person with BPD believes her partner is going to leave
her, she may become panicked and distraught, even if her partner has no intention of breaking
up with her. Her heart may race, she may cry, and she may feel a rush of adrenaline and take
a rash action to prevent her partner from leaving.

The cause of this heightened response is unknown. Some healthcare professionals believe
BPD is caused by a mix of biological and environmental factors, including both genetics and
how you were brought up. Abuse, trauma, and abandonment have all been linked to an
increased risk of BPD, but your family's health history also plays an essential role.

https://www.verywellmind.com/borderline-personality-and-problems-in-thinking-425473
Borderline Personality
Disorder and Problems
Related to Thinking
Borderline personality disorder (BPD) is associated with a few different problems related to
thinking. These cognitive problems often contribute to other symptoms,
including relationship problems, emotional instability, and impulsive behavior. Some
treatments for BPD focus on addressing these problems in thinking.

Paranoid Ideation

Many people with BPD experience paranoia as part of their disorder; they have beliefs that
others mean them harm, without basis in reality. Most people with BP who have paranoia
experience transient symptoms that occur under conditions of stress rather than all the time.
Chronic paranoid ideation, the long-standing and unchanging delusional beliefs that others
plan to harm you, may be indicative of a psychotic disorder, such as schizophrenia. This can
be a debilitating symptom, making the person with BPD feel constantly threatened, even by
friends, coworkers, and family.

Dichotomous (Black or White) Thinking

People with BPD also have a tendency to think in extremes, a phenomenon

called “dichotomous” or “black-or-white” thinking. People with BPD often struggle to see
the complexity in people and situations and are unable to recognize that things are often not
either perfect or horrible, but are something in between. This can lead to "splitting," which
refers to an inability to maintain a cohesive set of beliefs about oneself and others.

Because of these extreme patterns of thinking, people with borderline personality are prone to
slip from one side to the opposite side in their thinking. For example, they might one day
believe that their partner is the most wonderful, loving person in the world, and the next think
that they are evil, hateful and full of contempt. This can harm their potential to hold lasting
interpersonal relationships and how they can interact with others.

Dissociation

Another problematic pattern of thinking that occurs in BPD has less to do with the content of
thoughts, what people with BP think about, but rather the process of
perception. Dissociation is a common symptom of BPD that involves feeling “unreal,” numb,
or separate from one’s own body or psychological experiences.

Again, in most people with BPD, dissociative symptoms tend to occur under conditions of
stress. Some experts believe that dissociation is actually a way of coping with very intensely
emotional situations by “shutting down” or separating from the experience. This distance can
cause people to take more risks, as they do not feel connected to the situation at hand.

How BPD Treatments Address Problems in Thinking

Most psychotherapies for BP include strategies for addressing the problems in thinking that
are characteristic of BPD. Some therapies accomplish this indirectly by working on problems
in relationships, as in transference-focused psychotherapy and some try to intervene directly
with thoughts and thinking patterns.

For example, in dialectical behavior therapy (DBT), clients are taught grounding skills, which
can help them end dissociative episodes when they occur.

In schema-focused therapy, clients learn the origins of their ways of thinking (for example,
many people with BPD come from childhood environments that may promote dichotomous
thinking patterns), and work with their therapist and on their own to recognize maladaptive
ways of thinking and to change those patterns.

https://www.verywellmind.com/bpd-and-shame-425474

Relationship Between
Borderline Personality and
Shame
Many people with borderline personality disorder (BPD) experience intense and chronic
shame. Shame, a self-conscious emotion associated with a sense of worthlessness, self-
contempt, or self-loathing may in part explain the high rates of self-harm and suicidal
behavior in people with BPD.

What Is Shame?

We use the word all the time, but what exactly is "shame?" Shame is considered one of
the self-conscious emotions; it is an emotion that relates to our behavior or self, often in
relation to other people's opinions. Other self-conscious emotions include embarrassment and
guilt.

Although the lines between these emotions have been conceptualized in different ways, one
way to think about this is that shame is different than embarrassment or guilt because we
experience these two emotions in relation to our behavior, whereas shame is an emotion that
relates directly to our sense of self. To understand this distinction, let's use the example of
an impulsive act that some people with BPD struggle with shoplifting.

Imagine that, on impulse, you shoplifted something from a store. Even if no one found out
about the shoplifting, you may experience guilt, a feeling that you have done something that
is wrong. If someone did find out about your behavior, you might experience embarrassment,
the feeling you get when other people find out you have done something that violates social
norms.

Shame, on the other hand, is a feeling that you are bad or worthy of contempt. It is not
necessarily about a specific behavior or event but is a feeling of being inadequate as a person.
You may feel shame after shoplifting, but shame carries with it an additional judgment.

BPD and Shame

Many people with BPD experience pervasive and chronic shame, regardless of their behavior.
In fact, research suggests that shame may distinguish BPD from other disorders. In one study,
women with BPD reported more shame-proneness than healthy women or women with social
phobia, an anxiety disorder characterized by a fear of social situations and being evaluated by
others.

Women with BPD and posttraumatic stress disorder (PTSD) do not have greater shame-
proneness than women with BPD alone. This suggests that shame-proneness may be related
to specifically to BPD rather than to co-occurring trauma-related symptoms.

The Relationship Between Shame, Self-Harm, and Suicide

In addition to growing research that shows a connection between BPD and shame, a number
of experts have suggested a connection between shame and deliberate self-harm and suicide
attempts.

Self-reported shame has been shown to be associated with past suicide threats and current and
past suicidal thoughts. Shame may also precede episodes of deliberate self-harm. For
example, one study demonstrated that women with BPD who expressed more shame when
talking about their self-harm behaviors were more likely to self-harm in the future.

Reducing Shame

Despite the intense emotional pain generated by feelings of shame in BPD, very few experts
have attempted to develop treatments that directly reduce shameful feelings. However, some
preliminary studies have shown that the Dialectical Behavior Therapy skill of "Opposite
Action" may help reduce shame about specific events.

Unfortunately, people who feel high levels of shame may also feel motivated to hide their
shame for fear that others may judge them to be unacceptable. But, this secrecy may also get
in the way of recovery. If your therapist doesn't know that you are experiencing shame, it will
be hard for them to intervene.
https://www.verywellmind.com/what-is-mood-lability-425304

Mood Lability and

Borderline Personality
Disorder
People with borderline personality disorder (BPD) are often described as having mood
lability. Mood lability is an emotional response that is irregular or out of proportion to the
situation at hand. It is associated with severe mood swings, intense reactions, and dramatic
changes in opinions and feelings.

Understanding the Scope of Mood Lability

Mood lability is often evidenced by destructive or harmful behaviors. Those actions can
include angry tantrums or screaming, destroying objects, aggression or violence towards
others, and self-harm. The responses can occur seemingly out of nowhere, triggered in
seconds.

Mood lability is present in people with various mental illnesses, including bipolar disorder,
post-traumatic stress disorder, and BPD. Because of how disruptive mood lability can be, it
can inhibit daily life and functioning. This may include harming interpersonal relationships
and careers.

Symptoms of Mood Lability With BPD

Many of the symptoms of BPD involve difficulties in managing or regulating emotions. This
highlights the role of mood lability in BPD. According to the Diagnostic and Statistical
Manual of Mental Illnesses, 5th edition — the reference manual mental health professionals
use — BPD's criteria outlines several difficulties with emotions, including:

 Emotional Lability: Those with BPD experience unstable emotions and frequent mood
swings. Emotions are easily triggered and are typically inappropriate or disproportionate to
the circumstances.
 Anxiety: People with BPD may display symptoms of intense anxiety, even seeing things in a
distorted light. For instance, they may think they're going to fail or mess up even when they
are well prepared. This can lead to serious paranoia and stress.
 Insecurity: Often, those with BPD are insecure in interpersonal relationships. They regularly
assume that other people will leave them or reject them, leading to constant worrying and the
need for reassurance.
 Impulsiveness: In response to some sort of stimulus, people with BPD often respond
erratically and may engage in dangerous behaviors. This can even include self-harm when
confronted with times of stress.
Many people with BPD cycle between emotions rapidly. In the morning, they may be happy,
full of energy, and optimistic. As the day progresses, they can become despondent, depressed,
and express feelings of hopelessness.

Particularly in the case of mood lability in people with BPD, the effects of the outbursts can
last much longer than in other people. That's because those with BPD tend to have heightened
emotional states, to begin with. This longer-lasting effect can make managing mood lability
all the more difficult.

Treatment

The heavy mood swings associated with mood lability and BPD can be extremely disruptive.
It may keep people from being able to manage their daily routines. Routine functions can
become more difficult, requiring intervention.

However, BPD and mood lability can be treated. If you have BPD, it's important to look for a
therapist or healthcare professional who specializes in emotional regulation and personality
disorders. Engaging in psychotherapy will help you learn how to manage your emotions and
urges in a healthy way. From learning new coping skills to better understanding your
emotional triggers, you will be prepared to handle all aspects of your mood lability.

https://www.verywellmind.com/internalizing-425251

Internalizing and Borderline

Personality Disorder
Internalized symptoms include depression and social issues

Internalizing is a symptom of several mental disorders, including borderline personality

disorder (BPD). If you are internalizing, this means you are keeping your feelings or issues
inside and do not share your concerns with others.

If you frequently find yourself internalizing, you may show signs of low self-esteem, self-
harm, and social isolation. Internalizing emotions can make you feel lonely and depressed,
without anyone to relate to. For many, people who internalize for a long time can make the
issues larger, causing you to burst into a tirade or contemplate suicidal actions.

Internalizing and Borderline Personality Disorder

Usually, when we think of someone with BPD, we may picture someone with intense
emotions and reactions. He may be likely to get angry quickly or go into rages and often has
very tumultuous personal relationships. However, many people with BPD do not act this way
and instead internalize feelings. While they still meet the diagnostic criteria for BPD outlined
in the Diagnostic and Statistical Manual of Mental Illnesses, 5th edition, they will handle and
display their symptoms differently than others.

Rather than throwing tantrums or yelling, you may internalize these urges, often hiding how
much pain and sadness you are in. You may feel like you don't connect to the outside world
or do not fit into the larger group. Those who internalize are often viewed as introverted,
withdrawn and more stoic than others with BPD.

You also may spend a lot of time trying to control your feelings or rationalizing your
emotions. You may feel a lack of control which makes these symptoms feel even worse. Like
others with BPD, you may feel confident about yourself one day and feel incompetent the
next. This can worsen because you feel you can not share your insecurities with friends or
loved ones.

Recovering From Internalization

While BPD can be a debilitating mental disorder, it does have a good prognosis if you
undergo treatment. It is possible to control your habit of internalization and manage your
BPD symptoms in a healthier way.

BPD is often treated with psychotherapy. Cognitive behavioral therapy and dialectical
behavioral therapy are two common forms of psychotherapy used to successfully treat
internalizing emotions and BPD.

In therapy, you will learn how to stay in the moment and will begin to challenge your
thoughts of yourself and others. You will learn coping skills to help you manage intense
feelings and urges, improve relationships and prevent impulsive or destructive behaviors.

While you go to therapy, your doctor may also recommend medications to help treat your
symptoms. While no medication has been approved to date to treat BPD, some physicians opt
to prescribe medication to help control anxiety, depression or suicidal thoughts.

If you or someone you know has BPD and is struggling with symptoms and internalizing
emotions, it's important to see a therapist specializing in BPD. By outlining concerns,
common triggers and learning new coping mechanisms, your internalization and other
symptoms of BPD can be better managed. This can help improve your relationships with
others as well as heal your view of yourself.

https://www.verywellmind.com/what-is-disinhibition-425293

Disinhibition (Impulsivity) in
BPD
Disinhibition is saying or doing something on a whim, without thinking in advance of what
could be the unwanted or even dangerous result. There’s also another way to think of
disinhibition: as reduced control over your impulses, or urges, which means being unable to
stop, delay, or change (“inhibit”) an action that is not appropriate for the situation you’re in.

Disinhibition is the opposite of inhibition, which means being in control of the way you
respond to what’s going on around you.

You Know More About Disinhibition Than You May Think

Do the definitions provided above sound familiar, even if you haven’t heard the word
”disinhibition” before?

If you have borderline personality disorder (BPD), chances are you’ve seldom, or possibly
never, been called “disinhibited.” But you’ve likely heard the word “impulsive” many times.
That’s right: Disinhibition and impulsiveness (also called impulsivity) are essentially the
same thing. Disinhibition is common in people with BPD.

Not all states of disinhibition are due to mental health disorders, such as BPD. For example, a
traumatic brain injury can lead to disinhibition.

Of course, everyone has moments when their “uninhibited” behavior does no harm and even
contributes to having a good time, such as energetic dancing at a party. In contrast,
disinhibition, as the word is used by mental health professionals, is always harmful in some
degree to the person behaving impulsively.

What Does Disinhibition Look Like?

Disinhibited or impulsive actions often have unwanted or even harmful outcomes. Why?
Because they range from behavior that’s simply inappropriate, such as suddenly grabbing
food off someone else’s plate, to unnecessarily risky and even dangerous, such as stealing,
setting fires, explosive attacks of rage, or self-injury.

Stages

You can think of disinhibition as occurring in stages even though only a few seconds may
pass between thinking of the impulsive act and doing it:

Stage 1: You feel a sense of increasing tension or arousal, an urge.

Stage 2: You commit the impulsive act. During it, you may feel pleasure, relief, and/or a
sense of fulfillment or satisfaction.

Stage 3: After the act, you may feel guilt or regret. You also may blame yourself for doing
what you did.
Do Addictions Involve Disinhibition?

Yes. Disinhibition is a key feature of many if not all addictions. Examples include addictive
gambling, sex addiction, shopping addiction (especially if you can't afford it), and substance
abuse.

https://www.verywellmind.com/bereavement-definition-of-bereavement-425238

Bereavement and
Borderline Personality
Disorder
Bereavement, also known as grief, is defined as a set of reactions to a significant loss. While
bereavement usually refers to the loss of a loved one, it may also refer to the loss of
employment, a physical ability, possessions, or other events.

Bereavement is a complex process that is considered normal and may be accompanied by a

variety of emotional reactions, behavioral responses, and thoughts. For example, in the course
of bereavement, you may experience sadness, anger, and/or relief. You may also feel the urge
to withdraw from other people or to seek out social support.

Bereavement that's prolonged, overwhelming, or that seriously impairs your daily life is
considered "complicated bereavement," a condition that may require therapy with a
healthcare professional.

Bereavement and Borderline Personality Disorder

While there is very little research in this area, people with borderline personality
disorder (BPD), which is characterized by an intense fear of abandonment, may theoretically
be at greater risk for complicated bereavement due to their intense emotional reactions to
separation from loved ones.

If you have BPD, grief can be much more intense when you lose a friend or loved one than it
is for other people. You may express your grief through impulsive or destructive behaviors,
like drinking or violence. These actions usually only worsen your grief and continue a cycle
of pain and distress.

BPD can also limit your expression of grief. It can cause a sense of anger, guilt, and shame
that's completely unwarranted. Frustration and rage are particularly common. Your anger can
be spurred by feelings of helplessness and loneliness. In the case of the death of a loved one,
you may feel responsible for what happened, even when that's not the case whatsoever.

You may already continually struggle with feelings of abandonment and rejection sensitivity,
which can be heightened with the death of a loved one. This can keep you from handling
bereavement in a healthy way because you feel so alone and isolated.

Or you may be so used to hiding your emotions that you cannot go through the natural
grieving process. By suppressing your feelings and your sense of loss, you extend the
bereavement process and make it much more complicated, inhibiting your ability to function.

Bereavement in Therapy

Unfortunately, loss and grief is part of life and learning to handle bereavement is essential for
your mental and physical well-being. If you have BPD and are struggling with managing
your emotions and grief after a loss, seek out a therapist specializing in personality disorders.

A good therapist can help you through the normal bereavement stages and help you handle
those feelings of anger, helplessness, and frustration. He or she will walk you through the
natural process so you can handle it healthily without resorting to dangerous behaviors
or self-harm. You may also learn some coping techniques to help you manage your intense
emotions, from mindfulness meditation to keeping a journal.

While the bereavement process can be painful and upsetting, it's essential in order for you to
heal and move forward. By seeking treatment, you can begin learning how to handle losses
appropriately.

https://www.verywellmind.com/community-sample-425241

Community Sampling to
Estimate the Occurrence of
Health Problems
Learn why this type of research is important in BPD

Have you ever wondered what community sampling is?

Are you shaking your head? If you're like most people (and especially if you've struggled
through difficult math courses you never had a use for later), just the thought of anything
with a mathematical basis, particularly statistics, turns you off.

So your answer to this question is likely to be, "Of course not!"

But consider this: Math problems you struggled with weren't about you. A community sample
is another matter: You have a reasonable chance of being part of one, especially if you
have borderline personality disorder (BPD)

Community Sampling Is a Different Type of Research

You probably know that medical researchers often seek out people to study who've been
identified as having certain characteristics, which may include specific diseases or disorders.
An example would be a collection of randomly selected persons who are seeking treatment
for a mental health disorder such as BPD. This is called a treatment sample.

This is the type of study typically done to assess the safety and effectiveness of new
pharmaceutical medications. Maybe you or someone you know has taken part in this type of
clinical study, also called a clinical trial.

Community sampling is different. How? In community sampling, the researchers take their
study participants, their "sample," from the community in general. Not surprisingly, this is
called a community sample. Their goal is to learn how many people in the sample have a
certain condition, such as BPD.

 Sometimes, as with other types of research studies, the results of one community sampling
may be used to estimate the number of people in larger populations who have the disease or
disorder.
 When BPD is estimated for larger populations, the result may be that many people who have
BPD without knowing it eventually receive the correct diagnosis and treatment.

It Is Also Researched Differently

Clinical studies like the ones done to test new medications are almost always done at medical
research centers. The participants come to the researchers.

In contrast, the interviewers for community sampling contact one randomly selected person
or household at a time. They go to them. The interviews may be done face to face, by
telephone or postal mail, or on the Internet. The participants are interviewed once, whereas
those taking part in medication-testing clinical trials are most often evaluated over weeks,
months, or even years.

What Else Should I Know?

Researchers choose the type of study they want to do based on many criteria, particularly the
specific ways the study findings may be used. For this reason, if you should find yourself
looking at a study of, say, people with BPD, you should pay attention to whether the
participants were drawn from a treatment or a community sample.
https://www.verywellmind.com/impulsive-behavior-and-bpd-425483

Impulsive Behaviors and

Borderline Personality
Disorder
Acting without foresight is characteristic of the disorder

If you have borderline personality disorder (BPD), you may find yourself struggling to
manage impulsive behaviors. From making hasty decisions to getting into fights, impulsivity
can cause harm to yourself and those around you. In addition to undermining
relationships and your overall sense of well-being, impulsive behaviors can also lead to
financial and legal harm if left unchecked.

Fortunately, there are treatments that can help bring impulsivity under control,
including psychotherapy, mindfulness training. and pharmaceutical drugs.

Understanding Impulsivity

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), impulsive
behaviors are a hallmark of BPD. Impulsivity is broadly defined as actions without foresight
that are poorly conceived, prematurely expressed, unnecessarily risky, and inappropriate to
the situation. Impulsivity is associated with undesirable, rather than desirable, outcomes.

People who are impulsive are commonly described as being rash, hot-headed, unpredictable,
or unstable. It is, in fact, instability that best characterizes BPD as a disorder.

People with BPD typically suffer from feelings of inadequacy that manifest with unstable
emotions, unstable behaviors, and unstable relationships. They are quick to lash out at
anything considered a slight and will often fail to recognize how those emotions are
unreasonable or excessive.

In psychological terms, impulsive behaviors are inherently inappropriate either in terms of

scale or potential risk. A person with BPD is less likely to take into account potential
consequences and will often turn to self-harm behaviors (like binge eating or excessive
drinking) as a means to cope.

However, impulsive behaviors are not, in and of themselves, diagnostic of BPD. It only when
the behavior is pervasive, detrimental, and interferes with a person's ability to function
normally that BPD may be considered.
Impulsivity should not be confused with a compulsion, in which a person recognizes the
behavior is abnormal but cannot stop it. With impulsivity, the person will act out without
inherently recognizing that the behavior is abnormal.
Examples

There are many different types of behavior that can become impulsive with BPD; each
situation is different. There are, however, themes and scenarios that are common among
people with BPD:

 Oversharing of emotions
 Overspending
 Over-apologizing
 Quitting a job suddenly
 Frequent emotional outbursts
 Meaningless or risky sex
 Joining and quitting a lot of groups
 Jumping to conclusions
 Clearing out belongings to "start anew"
 Constantly "turning over a new leaf"
 Abruptly changing or canceling plans
 Inability to receive criticism without affront
 Binge eating or drinking
 Threatening to harm others
 Self-harm
 Self-mutilation
 Destroying property
 Escalating confrontations
 Physical violence

Causes

No one can say for sure what causes BPD and, more specifically, what causes impulsivity in
BPD. There is some evidence that BPD is triggered by post-traumatic stress disorder (PTSD),
particularly if the trauma occurred in childhood.

Studies into behaviors in twins have suggested that genetics may play a larger role in BPD
than imagined. It is believed that a genetic error on chromosome 9 may be linked to features
of BPD, including the partial inheritability of impulsive aggression.

Mutations like these may alter the otherwise normal production of serotoninand dopamine,
the neurotransmitters associated with mood and cognition. In people with BPD, impulsivity
may also be closely tied to dopamine receptors on the brain itself, according to research from
Vanderbilt University.

If these receptors are impaired, particularly on the frontal lobe of the brainwhere logical
decisions are made, a person may have less capacity to "think things through" before acting.

The same faulty receptors may explain why people with BPD often have feelings of
emptiness and self-loathing characteristic of depression. Without the means to effectively
receive and transmit the dopamine signals, a person is less able to achieve self-control or
sustain a sense of emotional well-being.

It is this combination of environmental, genetic, and physiological factors that likely create
the perfect storm for the development of BPD and BPD-associated impulsivity.
Diagnosis

No single test can confirm whether your impulsive behavior is the result of BPD or some
other condition. If BPD is suspected, the doctor would perform a psychological exam to
determine whether your body of symptoms are consistent with BPD as outlined in the DSM-
5.

To this end, a person must meet the two major diagnostic criteria for the disorder:

1. An impairment of personality functioning, either in terms of poor self-image and self-

criticism or an instability of goals, aspirations, values, or career plans
2. An impairment of interpersonal functioning, either in terms of a lack of empathy (due to
negative attitudes and hypersensitivity) or the inability to sustain intimacy (due to mistrust,
neediness, or the fear of abandonment)

Both criteria must be met to be diagnosed with BPD. It is a complicated process requiring
clinical expertise and one that is prone to misdiagnosis. To avoid this, all other possible
causes must be explored and excluded, both psychological and physical.

Borderline Personality Disorder Misdiagnoses

Differential Diagnoses

Impulsive behaviors are not exclusive to BPD. It is also associated with bipolar mania, often
in tandem with grandiosity and a flight of ideas. During an acute manic episode, a person will
often act impulsivity with little thought of the consequence. Spending sprees and hypersexual
behaviors are two common examples of impulsivity related to bipolar disorder (BD).

Attention-deficit hyperactivity disorder (ADHD) can also manifest with impulsiveness.

Known as hyperactive-impulsive ADHD, the behavior is spurred by the child's inability to
keep still or control inappropriate behavior. It is this lack of control, combined with a
constantly shifting focus of interest, that spurs impulsivity.

A similar thing occurs with substance abuse disorders, although the impulsiveness is typically
exhibited under the influence of drugs, when craving drugs, or when actively seeking drugs.

Antisocial personality disorder (ASPD) is closely aligned with BPD but differs in that there is
a pervasive and persistent disregard for morals, social norms, and the rights and feelings of
others.

With borderline personality disorder, a person will have extreme emotions that they find hard
to control. With antisocial personality disorder, there will be a marked lack of emotions.
Physical causes of impulsivity may include an acquired brain injury or a neurodegenerative
disease like Alzheimer's disease or Huntington's disease.

Treatment

While impulsive behaviors can be severe and pervasive, these symptoms can often be
successfully managed with treatment. Many treatments for BPDhave components that
specifically target impulsivity.

Dialectical behavior therapy (DBT) focuses on building skills that reduce your impulsive
behaviors and increase your ability to think and reflect before acting. By using coping
mechanisms to handle intense emotions, a person with BPD is better equipped to face
situations without confrontation.

Mindfulness, a skill taught in DBT, encourages you to stay in the moment. This can help you
to remain more aware of your actions so you take the time to consider consequences.
Practicing this technique can help you to take the time needed to reflect on your options,
empowering you to make more rational decisions about how to respond to events around
you. Mindfulness meditation is a modality often used to support the training.

Medications like a selective serotonin reuptake inhibitor (SSRI) sometimes combined with a
low dose of an antipsychotic may also help. This is especially true if your behavior is extreme
and poses a risk to your safety or those around you.

There are a number of drugs that specifically treat impulsive behaviors. Among the atypical
antipsychotics, Abilify (aripiprazole) is seen to reduce interpersonal problems and
impulsivity. Among the mood stabilizers, Lamictal (lamotrigine) may help reduce impulsivity
and anger, while Topamax (topiramate) may ameliorate impulsivity, anger, and anxiety.

Medications are most effective when used in conjunction with psychotherapy with a therapist
who specializes in BPD.

https://www.verywellmind.com/avoidant-personality-disorder-4172959

Symptoms and Features of

Avoidant Personality
Disorder
Avoidant personality disorder (APD) is an enduring pattern of behavior related to social inhibition,
feelings of inadequacy, and sensitivity to rejection that causes problems in work situations and
relationships. People with the disorder show a pattern of avoidance due to fear of rejection or
disapproval, which they experience as extremely painful. The disorder affects about two percent of
the population, with roughly equal numbers of men and women being afflicted.

Symptoms

The following is a list of common symptoms associated with avoidant personality disorder:

 Social inhibition
 Feelings of inadequacy
 Hypersensitivity to negative evaluation
 Anxiety about saying or doing the wrong thing
 A need to be well-liked
 Avoiding situations due to fear of rejection
 Avoiding intimate relationships or sharing intimate feelings
 Avoiding social situations or events
 Avoiding interaction in work settings or turning down promotions
 Avoiding conflict (being a "people-pleaser")
 Low self-esteem
 Lack of assertiveness
 Extreme self-consciousness
 Viewing oneself as socially inept or inferior
 Lack of trust in others
 Self-isolation
 Failure to initiate social contact
 Anhedonia (lack of pleasure in activities)
 Anxiety in social situations
 Avoiding making decisions
 Vigilant for signs of disapproval or rejection
 Easily hurt by criticism or disapproval
 No close friends/lacking a social network
 Unwilling to take risks or try new things
 Fearful and tense demeanor
 Misinterpreting neutral situations as negative

Causes

The causes of avoidant personality disorder are thought to involve genetic, environmental,
social, and psychological factors. Emotional abuse, criticism, ridicule, or lack of affection or
nurturing by a parent may result in the development of this personality disorder if other
factors are also present. Rejection by peers may similarly be a risk factor.

Often, individuals with the disorder are very shy as children and do not outgrow this shyness
as they age. Social anxiety disorder and avoidant personality disorder share similar symptoms
and genetics, with APD being the more severe form of the condition.

Diagnosis

Avoidant personality disorder can only be diagnosed by a trained mental health professional
based on criteria outlined in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5). While a family physician can be a first point of contact for a diagnosis,
your doctor should make a referral to a psychologist, psychiatrist, or other professional for
diagnosis.

Avoidant personality disorder is typically diagnosed in adults, as children's personalities are

still developing, and behaviors such as shyness can be normal experiences in childhood that
are later outgrown.

According to the DSM-5, at least four of the following criteria must be met in order for a
diagnosis to be made:

 Avoidance of occupational activities involving significant social contact out of fear of

criticism, disapproval, or rejection
 Unwillingness to become involved with others unless you are certain that they will like you
 Holding back in intimate relationships out of fear of being ridiculed or humiliated
 Preoccupation with criticism or rejection in social situations
 Inhibition in new social situations due to feeling inadequate
 Feelings of being socially inept, unappealing, or inferior to others
 Refusing to take risks or do new things out of fear of embarrassment

Treatment

Most people with avoidant personality disorder do not seek treatment. When they do, it is
often for a specific life problem they are experiencing or other types of symptoms such as
depression and anxiety, and they will usually discontinue treatment if that problem is
resolved.

Avoidant personality disorder can be hard to treat like other personality disorders because it
is an enduring pattern of behavior and it can be difficult for the sufferer to recognize that
psychotherapeutic help is needed and can be beneficial.

Unfortunately, the outlook for people with avoidant personality disorder who do not seek
treatment is rather bleak—typically they become self-isolated and use avoidance as their only
coping strategy.

On the other hand, when treatment is successfully applied, it can help to reduce symptoms
and increase the range of coping strategies that a person can use. A person with avoidant
personality disorder will probably always be somewhat shy, but avoidance won't dominate
his or her thoughts.

Talk Therapy

Talk therapy for avoidant personality disorder includes cognitive-behavioral therapy (CBT),
psychodynamic therapy, and schema therapy. Group therapy and social skills training may
also be helpful.

 CBT is helpful for learning how to change unhelpful thinking patterns.

 Psychodynamic therapy is aimed at being aware of how past experiences, pain, and conflict
may be contributing to current symptoms.
 Schema therapy for avoidant personality disorder is an integrative approach that builds on
CBT as well as many other therapeutic techniques. It has a focus on the therapeutic
relationship between therapist and client, and a goal of improving daily functioning and
 gaining insight for change based on understanding and re-engineering of early life
experiences.

In schema therapy, the client learns about four main concepts:

1. How maladaptive schemas are patterns that are repeated throughout life. These patterns are
grouped into five areas: disconnection and rejection, impaired autonomy and performance,
impaired limits, excessive responsibility and standards, over-vigilance and inhibition.
2. What coping styles were learned as a child (e.g., escape, fighting back).
3. What schema modes are being used to cope, and how they are unhelpful (e.g., avoidance,
detachment, compliance, punishment).
4. How to develop healthy adult modes of coping and get core emotional needs met.

A key feature of schema therapy is "limited reparenting," in which the client expresses
childhood needs and learns to develop and internalize a healthy parent voice.

Medication

While there are currently no medications specifically approved for avoidant personality
disorder, if a person has other related disorders such as depression or anxiety, medication
may be prescribed to help with these symptoms. For example, antidepressant medication can
be helpful for improving mood and anhedonia, decreasing anxiety symptoms, and may also
reduce sensitivity to rejection.

Related Conditions

Avoidant personality disorder may co-occur and overlap with a variety of other conditions,
including:

 Social anxiety disorder

 Dependent personality disorder
 Borderline personality disorder
 Substance abuse
 Depression
 Agoraphobia

A Word From Verywell

If you think you, or someone you know or love may be living with avoidant personality
disorder symptoms, it is important to encourage that person to seek help. Without
professional treatment such as talk therapy, it is unlikely that the symptoms and their related
impacts on relationships will improve.

https://www.verywellmind.com/understanding-borderline-anger-425480
The Link Between
Borderline Personality
Disorder and Anger
Intense, inappropriate anger is one of the most troubling symptoms of borderline personality
disorder (BPD). In fact, it's so intense that it's often referred to as “borderline rage.”

Even so, while anger is a key feature of BPD, very little is known about why people with
BPD experience anger differently than other people or how this experience is different.

New research, however, is shedding light on the nature of borderline rage.

Inappropriate Anger in BPD

Borderline anger is more than just a standard emotional reaction. In the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition, anger in BPD is described as
"inappropriate, intense anger or difficulty controlling anger."

The reason anger in BPD is called “inappropriate,” is because the level of anger seems to be
more intense than is warranted by the situation or event that triggered it. For example, a
person with BPD may react to an event that may seem small or unimportant to someone else,
such as a misunderstanding, with very strong feelings of anger and unhealthy expressions of
anger, such as yelling, being sarcastic, or becoming physically violent.

Research on Anger in BPD

While borderline anger has long been a topic of debate and speculation among BPD
specialists, it has only recently become a focus of careful research. Experts are now
examining how borderline anger is different than normal anger and why it occurs.

More specifically, researchers are trying to understand whether it's that people with BPD are
more easily angered, have more intense anger responses, or have more prolonged anger
responses than people without BPD (or whether it's some combination of these factors).

One study examined anger in people with BPD compared to people without BPD, in response
to an anger-producing story. This study found that people with BPD reported the same level
of anger as the healthy controls (in response to the story). But, the healthy controls reported
that their anger decreased more quickly over time than the people with BPD reported.

So it may not be that people with BPD have a stronger anger reaction, but that their anger has
a much longer duration than other people experience.
Furthermore, other research shows that anger in BPD may trigger rumination (when someone
thinks over and over about his or her angry experience). This repetitive thinking creates a
vicious emotional cycle that worsens the person's anger and increases its duration (as
supported by the study mentioned above). Eventually, the prolonged and intense anger
triggers aggressive behavior, which a person engages in to relieve their rage.

Research in this area is very preliminary, and much more work is needed to fully understand
how and why people with BPD experience borderline anger.

Treatment of BPD

There are a number of therapies that can be used to treat borderline personality disorder,
including the often debilitating symptom of anger.

Psychotherapy: Most psychotherapies for BPD target the strong anger responses that people
with BPD report and exhibit. For example, in dialectical behavior therapy (DBT), patients are
taught skills to help them better manage their anger and decrease angry outbursts.

Other types of psychotherapy for BPD, including schema-focused therapy, transference-

focused therapy, and mentalization-based therapy, target anger as well.

Medications: While there are no medications for BPD that are currently FDA approved to
treat the disorder, there are some that have been shown to reduce anger in BPD.

However, these BPD medications are probably most effective when used in conjunction with
psychotherapy. This is because while medications can alter the intensity of anger, they cannot
fully prevent or erase a person's anger when a life stressor or difficult situation arises.

A Word From Verywell

If you or a loved one has difficulties with borderline anger, please seek out care from
a therapist or other mental health professional. You (or your loved one) can gain control over
this distressing symptom and feel better.

On a final note, it's important to remember that anger itself is a normal emotion, so
experiencing angry reactions does not mean you have BPD. Remember, a person with
borderline personality disorder experiences frequent, extreme, and inappropriate anger
outbursts that often lead to destructive behaviors like physical fights.

Still, if you have difficulties with anger control, reaching out to a mental health professional
is a good idea.

https://www.verywellmind.com/genetic-causes-of-borderline-personality-disorder-425157
Genetic Causes of
Borderline Personality
Disorder
Are you wondering about the genetic causes of borderline personality disorder? You're not
alone. Many people wonder why they or a loved one has borderline personality
disorder (BPD). Unfortunately, there are no easy answers, but research is getting closer to
understanding the causes of BPD.

Genetics or Environment?

Studies of BPD in families show that first-degree relatives — meaning siblings, children, or
parents — of people treated for BPD are ten times more likely to have been treated for BPD
themselves than the relatives of people with schizophrenia or bipolar disorder.

However, while this suggests that BPD runs in families, studies of this type do not tell us
exactly how much of BPD is due to genetics. That's because first-degree relatives share not
just genes, but also environments in most situations. For example, siblings may be raised
together by the same parents. This means that these studies may reflect, in part, any
environmental causes of BPD as well.

Twin Studies Show Genetics Play a Large Role in BPD

A more direct, though still imperfect, way to study the influence of genes on BPD is to
examine rates of BPD among identical versus fraternal twins. Identical twins have the exact
same genetic makeup whereas fraternal twins only have similar genetic makeup, just like two
regular siblings.

There have been a few twin studies of BPD, which have shown that 42 to 69 percent of the
variance in BPD is caused by genetics. This means that 58 to 31 percent of the variance in
BPD is caused by other factors, such as the environment.

This suggests that BPD is fairly strongly related to genetic causes. Yet, most likely an
interaction of genes and environment leads to BPD in most people with the disorder.

What the Genetic Factor Means

What does this mean for you? If you have BPD, it means that it is not your fault. You
probably have a genetic predisposition to develop the disorder. Perhaps you have also
experienced a few of the environmental events that seem to be linked to BPD in some cases,
such as being abused as a child or losing a loved one.
You do not have BPD because you are “weak” or “can’t handle things.” There is a reason
why you experience the symptoms you do.

If you have a first-degree relative with BPD, it means that you may have an increased chance
of developing the disorder yourself. However, this by no means guarantees that you will
develop BPD. In fact, chances are likely that you will not.

Treatment Is Essential

If you're concerned that you're showing signs of BPD, it's important to get treatment early.
This will reduce any risk factors and help alleviate your symptoms.

If you are a parent and you have BPD, you may be concerned about whether your kids will
have BPD too. While it is a possibility, know that even though genes are important, they are
not the sole cause of BPD.

There may be ways to ensure the environment you provide for your kids reduces their risk.
Part of that is ensuring that you get treatment and that you stick with the treatment plan you
and your doctor decide on. Psychotherapy may also be an option to help you learn effective
parenting skills.

https://www.verywellmind.com/invalidating-environment-contributor-to-bpd-425186

An Invalidating
Environment May Be a
Cause of BPD
Growing up in an environment perceived as invalidating is one factor commonly discussed as
contributing to the development of borderline personality disorder (BPD). Coupled with
a genetic tendency to be over-emotional, an invalidating environment is theorized to be one
of the two major causes of BPD.

What an Invalidating Environment Looks Like

In this sense, to invalidate means to attack or question the foundation or reality of a person’s
feelings. This can be done through denying, ridiculing, ignoring, or judging another’s
feelings. Regardless of the means, the effect is clear: the person's feelings are “wrong.”
An environment perceived as invalidating generally means that the child grows up feeling
that his emotional responses are not correct or considered in the regular course of things.
Over time, this can result in confusion and a general distrust of a person’s own emotions.

Invalidation Can Be Subtle

An invalidating environment is not the same thing as an abusive environment, although

abusive relationships are certainly invalidating. Invalidation can be quite subtle and may
reflect a general way of interacting. It is generally characterized by intolerance of the
expression of emotional experiences, which often leads to extreme displays of emotion.

Marsha M. Linehan, borderline personality disorder clinician and researcher, proposed the
idea that the development of BPD happens during the developmental years, where the child
receives the message that he or she should learn to cope with emotions internally and without
support from his or her parents. As a result, the child never learns how to regulate or tolerate
her own emotions, and fails to learn how to solve the problems that are inciting these
emotions.

Some Forms of Praise May Also Be Invalidating

Validation is not the same thing as praise; it is more an acknowledgment of the person,
whereas praise is just a compliment. To validate someone is to acknowledge the feelings
involved, regardless of whether you agree with how the other person is feeling or not.

Praise addresses the action or behavior without addressing the emotion behind it. Praise can
also be invalidated, because although a child’s behavior is acknowledged and reinforced, the
effort or negative feeling they have is not addressed. This can cause the child to feel that his
total experience is not accepted, or even dismissed.

Example of Invalidation Disguised as Praise

A few examples can help explain much better how validation differs from praise and how
invalidation can actually be disguised as praise.

A young child goes into the classroom by herself on the first day of school, although she is
scared. Praising her would be a simple, “Good job!” On the other hand, “You were so brave
to go in even though you were scared. It couldn't have been easy. What a good job you did,”
validates the troubling feelings, remarks on the effort overcoming those feelings took, and
praises the effort.

However, it is possible to praise while being invalidating at the same time: “Good job. Now
don’t you see how silly you were being?” This response invalidates the feelings the child was
having by calling them “silly,” despite the praising of the behavior.

"Hidden" Invalidation

Those who grow up with invalidating comments, especially those that are disguised as praise
and support, can find it difficult to see the difference between these comments and validating
comments. Not only does the child feel the discomfort that comes from invalidation disguised
as praise, but those not directly involved in the dynamics may not recognize this either. Other
adults, instead of recognizing the impact these invalidating comments disguised as praise
may have on a child, might dismiss the resultant insecurity or sadness of the child as "over-
sensitivity" on the part of the child rather than lack of thoughtfulness on the part of the
parent.

Perception is Also a Factor

It is important to remember that people tend to experience relationships and interactions

differently. This means that what one person experiences as an invalidating environment is
not necessarily experienced as such by another. It is possible that individual
temperaments affect a person’s general sensitivity to invalidation, but everyone has times
when they are more vulnerable or sensitive.

It is important to note, however, that invalidation—as it relates to the development of

borderline personality disorder—is not a periodic experience, but a pervasive one. It is not
one invalidating experience that leads to BPD but rather a complex an repeated exposure to
situations in which feelings and thoughts are simply considered unimportant.

https://www.verywellmind.com/borderline-personality-disorder-bpd-causes-425154

Causes of Borderline
Personality Disorder
If you or a loved one has borderline personality disorder (BPD), you may be wondering what
caused it or if you are to blame. The development of this disorder is complex, and there are
likely a variety of borderline personality disorder causes—and you should rest assured that no
one person or thing is at fault. Most experts believe that BPD develops as a result of
biological, genetic, and environmental factors. However, it is important to keep in mind that
the exact causes of BPD are not known yet. Right now, these are theories that have some
support in support but are by no means conclusive. More research is needed to determine how
and why the factors discussed below are related to BPD.

Potential Environmental Borderline Personality Disorder Causes

There is strong evidence to support a link between distressing childhood experiences,

particularly involving caregivers, and BPD. The types of experiences that may be associated
with BPD include:

 Physical and sexual abuse

 Early separation from caregivers
 Emotional or physical neglect
 Parental insensitivity
It is thought that an interaction between biological factors (discussed below) and an
invalidating childhood environment may work together in predisposing a person to develop
BPD. An emotionally invalidating environment is one in which a child's emotional needs are
not met.

An invalidating environment is not always obvious to those who have experienced it or to

others around them. These painful experiences can be hidden and even disguised as praise.

It is important to remember, however, that not everyone who has BPD has had these types of
childhood experiences (although a large number have). Further, even if a person does have
these types of experiences, it does not mean that they will have BPD. Again, it is likely that a
combination of factors, rather than a single cause, is responsible for most cases of borderline
personality disorder.

Potential Genetic and Biological Borderline Personality Disorder Causes

While early studies showed that BPD does tend to run in families, for some time it was not
known whether this was because of environmental influences or because of genetics. There is
now some evidence that in addition to the environment, genetic factors play a significant role.

In particular, studies have shown that a variation in a gene which controls the way the brain
uses serotonin (a natural chemical in the brain) may be related to BPD. It appears that
individuals who have this specific variation of the serotonin gene may be more likely to
develop BPD if they also experience difficult childhood events (for example, separation from
supportive caregivers). One study found that monkeys with the serotonin gene variation
developed symptoms that looked similar to BPD, but only when they were taken from their
mothers and raised in less nurturing environments. Monkeys with the gene variation who
were raised by nurturing mothers were much less likely to develop BPD-like symptoms.

In addition, a number of studies have shown that people with BPD have differences in both
the structure of their brain and in brain function. BPD has been associated with excessive
activity in parts of the brain that control the experience and expression of emotion. For
example, people with BPD have more activation of the limbic system, an area of the brain
that controls fear, anger, and aggression, than people without BPD. This may be related to the
emotional instability symptoms of BPD. Newer studies are also findings associated with the
hormone oxytocin and the development of BPD.

Bottom Line on the Causes of Borderline Personality Disorder

As noted above, there is much to be learned about the causes of BPD and it's likely that it is a
combination of factors rather than any one specific finding which can lead to the disorder.
Research is in progress and hopefully we will learn more in the coming years.

Understanding the causes may help prevent the onset of the disorder, especially in those who
have a genetic or biological predisposition to the disorder. As it is, an invalidating
environment is harmful to a child whether or not it raises the likelihood of BPD in the future,
and it is important for therapists to be alert for this setting in children. Since an invalidating
environment can be hidden, with many comments appearing to be comments of praise on the
surface, emotions can easily be mistaken as an oversensitivity on the part of the child rather
than a lack of sensitivity on the part of the parent. It's important for adults who experienced
emotional invalidation as a child to learn to recognize the difference between validating and
invalidating remarks from others to protect themselves from further hurt.

https://www.verywellmind.com/self-conscious-emotions-425266

How Self-Conscious
Emotions Affect BPD
If you have borderline personality disorder (BPD), self-conscious emotions can play a major
role. Due to the disorder, feelings are intensified and can cause harmful reactions. Find out
more about self-conscious emotions and how they impact your mental health.

What Are Self-Conscious Emotions?

While some emotions are considered "basic emotions," meaning that they require little or no
sense of self to experience or recognize, self-conscious emotions are related to our self-
concept and an understanding of our relationship to other people and the larger community.

For example, to experience the basic emotion "fear," you only need to perceive something as
threatening. But to experience a self-conscious emotion, such as guilt, you must have both a
sense of self and an understanding of your behavior, such as recognizing when you did
something wrong.

The self-conscious emotions include both positive emotions like pride or confidence as well
as negative emotions like shame or jealousy.

Purpose

Scientists believe that self-conscious emotions have an evolutionary basis. They help you
survive by promoting social inclusion, such as helping you stay in the good graces of others.
For example, when you express embarrassment after violating some social norm, the
expression of that emotion helps you to repair relationships. For instance, if you have hurt a
friend and apologize to her, your face may turn red and you may not be able to meet her eyes.
Your friend will know how badly you feel and may be less angry with you.

These feelings also probably help prevent you from violating social norms in the future. If
you know you will feel guilty if you steal from someone, you are more likely to avoid that
behavior altogether.
Borderline Personality Disorder and Self-Conscious Emotions

Research has shown that people with BPD are more likely to have unpleasant or negative
self-conscious emotions. The cause of this is two-fold. Because BPD can cause you to
experience more intense emotions and feelings of shame or guilt, this can cause inappropriate
or destructive behaviors, such as sexual interactions or violence. These experiences also
shape how people with BPD interpret behaviors. For instance, someone who has had an
inappropriate sexual relationship will feel shame or guilt and may perceive a person's actions
as predatory. This can cause them to react to that person aggressively, even if the other
person is innocent. The link between BPD and self-conscious emotions can start a cycle of
destruction, leading a person to self-harm or suicidal thoughts.

If you feel you struggle with self-conscious emotions and you have borderline personality
disorder, it's important to talk about this with your therapist or health care provider. They can
help you handle self-conscious emotions in a healthy way that doesn't harm yourself or
others. By learning coping strategies, such as taking a break from the situation, you can
process the emotions fully and establish whether or not your reaction is equal to what has
actually happened. Your therapist will help you improve these skills so you can manage your
illness and better maintain your relationships.

https://www.verywellmind.com/why-do-bpd-symptoms-decline-with-age-425211

Do BPD Symptoms Decline

With Age?
If someone you know has borderline personality disorder (BPD), you may have noticed that
as that person grows older (into his or her late 30s and 40s), their symptoms seem to decline
in frequency and severity.

In fact, this a common phenomenon among those with BPD and has become a major subject
of research among healthcare professionals and psychiatrists.

While researchers are not exactly sure why BPD symptoms decline with age, some experts
have suggested some potential reasons, including burn out, learning, and avoidance of
relationships. These can be linked to both biological and environmental factors.

Burn Out in BPD

Some experts have speculated that BPD symptoms decline because the symptoms naturally
“burn out” or that people simply grow out of the symptoms as they mature. In particular,
research has shown that the impulsivity symptoms of BPD are the most likely to decline over
time. This is consistent with the observation that, in general, older people engage in
less impulsive behavior, even if they do not have BPD.

It may be that as we age and mature, the urge to engage in impulsive behaviors slowly goes
away, allowing us to make more measured and rational decisions. Just as partying all night
loses it's appeal for many in their forties and fifties, impulsive or reckless BPD behaviors
may also seem less natural.

Learning in BPD

Other experts think that BPD symptoms may decline because as you age, you learn how to
better manage your symptoms. For some people, this learning may come as the result of
intensive treatment, but for others, this may be the result of the natural learning that comes
from negotiating life’s challenges.

Through experience and trying different treatment options and coping skills, you may be able
to decrease the severity of symptoms or handle them before they start. This is similar to
learning any skill—with practice over time, it becomes easier to accomplish.

Avoidance of Intimate Relationships in BPD

Finally, experts have speculated that BPD symptoms decline because, over time, a person
with BPD may learn to avoid situations that trigger symptoms. For example, for many people
with BPD, problems in interpersonal relationships trigger the most intense reactions and
symptoms. As a result, people with BPD may start to avoid interpersonal relationships
altogether in order to reduce their distress. This has been referred to as being "comfortably
alone."

While some people have reported success with this approach, it is hardly considered a solid
treatment option. Avoidance and living a solitary life are not considered healthy approaches
to BPD but does play a role in decreasing symptom frequency.

Another Perspective on This Link

It is important to note that some experts dispute whether it is a person's age or simply the
duration of time he or she has had BPD that is linked to the decline in their symptoms. In
other words, is it the age of the person that predicts their symptoms, or how long they have
had BPD?

Also, it is important to understand that while BPD is often thought of as a younger adulthood
disorder, there are a group of people who meet the criteria at an older age (40 to 60 years of
age), as suggested by a study in the Journal of Psychiatric Research.

In this study, older people with BPD were more likely to exhibit feelings of chronic
emptiness and have higher degrees of social impairment. They were less likely to
have impulsivity, engage in self-harm, or have rapid shifts in mood.
A Word From Verywell

While there appears to be a link between age and decreased symptoms in BPD, research has
yet to identify the exact cause. Whether it is a result of natural maturation or a change in
brain chemistry over time, scientists continue to look for the association as it may have
a significant impact on diagnosing and treating people with BPD in the future.

If there is, in fact, a change in brain chemistry, it could mean that potential medications could
mimic this effect and help lessen symptoms.

https://www.verywellmind.com/link-between-borderline-personality-and-lying-q-a-425190

Why People With

Borderline Personality
Disorder Lie
Lying can destroy relationships, whether between a child and parent or between a wife and a
husband. It can ruin trust and intimacy and foster resentment. Many times, the people who
feel deceived will cut ties completely with the person they believe lied.

Borderline Personality Disorder and Lying

Unfortunately, borderline personality disorder (BPD) is not a well-known or well-understood

disease. Even so, many people believe lying is part of the disorder. However, you may be
surprised to learn that the link between BPD and deceit is not so clearly defined.

In fact, if you review the symptoms of borderline personality disorder (BPD), lying is
nowhere to be found. In the Diagnostic and Statistical Manual of Mental Illnesses-5th
edition, which is the standard source healthcare providers use to make appropriate diagnoses,
deceit is not part of BPD's diagnostic criteria.

However, that doesn't necessarily mean that those with BPD do not lie or that they aren't
more likely to lie. In fact, many family members and friends of those with BPD cite lying as a
major concern in their relationship with their BPD loved one.

Why Lying Occurs in BPD

There are a few potential reasons as to why lying may occur in people with BPD.
Intense Emotions

People with BPD feel incredibly intense emotions. These feelings can be so intense that they
cloud the individual's thinking, making them view things through an emotional lens that may
be different from how other people see it.

They look for details that confirm what they feel and ignore facts that will contradict them,
and this can be incredibly frustrating for friends and family members. It's important to
understand that the person with BPD isn't consciously lying—he truly believes his viewpoint
is correct even when it's blatantly false.

Impulsivity

BPD is also associated with impulsivity, the tendency to do things without thinking about the
consequences—so some instances of lying may be the result of a person with BPD just not
thinking before giving a response.

Shame

In addition, people with BPD often experience deep and entrenched shame, so lying may be
one way to conceal mistakes or weaknesses that increase shameful feelings. People with BPD
are often also very sensitive to rejection, so one function of lying could be to “cover up”
mistakes so that others will not reject them.

Biology of Lying

Based on a sophisticated imaging technique called functional magnetic resonance imaging

(fMRI), researchers have found that deception is linked to activation of the prefrontal cortex,
which lies at the very front of the brain. The prefrontal cortex plays an important part in
determining a person's personality, planning cognitive tasks, and regulating social and
emotional behavior.

Interestingly, this activation of the prefrontal cortex has been found to occur whether the
deception is related to emotional or neutral deception (for example, lying about something to
avoid a negative reaction or out of fear versus lying about what you ate for breakfast).
However, the basis of the lying, like whether the lying is meant to help or harm the person
doing the lying, may affect whether other regions of the brain are affected.

Lying and the Impact on Relationships

No matter why a person with BPD lies, whether it's because he truly thinks his skewed
worldview is correct or if he's feeling ashamed, the impact on relationships can be extremely
detrimental. Friends and family members may no longer trust the person, isolating them away
from their loved one.

Finally, lying can destroy relationships completely. Even loving and devoted family members
may feel they have to separate from their loved one if lying has become common. This can
eliminate an essential support system and harm both people.
A Word From Verywell

In the end, it can be difficult to maintain a relationship with a friend or family member with
BPD. However, it's important to understand that people with BPD often engage in destructive
behaviors not because they intend to hurt you but because their suffering is so intense they
feel they have no other way to survive.

Lying may be one example of this. While that doesn't excuse the behavior, if you understand
the cause, you can help your loved one get appropriate therapy to help manage their
symptoms of BPD.

https://www.verywellmind.com/emotion-regulation-425298

Borderline Personality
Disorder and Emotion
Regulation
Many people with borderline personality disorder (BPD) experience intense emotions. In
the Diagnostic and Statistical Manual of Mental Illnesses, 5th edition (DSM-5), the reference
manual healthcare providers use to make a diagnosis, many of the symptoms of BPD relate to
emotion regulation issues.

What Is Emotion Regulation?

Emotion regulation is a fairly complex combination of ways in which a person relates to and
acts on his or her emotional experiences. This includes:

 Your ability to understand and accept his or her emotional experiences

 Your ability to engage in healthy strategies to manage uncomfortable emotions when
necessary
 Your ability to engage in appropriate behaviors when distressed

People with good emotion regulation skills are able to control the urges to engage
in impulsive behaviors, such as self-harm, reckless behavior or physical aggression, during
times of emotional stress.

Example of Emotion Regulation vs. Dysregulation

For example, if someone who does not have BPD goes through a breakup, she likely feels sad
and may be a bit depressed, but is still able to control her emotions and carry on with her
routine. She'll still attend class or go to work. However, someone with BPD lacks the ability
to regulate emotions appropriately. If he goes through the same situation, he may become
depressed to the point of not functioning, such as engaging in destructive or violent behaviors
or impulsive activities like promiscuity.

BPD and Emotions

In the criteria for diagnosing BPD, the majority include issues with emotions. Some of these
include:

 Quickly changing mood swings and irritability: People with borderline personality disorder
have issues managing moods and expressing emotions, leading to intense anxiety and
irritability. Mood swings can be intense as well as rapid. The anxiety and irritability may
interfere with normal activities such as working on a job or even caring for yourself. Others
may have trouble being around you during these episodes for a number of reasons,
thus harming your relationships.
 Feelings of emptiness: Those with BPD often experience chronic feelings of emptiness. They
will engage in all sorts of activities to try and fill the void, without any effect. Regardless of
how many friends and loved ones they have, they often feel alone and sad. BPD can, in
essence, begin a vicious cycle. Problems regulating emotions can lead to loss of
friends. Loneliness, in turn, can worsen the ability to regulate emotions, and the feeling of
isolation can interfere with your motivation to learn to regulate your emotions.

 Difficulty controlling anger: Along with intense mood swings comes intense anger,
seemingly out of nowhere. Slight inconveniences or slights can trigger rages in those with
BPD, potentially leading to destructive or violent behaviors.
 Paranoia and a fear of abandonment: Individuals with BPD often are afraid of being alone
or rejected, causing intense paranoia. That can cause them to act obsessive and constantly
seek reassurance. Unfortunately, many of the behaviors which result from a need for
reassurance can lead people to push someone with BPD further away. (Learn more
about paranoid ideation in BPD.)

With difficulty regulating emotions, if you have BPD, you may experience difficulty coming
down from anger or relaxing feelings of rejection. You may lack the ability to regulate your
emotions appropriately, causing disruptive behaviors. This can have a negative impact on
your relationships, including with your significant other, friends and family.

Managing Emotions

While BPD can make emotion regulation difficult, it is not impossible to learn this skill and
recover from BPD.

If you struggle with BPD and emotions, you may want to consider seeing a therapist
specializing in borderline personality disorder who will have a better understanding of the
origins which lead to your emotional struggles. Together, you can work on strategies to help
regulate your emotions.

Types of psychotherapy which have been found particularly helpful for people with BPD
include cognitive behavioral therapy and dialectical behavior therapy.
There is a lot to be gained from therapy. You will learn appropriate reactions and skills to
manage your mood swings. Over time, your emotion regulation will improve, helping you in
your interpersonal relationships and daily life.

In addition to therapy, there are several self-help strategies for BPD which can further
improve your ability to manage your emotions.

Bottom Line

As noted above, emotion regulation plays a large role in many of the symptoms of BPD, but
this does not mean that you will need to live with these symptoms forever. Newer studies are
finding that, for those who are motivated, therapy can make a large difference which can, in
turn, affect nearly every area of your life in a positive way. With continued therapy with a
medical professional, recovery from BPD is possible.

https://www.verywellmind.com/self-mutilation-425484

Self-Mutilation and
Borderline Personality
Disorder
Warning: The content of this article may be very triggering if you engage in self-mutilation;
please consider this carefully before reading on.

Self-mutilation is very difficult to understand if you have never experienced the urge to
engage in this behavior yourself. If you have a friend or family member with borderline
personality disorder (BPD) who self-mutilates, it can scary, confusing and frustrating. By
understanding why self-mutilation occurs, you can help your loved one cope with these urges
and act as a support network for her.

What Is Self-Mutilation?

Self-mutilation involves the direct and deliberate destruction or alteration of the body.
Examples of these behaviors include cutting, burning, sticking oneself with needles and
severe scratching.
Self-mutilation is usually very different than other self-harming behaviors. Research has
shown that individuals who engage in self-harm are usually not trying to kill themselves
when they engage in the behavior, although some may report that they have mixed feelings
about the intent of the act. This is not to say that people who engage in self-mutilation are not
suicidal; many people who self-mutilate also have suicidal thoughts or even make suicide
attempts. In addition, in cases of very severe self-mutilation, people have died from their
injuries.

Why People Engage in Self-Mutilation

Many believe that people engage in self-mutilation to get attention. This is a myth. Most
people who self-harm do it in private and make sure that the marks or scars are hidden. They
often will wear long sleeves to cover these signs. They are often ashamed of the behavior and
keep it a secret. Particularly for those with BPD who have rejection sensitivity, they worry
continuously about people finding out about their secrets.

Research has shown that most people self-mutilate in order to help regulate internal
experiences such as intense emotions, thoughts, memories, and physical sensations.

Who Engages in Self-Mutilation?

Unfortunately, self-mutilation is a common behavior, particularly among those with BPD.

One study found that about 40% of college students have engaged in self-mutilation at least
once and about 10% have engaged in self-mutilation 10 or more times. Evidence suggests
that men and women engage in self-mutilation at equal rates.

People who have experienced maltreatment during their childhood, such as through sexual
abuse or neglect, or who were separated from a caregiver in childhood, are at greater risk for
self-mutilation than the general population.

Treatment

Because self-mutilation is often an attempt to manage intense feelings, cognitive

behavioral treatments for self-mutilation focus on helping the person find new, healthier ways
of managing emotions and thoughts. For example, one cognitive-behavioral treatment for
borderline personality disorder, dialectical behavior therapy, addresses unhealthy attempts at
coping by helping the patient learn and practice a new set of coping skills.
In some cases, a doctor may prescribe medications to help regulate emotions and feelings and
decrease the urge to self-harm.

What to Do If a Friend or Loved One Self Mutilates

If you are going to talk to your friend or loved one about self-mutilation, it's important to do
it in a non-judgmental fashion. Approaching them calmly and with care can make the person
feel heard and understood.

Before talking with a loved one, it may be a good idea to consult with a therapist who
specializes in treating BPD and self-mutilation. He can give you professional advice on the
best way to approach the situation without frightening or upsetting your loved one.

Getting Treatment for Self-Mutilation

If you or someone you know is struggling with self-mutilation, there are a variety of
treatment resources available including finding a therapist to talk to.

https://www.verywellmind.com/myths-borderline-personality-disorder-425499

6 Common Myths About

Borderline Personality
Disorder
Borderline personality disorder (BPD) is a mental illness that is commonly misunderstood by
the general population and even some healthcare professionals. In addition, it is a disorder
that has the potential to negatively impact the lives of others. Because of these two issues,
there are many myths about BPD that exist. If you or someone you know has BPD, it's
important to understand the truth about the illness in order to begin recovery. Below are some
of the most common myths about BPD.

Myth 1: Borderline Personality Disorder Is Not Treatable

This is completely false; BPD is treatable. If you think you have BPD, don't let this myth
scare you away from therapy or make you feel helpless. Having a diagnosis does not mean
that you will forever experience the symptoms of BPD. Hard work and effective treatment
can greatly reduce the severity of BPD symptoms and may help you live a normal life.

Even without treatment, the symptoms of the disorder will ebb and flow over time;
some people with BPD are able to function at a higher level than others, so recovery is
different for each person.

Myth 2: All People With BPD Are Victims of Childhood Abuse

Too often, well-meaning people who do not understand BPD believe it is caused by abuse
experienced while the affected person was a child. This can change the way people interact
with you or talk to you if you have BPD, which can be frustrating if you did not experience
abuse. It can feel like your own experience isn't understood or is different. While some
people who have BPD were abused, it is not true of all BPD patients and should be viewed
with a more open mind.

There is no known cause of BPD at this time. However, the cause is generally seen as a
combination of biological and environmental factors, rather than linked to any one cause.

Myth 3: Children and Adolescents Cannot Be Diagnosed With BPD

Children and adolescents can be diagnosed with borderline personality disorder. However,
due to the generally accepted belief that personality is still forming throughout adolescence,
diagnosing kids or teens with BPD has been controversial.

The Diagnostic Statistical Manual, Fifth Edition (DSM-V) lays out clear standards for a
diagnosis for BPD. Caution must be used when giving any diagnosis, and this can be
especially true for BPD as the symptoms can often mimic typical adolescent behavior. A
professional therapist with experience with BPD can help distinguish the difference. Early
diagnosis can be helpful in ensuring that an individual gets the intervention needed to begin
recovery.

Myth 4: BPD Is a Variation of Bipolar Disorder

BPD and bipolar disorder are completely different disorders. Although the symptoms of
bipolar and BPD may appear somewhat similar, they are two very distinct illnesses.

Because even healthcare providers lack knowledge about BPD, people with BPD are often
misdiagnosed with bipolar disorder, adding to the confusion. It is also important to note that
medications used to treat bipolar disorder often do not work on BPD patients, so a therapist
with a background in BPD is essential to get an appropriate diagnosis and treatment plan.

Myth 5: BPD Is Only Found in Women

BPD is found in both genders, although it is true that women are more commonly diagnosed
with BPD than men.
This does not necessarily mean that women are more likely to develop BPD; it could mean
that the symptoms men discuss are more incorrectly associated with other disorders, such as
post-traumatic stress disorder or depression. The hallmarks of BPD are instability and poor
impulse control, which can impact both genders equally.

Myth 6: If You Know One Person With BPD, You Know Them All

Every person is unique, and having BPD doesn't change that.

According to the DSM-V, the standard for mental healthcare, certain criteria must be met for
BPD to be diagnosed. The criterium includes impairment in personality functioning and
in interpersonal relationships. The way these impairments show themselves is different in
every individual.

In addition, not all individuals experience specific symptoms in the same way. One person's
difficulty with relationships may be different than yours. Each person experiences BPD in
very different ways.

https://www.verywellmind.com/dichotomous-thinking-425292

Dichotomous Thinking and

Borderline Personality
Disorder
Dichotomous thinking, also known as "black or white thinking," is a symptom of many
psychiatric conditions and personality disorders, including borderline personality
disorder (BPD). Dichotomous thinking contributes to interpersonal problems and to
emotional and behavioral instability.

Characteristics of Dichotomous Thinking

Many people experience dichotomous thinking sometimes, but it can be a problem when
extreme conclusions about yourself, other people, or circumstances, interfere with your
emotional stability, relationships, and decisions. If most of your thoughts break down to black
or white, good or bad, and all or nothing, then it is possible that you have a strong tendency
towards dichotomous thinking.

This extreme thinking can cause serious overreactions or emotional responses and may result
in significant consequences if you tend to behave impulsively in response to your extreme
feelings. Whether it's breaking off a relationship or poor work performance, dichotomous
thinking can affect your quality of life.

Dichotomous Thinking and Borderline Personality Disorder

BPD is a condition that is challenging to live with. BPD is often difficult to diagnose because
people who have it may experience extreme mood swings and erratic behavior, but generally
cannot see themselves as having a problem, and instead view others as the problem. People
with BPD are more likely to display dichotomous thinking than people who do not have
BPD.

Examples of Dichotomous Thinking

Dichotomous thinking can cause conflicts and agitation, disrupting your own inner sense of
peace and disrupting peace between yourself and others. If you have BPD, you may
experience dichotomous thinking without even realizing it.

For example, you might frequently flip-flop between seeing yourself as a remarkable success
or a major failure based on the praise or criticism of others.

A person with dichotomous thinking may meet a new coworker at work. In the beginning, the
coworker is viewed as amazing, perfect, and better than any other coworker or friend ever
encountered before. People with dichotomous thinking tend to have favorites and to believe
that everything about a favorite person or thing is superior to others. However, as time goes
on, someone with dichotomous thinking may suddenly swing to the opposite extreme. If
ignored by the coworker, or if the coworker behaves in a disappointing way, a person with
dichotomous thinking may lose respect for or hate this formerly favorite coworker, unable to
sustain relationships that are not distinctly "love" or "hate". This can lead to being easily
manipulated by those who are viewed as "good" or to abrupt breakups in friendships and
romantic relationships.

In some instances, dichotomous thinking can result in financial problems. Impulsive

purchases and a lack of balanced judgment at work and in one's personal life can have serious
consequences.

Treatment of Dichotomous Thinking

Dichotomous thinking and BPD can be very detrimental, holding you back from living a rich,
full life. There are treatments for both conditions. If you have symptoms, it is recommended
that you seek out a healthcare professional who is trained and experienced in treating
borderline personality disorder.

During your therapy sessions, your therapist or psychologist may ask you to discuss examples
of your daily routine and talk about different perspectives. If you often think in extremes,
your therapist can help you identify the middle ground, introducing you to a new, more
balanced way of thought. As you progress, you will learn to consider your own assumptions
by asking yourself the following questions before you allow your thoughts to upset you:

 Is there evidence that supports my thoughts?

 Am I considering all angles or am I leaving things out?
  Could your assumption be challenged by someone else? How?
 Does everyone else see it this way?
 Am I being fair to others in making this opinion?

By taking a step back, you can build the skills necessary to learn to form a more realistic
perception of your relationships and your environment.

If you recognize that you have a tendency to dichotomous thinking, it is also important to
avoid acting on your extreme thoughts or making sudden decisions. You might want to write
things down or discuss them with a trusted friend or therapist. These steps can give you time
to consider your decisions and to get feedback from a neutral source before you take action
that could cause harm to your relationships or your finances.

https://www.verywellmind.com/dopamine-medical-glossary-definition-425296

Dopamine's Role in
Borderline Personality
Disorder
Dopamine is a neurotransmitter (a chemical released by nerve cells) that plays an important
and diverse role in how your brain functions.

Dopamine's Role in the Brain

Dopamine neurons (nerve cells) have cell bodies in the midbrain with nerve fibers (called
axons) that extend into a number of other sites in the brain. This allows for dopamine to be
transmitted from one brain site to another, and these connections are called dopaminergic
pathways.

One dopaminergic pathway projects from an area of the midbrain called the substantia nigra
to the basal ganglia, which coordinates movement in the body. When there is a loss of
dopamine neurons in the substantia nigra, Parkinson's disease occurs — a neurological
disease characterized by slowed movements, a rigid appearance, and a resting tremor.

Other sites of dopamine signaling include the prefrontal cortex, an area of the brain that is
important for problem-solving, complex thinking, memory, intelligence, and language. Minor
dopamine signaling pathways include the amygdala, which plays an important role in
emotion processing, and the hippocampus, which is important for memory.
In addition to movement, emotion, memory, and thinking, dopamine neurons play a critical
role in motivation and reward. This is why certain substances of abuse,
especially cocaine and nicotine, are addictive — as these substances stimulate the dopamine-
mediated reward system in the brain.

Dopamine's Link to Your Health

Besides Parkinson's disease, a number of psychiatric illnesses have been linked to dopamine
dysregulation like schizophrenia, attention deficit disorder (ADD), bipolar disorder,
and depression.

The manner in which dopamine has affected these psychiatric illnesses is unique. For
example, in ADD, impairment in the dopamine system causes poor attention. This is why
stimulants, like Ritalin (methylphenidate) or Adderall (amphetamine), which increase
dopamine levels in the brain, help improve attention and alertness.

On the other hand, in schizophrenia, the dopamine system is overactive. This is why
medications that block dopamine receptors in the brain (called antipsychotics) are used in its
treatment.

Does Dopamine Play a Role in Borderline Personality Disorder?

Some researchers believe that dopamine dysfunction may be involved in the development
of borderline personality disorder (BPD). This mainly stems from studies that support
dopamine's role in thinking, regulating emotions, and impulse control — all of which are
impaired in people with BPD. Also, antipsychotic medications seem to reduce some BPD
symptoms, especially those of anger and cognitive problems (like paranoid thinking).

That being said, other experts argue that the manner in which antipsychotics benefit patients
with BPD is through non-dopamine pathways. Overall, it's hard to say at this time how
critical dopamine is in the development or course of BPD. More research will be helpful in
elucidating this connection.

Bottom Line

The dopamine system is an intricate, fascinating system that participates in a number of

different neurological and mental functions. By further examining dopamine's role in the
brain, scientists will hopefully gain the information they need to develop more targeted
dopamine medications — so people with dopamine-mediated illnesses, like schizophrenia,
can get well and avoid undesirable side effects.

https://www.verywellmind.com/interpersonal-relationships-and-bpd-425477
Unstable Interpersonal
Relationships and
Borderline Personality
Borderline Personality Disorder Can Make Relationships More Difficult

What are the challenges of unstable interpersonal relationships with BPD and how is this managed?

Does borderline personality disorder affect relationships between family members, friends, or
other people in the community? How could BPD specifically create troubles, and what can be
done to resolve these problems?

Interpersonal Relationships in People with Borderline Personality Disorder

(BPD)

Many people with borderline personality disorder (BPD) have intense and unstable
relationships with others. Their relationships tend to fluctuate between being all good or all
bad and they can be unable to experience contradictory feelings when relating to the world or
others. This black and white thinking, or splitting, can spill over into all relationships
including those at school or work with peers, professors and instructors, managers and
supervisors.

Idealization and Devaluation Cycles in Relationships with BPD

If you have BPD, you may initially idealize a person or situation, throwing yourself into a
relationship fully and without reservation. However, soon something may occur that conflicts
with this idealized view, such as a harsh comment from a supervisor, a poor grade on a paper
or a fight with your partner. This can cause you to switch from an idealized view to one of
devaluation. You may think that there is suddenly nothing good about the person or situation
and there never was.

A heightened sensitivity to rejection (abandonment sensitivity) may trigger your devaluing

reaction. This sensitivity can cause you to overreact to real or perceived rejections. The
feeling of rejection is overpowering and consuming and can feel very real, regardless of
whether it was truly meant or unintended.

In response to devaluation, you may erupt in anger, quit the related task, become aggressive
or just give up. It is possible that the person, relationship or task will again be seen as ideal,
but it is also possible that the negative view will remain constant or that the damage that
occurred will be irreversible. Friendships can be destroyed, jobs quit or classes dropped. It
can be a debilitating experience with significant consequences.
Treating Borderline Personality Disorder and Managing Relationships

Borderline personality disorder can have a significant impact on your relationships. Even
with your family members, you may be sensitive to rejection, changes in plans or feelings of
being slighted. These distortions in thinking can make you feel isolated, lonely and helpless.

In the past few years, significant progress has been made in understanding and treating BPD,
both from a psychotherapy standpoint and through the use of medications.

Therapy - There are many treatment options that have been proven to be effective. Specific
therapies that have shown promise in helping with the relational aspects of BPD include:

 Dialectal behavior therapy (DBT) - DBT, sometimes called "talk therapy" is a form
of cognitive behavioral therapy. It looks at cognition, or thought, and relates this to behavior,
or actions. There are now other forms of therapy available which address relationship
concerns with BPD, but DBT is one of the therapies that was first found most effective for
BPD. There are four primary skills taught in DBT, with one being interpersonal effectiveness
skills designed to help people successfully state their needs in a relationship and manage
conflict.
 Mentalization therapy (MBT) - MBT is a therapy that focuses on looking at your feelings,
thoughts, and hopes, in order to see how they may be connected to your behaviors. MBT is a
form of psychodynamic therapy which focuses on present situations rather than prior events
and uses your relationship with the therapist to work through issues. Using specific examples
or settings, MBT helps you to analyze both your feelings and the feelings and thoughts of
others in a specific situation. For example, if a friend of yours gets angry and leaves your
home, you would address what feelings she had which may have prompted her behavior of
leaving rather than focus on the behavior of leaving.

In some cases, inpatient treatment may be necessary.

Medications - While there are currently no medications approved to treat BPD, medication is
sometimes prescribed by doctors to help manage BPD symptoms and improve your
interpersonal relationships. Some studies have shown that certain medications approved for
other mental disorders are effective in controlling symptoms like anger, impulsivity,
depression, and feelings of isolation. Results can vary greatly and it is unlikely that
medication will completely eliminate these feelings; you can most likely expect modest
results.

While medication may be a useful tool for managing your symptoms while undergoing
therapy, many of the medications used have significant side effects. Before taking any pills,
talk to your doctor and your therapist about potential side effects and if the advantages of
medications outweigh the drawbacks. For some people, the risk is not worth the modest
improvements in symptoms.

Bottom Line on Managing Relationships With Borderline Personality Disorder

Regardless if you take medication or not, therapy is essential for improving your relationships
with others and managing your other symptoms. Talk to your doctor about your specific
needs and concerns to come up with a strategy to meet your unique needs.
Take the time to learn about some of the most common issues faced by people with BPD in
their relationships. Romantic relationships with BPD in particular, tend to be chaotic and
intense and it is important that both you and your partner understand some of these issues and
how to address them before they become apparent.

If you are living with someone with borderline personality disorder, it can be helpful to learn
some of the ways in which a diagnosis of BPD affects the whole family.

While learning about BPD either in yourself or a loved one can leave you feeling depressed,
learning to understand the common issues and seeking out therapy can make a tremendous
difference. Family therapy, in particular, can make a huge difference not just for someone
living with BPD, but for the whole family.

https://www.verywellmind.com/emotionally-invalidating-environment-425303

Development of BPD in an
Emotionally Invalidating
Environment
Why an emotionally invalidating environment causes harm

An emotionally invalidating environment is any situation involving other people in which

they respond to your expressions of emotion inappropriately or inconsistently. In the context
of borderline personality disorder (BPD), "invalidating" means failing to treat your
expression of emotions with attention, respect, and understanding.

What Happens in an Invalidating Environment?

In an invalidating environment, you're essentially told that your expression of feelings

is wrong. The “invalidator” may deny, ignore, ridicule, deliberately misinterpret, or be
critical of your feelings.

Whatever form the invalidating takes, a child growing up in an invalidating environment

learns that his emotions are somehow incorrect, perhaps not even worth considering. As he
grows up, this self-belief may lead him to distrust his own feelings. It may also contribute to
the development of BPD.

An emotionally invalidating environment in childhood is believed to be one of the life

experiences that put people at risk for developing BPD.
Invalidating Environments and Development of BPD

For example, in an emotionally invalidating home environment, a child who becomes

frustrated and starts to cry may be told, “Stop acting like a baby!” The child's real needs are
ignored. As the child matures and the emotional invalidation continues, he may try harder and
harder to get his parents to respond to his feelings in positive ways. If they don't, the child
may end up self-harming to get the attention, the validation of himself as someone to be
taken seriously, that he so desperately wants.

Sometimes emotionally invalidating relationships happen "naturally," such as when there's a

mismatch between parents' personalities and their child's. For example, a shy child growing
up in an outgoing, talkative family may be teased and taunted because she's quiet and keeps
to herself.

At the opposite end of the range of emotional invalidation experiences, parents may
deliberately neglect their children or inflict extreme emotional or physical abuse on them as
punishment for expressing their emotions.

What Is Validation?

Basically, it’s letting another person know that you accept and understand his feelings,
whether you agree with what he’s said or not.

Some experts in BPD diagnosis and treatment think that another important childhood
experience, emotional vulnerability, is also a basic feature of BPD. Emotional vulnerability is
believed to "work with" an emotionally invalidating environment in the course of BPD
development.

People who are emotionally vulnerable:

 Become emotionally aroused or upset very quickly

 Express their emotions intensely, even dramatically
 Take a longer time to calm down and return to their normal emotional state

The tendency to respond in these ways in emotional situations can make it even harder to
cope with growing up in an emotionally invalidating environment.

Not Everyone Who May Be Invalidated Feels That Way

As you know, everyone is different, including in the way they experience relationships and
interactions with others. For example, if you grew up in an invalidating environment, maybe
you experienced some of what’s described above. That’s especially likely if you have BPD.
But then again, maybe you didn’t, and now you’re realizing that you didn’t view your
childhood emotional experiences that way.

Why such a wide range of reactions? Some BPD experts believe that temperament can also
influence how sensitive a person may be in an emotionally invalidating environment.
https://www.verywellmind.com/the-relationship-between-child-abuse-and-bpd-425153

The Relationship Between

Child Abuse and BPD
Does child abuse cause borderline personality disorder (BPD)? There is no simple answer;
we don't yet know exactly what causes BPD, though it is believed to be a mix of biological
and environmental factors. There is evidence that people with BPD are more likely to report a
history of some type of child abuse or other distressing childhood experiences. Yet many
people who have experienced child abuse do not have BPD and many people with BPD were
not abused or maltreated as children.

What Is Child Abuse?

The term "child abuse" covers a wide range of mental and physical injuries done to a
minor. Experts generally assign a set of experiences to this category:

 Physical abuse: Physically hurt or injured, such as bruising or broken bones

 Sexual Abuse: Being subjected to a sexual experience or exploited in a sexual manner by
someone older
 Emotional abuse: Undergoing emotional attacks, such as verbal abuse or degradation

Other forms of abuse can be more passive, such as in the case of physical neglect where the
child is denied basic necessities, like food or water. There is also emotional neglect, where a
child's emotional needs are ignored. No form of abuse is considered more severe than
another; all forms of abuse can have long-lasting implications for the person and can shape
their mental state.

Both child abuse and neglect can be related to the development of psychological disorders.
Sometimes the term "child maltreatment" is used to describe both abuse and neglect of
children.

Research

Research does indicate that there is a relationship between child abuse and borderline
personality disorder (BPD). People with BPD report high rates of childhood sexual abuse,
emotional abuse, and/or physical abuse. Forty to 76 percent of people with BPD report that
they were sexually abused as children, and 25 to 73 percent report that they were physically
abused. So, while there is a good deal of research that links childhood abuse to BPD, there is
also evidence that about a third of people with BPD report no abuse.
There is also evidence to link BPD to other forms of child maltreatment, such as emotional
and physical neglect. In fact, some research suggests that emotional and physical neglect may
be even more closely related to the development of BPD than physical or sexual abuse.
However, this is difficult to determine, since children who experience abuse also often
experience some form of neglect.

How Childhood Abuse Might Lead to BPD

If childhood abuse is a risk factor for BPD, what are the way in which these childhood
experiences lead to the development of BPD? A 2016 study found that emotional abuse was
the most significant type of abuse in later BPD and that preoccupied adult attachment may be
a mediator between the abuse and BPD. Other studies have likewise investigated the role of
emotional abuse in later BPD. While these studies are important in looking for causes that
may be preventable, they are also helpful in determining how treatment may help people
currently coping with the disease, in particular, approaches involving emotion regulation.

In addition to emotional abuse, emotional invalidation has also been tied to BPD, though it
could be argued that an invalidating environment is a form of emotional abuse.

Is BPD Different in Those Who Suffered Childhood Abuse?

When comparing the symptoms of BPD in those who were abused as children and those who
were not, it's been found that sexual abuse in childhood specifically appears to be linked to an
increased risk of suicidal attempts in people with BPD.

The Bottom Line

Research has fairly conclusively demonstrated a relationship between BPD and child
maltreatment. That said, there is no clear evidence that maltreatment causes BPD. Research
that demonstrates an association between two things doesn't necessarily prove that there is a
cause between them. Clearly, with child abuse statistics indicating that abuse is much more
common than we would think, it is important to determine whether or not it is one of
the causes of borderline personality disorder.

More research is needed to evaluate the precise relationships between childhood abuse and
BPD, and if abuse is a cause, what types of child maltreatment are most closely associated
with the development of BPD. It's likely that BPD is related to the combination of a number
of different factors, including genetic factors, temperament, biology, and other environmental
considerations.

BPD is a highly misunderstood disease. If you are living with BPD or know someone living
with the disorder, take the time to learn what you can. Contrary to popular opinion, BPD is
treatable, and those living with the disease can live meaningful lives. While there can be
significant problems with interpersonal relationships, this aspect as well can be improved
greatly with understanding on the part of both the person living with the disorder and those
who care about him or her.
https://www.verywellmind.com/mood-swings-in-borderline-personality-disorder-425478

Mood Swings in Borderline

Personality Disorder (BPD)
People with borderline personality disorder (BPD) often experience very intense mood
swings. But how can these mood swings be distinguished from normal variations in mood, or
from the types of mood swings associated with other disorders?

People with BPD often feel like they are on an emotional rollercoaster and typically have an
unstable sense of self and extreme fear of abandonment. BPD is part of the Cluster B
personality disorders, which are marked by dramatic, emotional, or erratic behavior.

Let's explore the typical pattern of mood swings in BPD, and how they are different from
mood swings that we all experience from time to time. In addition, there are many co-
occurring symptoms that a person with BPD will typically experience, which can help
differentiate it from other conditions.

Mood Swings

Everyone experiences emotional ups and downs, but people with BPD tend to experience
mood swings that are more intense and frequent than the typical person and last between a
few hours and a few days. While it's normal to have your mood shift from feeling good to
feeling down, someone with BPD may experience very extreme mood shifts for minor
reasons—going from feeling okay to feeling devastated, desperate, or completely hopeless
within a matter of moments. In fact, many people with BPD feel so overwhelmed by these
intense emotional shifts that they engage in impulsive behaviors such as substance abuse,
binge eating, self-harm, or even suicidal thoughts or behaviors, in order to feel better.

These mood swings may also happen frequently. Someone with BPD can have many mood
swings in the course of a day, whereas most people will only experience one or two major
emotional shifts in the course of a week.

In addition, while most people have times in their lives when they are more emotionally
vulnerable than other times, people with BPD experience emotional ups and downs
consistently for years. This can result in unstable interpersonal relationships with loved ones,
friends, and colleagues. Some other symptoms of this disorder may include:

 Intense anger that they have trouble controlling

 Paranoid thoughts
 Extreme sensitivity to perceived rejection and abandonment
 Feelings of emptiness
 Inability to self-soothe
 Feeling dissociated from oneself, including observing oneself from outside the body or not
feeling in touch with reality
External Trigger as a Distinguishing

Mood swings in BPD can also be distinguished from other types of mood problems by
examining the triggers that precede the mood shift. Very often, a mood swing in BPD
happens in reaction to an external trigger, and these triggers are often related to perceived
rejection or abandonment by another person.

Though researchers are still trying to understand the borderline personality brain, they know
that its fight-or-flight response is easily triggered, causing the rational part of the brain to turn
off and the survival instinct to turn on. This makes the person act in ways that are
inappropriate or out-of-proportion to the situation.

If You Have Mood Swings Does It Mean You Have BPD?

Keep in mind that even if you have mood swings that fit the description above, this is just one
of a number of symptoms of BPD. Having mood swings alone is not enough to warrant a
diagnosis of BPD.

However, if you are finding that your emotional ups and downs are interfering with your
work, school, relationships, or enjoyment of life, it makes sense to seek out professional help.
Remember it's important to take good care of your emotional health, just as you would your
physical health.

https://www.verywellmind.com/what-is-a-proximal-risk-factor-425316

Proximal Risk Factors in

Borderline Personality
When talking about borderline personality disorder (BPD) and the possible causes of BPD,
you may hear talk of both proximal risk factors and distal risk factors. What are proximal risk
factors, and what do we know about their role in BPD? How are causes of BPD, behaviors
associated with BPD, and risk factors related?

What Causes Borderline Personality Disorder (BPD)?

Researchers are still uncertain about how or why borderline personality disorder (BPD)
occurs. Many people with BPD have common backgrounds, but these are certainly not
universal among people with BPD.

In addition to environmental factors like experiencing abuse as a child, scientists suggest that
BPD could be linked to genetics or brain abnormalities. Some studies of people with BPD
have shown that it could be an inherited trait. People with BPD often have members of their
family tree who also experienced BPD. Other research has shown that people with BPD show
different brain activity than other individuals, particularly in the areas that regulate impulsive
behaviors and emotional responses.

Along with these potential causes, certain risk factors can be linked to BPD, including both
proximal risk factors and distal risk factors. These risk factors are very different in how they
are connected to BPD.

What Is a Proximal Risk Factor?

A proximal risk factor is a risk factor that precipitates a disease, such as BPD. They represent
an immediate vulnerability for a particular condition or event. Sometimes proximal risk
factors cause or shape an event. For example, an intensely stressful life experience, such as a
divorce or loss of a job, is a proximal risk factor for a suicide attempt. This type of experience
often occurs immediately prior to self-harm.

Proximal risk factors work directly, or almost directly, to cause a disease or symptom to take
place. However, they do not act alone or come out of nowhere. Someone with a solid
foundation is not likely to commit suicide after a divorce or job loss. But someone who has
experienced years of abuse during his childhood or constant rejection may commit suicide
after these setbacks. While the proximal risk factor may be the final straw, they are usually
built off of years of development, such as through distal risk factors.

What Is a Distal Risk Factor?

In contrast to proximal risk factors, distal risk factors represent background characteristics
that may put someone at risk for an event or condition at some point in his lifetime, but not
immediately. In the case of borderline personality disorder, this can include intense childhood
trauma or abuse. This background of trauma puts a person at higher risk of later being
diagnosed with BPD.

It is believed that distal risk factors are connected to BPD because of their link to learned
behaviors. Someone who grew up in an abusive household may have learned from an early
age that violence and aggression are an acceptable and useful tool to get what is desired.
These learned behaviors can stay with that person throughout their lives and influence how
they react to different situations or triggers.

Common Links Among People With BPD

While the exact cause of borderline personality disorder is still unknown, scientists and
researchers have identified some common links among people with BPD. From early life
traumas to emotional triggers, proximal and distal risk factors play a major role in how BPD
reveals itself in a person's life.

Proximal Risk Factors for Suicide With BPD

Proximal risk factors are important in BPD, not just for their contribution to the development
of the condition, but how they may play a role in some of the consequences of BPD, such as
suicide. For those who are living with BPD or have a loved one with the disease, learn more
about the proximal risk factors for suicide in people with BPD. Be alert for factors such as
stressful events, suicide in others ("contagion effect suicide"), a plan for suicide, and feelings
of hopelessness.

If You or a Loved One May Have BPD

A diagnosis of BPD can only be made by an experienced therapist. Many people have some
traits of the disorder, but with BPD these traits cause significant distress and an inability to
fully appreciate life.

If you or a loved one have been diagnosed with BPD, learn as much as you can about the
condition. Find a therapist you can trust. There are ways in which both the symptoms and
potential risk factors can be managed. Learn about the treatment options for BPD which are
available. And make sure to take the time to prepare a safety plan for yourself or your loved
one.

https://www.verywellmind.com/paranoid-ideation-425311

What Is Paranoid Ideation?

A Common Symptom of Borderline Personality Disorder

Paranoid ideation, or paranoia, means that you have beliefs you are being harassed or
persecuted. It can also refer to beliefs of general suspiciousness regarding the motives or
intent of others.

Paranoid ideation is not the same thing as the delusional paranoia that can occur
during psychosis. Delusional paranoia is based on false thoughts and beliefs rather than the
perception of harassment.

For example, if you are experiencing delusional paranoia, you might believe that the
government has bugged your house and car in order to keep tabs on you. If you are
experiencing paranoid ideation, you might see two people in the hallway talking and believe
they are talking about you.

If you have borderline personality disorder (BPD), it's likely that you have experienced
paranoid ideation. It is one of the possible criteria for diagnosis according to the
current Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

It's also important to note that stress may make these paranoid thoughts and beliefs worse.

Diagnosis

In order to be diagnosed with borderline personality disorder, you must have five of these
symptoms:
  Risky, impulsive behavior, such as going on shopping sprees, using illicit drugs, or engaging
in unprotected sex with multiple strangers.
 Perpetual feelings of being bored and/or empty.
 Intense love-hate relationships with others.
 Extreme efforts to avoid real or perceived rejection or abandonment by others.
 Suicidal behavior and/or behavior that's harmful to yourself.
 Anger issues, such as becoming extremely angry in inappropriate situations, exploding in
rage, or being unable to control your anger, followed by feeling guilty or ashamed.
 A perception of yourself that doesn't match up with what others think and changes often. This
affects your thoughts, behaviors, opinions, relationships, and moods.
 A feeling of disconnection with your body and/or your mind and paranoid thoughts that are
made worse by stress.
 Times of extreme emotion that last from a few hours to a few days and involve depression,
anxiety, or irritability.

Treatments

Treatment is important if you're dealing with BPD. Your treatment plan will likely involve a
combination of medications and psychotherapy.

Common psychotherapies used to treat BPD are dialectical behavioral therapy (DBT),
psychodynamic therapy, and cognitive-behavioral therapy(CBT). A combination of different
medications may be used to help treat your symptoms as well. Typical medications
include antipsychotics, antidepressants, and mood stabilizers.

Related Conditions

If you have BPD, you may have another condition as well. Those that commonly occur along
with BPD include depression, bipolar disorder, anxiety disorders, and other personality
disorders. Some people also deal with eating or substance abuse disorders.

Causes

No one knows what causes BPD. It's believed that environmental factors, genetics, and
abnormalities of the brain may all be involved. Specifically, people with a history of child
abuse or neglect or other childhood trauma are more likely to have BPD. Also, if you have a
parent or sibling with BPD, you are five times more likely to develop it yourself.

Additionally, there may be abnormalities in the brain that can lead to developing BPD. This
is particularly true of areas of the brain that control emotions and judgment.

https://www.verywellmind.com/borderline-personalities-425472
What Research Shows
About Borderline
Personality Disorder
Subtypes
Borderline personality disorder (BPD) is associated with a number of different signs and
symptoms. In order to be diagnosed with BPD, an individual must meet just five out of a total
of nine diagnostic criteria, meaning that BPD in one person can look very different from BPD
in another. This has led some experts to wonder whether there are actually distinct types of
borderline personalities.

BPD Subtypes in Popular Media

In popular media and pop psychology books, there is a great deal of discussion of different
BPD subtypes.

For example, in her book Understanding the Borderline Mother, Dr. Christine Lawson
describes four subtypes of mothers with BPD: the Waif (helpless), the Hermit
(fearful/avoidant), the Queen (controlling) and the Witch (sadistic).

In The Essential Family Guide to Borderline Personality Disorder by Randi Kreger, people
with BPD are grouped into lower-functioning/conventional types versus higher-
functioning/invisible types.

The conventional type is described as engaging in a lot of self-destructive behavior that

requires frequent hospitalization, and being very low-functioning, meaning he or she may not
be able to work or go to school. The author calls this self-destructive behavior "acting in," an
idea that correlates with the concept of internalizing symptoms.

In contrast, the invisible type is described as functioning well in most contexts, but engaging
in a great deal of "acting out" behavior, such as verbal abuse, criticizing others or becoming
violent. This description correlates well with the concept of externalizing symptoms.

These subtypes of BPD in popular literature were derived from the authors' own expert
opinions on the existence of different types of borderline personalities. More recently,
researchers have tried to take a quantitative approach to describe subtypes of BPD. The
research on the topic paints a more complicated picture.
Research on Borderline Personality Disorder Subtypes

The research on the existence of subtypes of BPD is mixed. Some research studies have
found that BPD can be treated as a unified diagnostic entity without the presence of clear
subtypes. But other studies have identified some subtypes of BPD.

One study, which examined types of borderline personalities based on patterns of co-
occurring personality problems, identified three subtypes of BPD that map onto the three
clusters of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders:
Cluster A, Cluster B, and Cluster C. Those in the Cluster A subgroup tended to engage in
more paranoid thinking and eccentric behavior, those in B tended to have more dramatic or
arrogant personalities, and those in C tended to be more fearful.

Another study that examined BPD subtypes in adolescent boys and girls with BPD found
reliable subtypes in girls, but not boys. Girls with BPD tended to fall into one of the
following categories: high-functioning internalizing, depressive internalizing, histrionic and
angry externalizing.

A third study found three BPD subtypes: withdrawn–internalizing, severely disturbed–

internalizing and anxious–externalizing.

Interestingly, these last two studies suggest that the distinctions between internalizing versus
externalizing symptoms and high versus low functioning may be an important one in BPD,
and may in part validate some of the popular psychology literature on the topic. However,
because of the inconsistencies in the research literature, much more study is needed on this
topic.

BPD Treatment Implications

At least one study has found that individuals with different presentations of BPD may
respond differently to treatment. In this study, individuals from the severely disturbed-
internalizing subtype did not see symptom improvement with treatment, whereas those in the
anxious-externalizing and withdrawn-internalizing subtypes did.

This suggests that the prognosis for BPD may be different depending on the subtype that an
individual belongs to. However, much more research is needed before we can say anything
definitive about differential treatment response.

https://www.verywellmind.com/distal-risk-factor-425295
What Is a Distal Risk Factor
in Borderline Personality
Disorder?
Proximal vs. Distal Risk Factors in BPD

A distal risk factor is a risk factor that represents an underlying vulnerability for a particular
condition or event. This does not predict that the condition or event will definitely happen or
that it will happen any time soon, but rather that a person may be at risk for the condition at
some time in the future.

Examples

Some examples of distal risk factors include poverty, having endured abuse or trauma as a
child, personality traits, and your genetic makeup. For instance, if you were sexually abused
as a child, you may have distal risk factors for certain psychological disorders,
including borderline personality disorder (BPD).

Borderline Personality Disorder

There are certain distal risk factors in developing a borderline personality disorder, including:

 Genetics. If you have a first-degree relative, that means a parent or sibling, with BPD or a
similar disorder, your risk is higher.
 Personality. If you tend to be aggressive and/or impulsive, this could increase your risk for
BPD.
 Childhood abuse or trauma. Any sort of significant childhood stress can also increase your
risk of developing BPD. Many sufferers say they were abused or neglected as children.

Proximal vs. Distal Risk Factors

In contrast to distal risk factors, proximal risk factors represent an immediate vulnerability for
a particular condition or event.

Some examples of proximal risk factors are ongoing abuse, having difficulties because of a
physical impairment or injury, poor academic or work performance and stressful life events.
All of these risk factors, particularly when combined with distal risk factors, can lead to the
development of a condition such as BPD.

Symptoms

Symptoms and patterns of BPD typically begin in the teenage years, and sometimes in young
adulthood. Symptoms may be different for different people, but can include:
  Unstable mood, including mood swings, that can last for hours or days
 Feeling chronically empty
 Engaging in risky behaviors, such as shopping sprees or unprotected sex with multiple
partners
 Suicidal thoughts or attempts or purposely injuring yourself
 Anger issues, including outbursts and difficulty controlling your temper
 An excessive fear of abandonment, whether real or imagined
 Intense relationships with others that are constantly up and down
 Actively and often changing the way you view yourself, including your values and goals, and
potentially seeing yourself as bad or as if you don't even exist

If you or a loved one experience any of these symptoms, make an appointment with your
physician for an evaluation.

Treatments

If you're diagnosed with BPD, the most helpful tool in your treatment plan will
be psychotherapy. Specific types that have been shown to be particularly helpful for BPD
are dialectical behavior therapy (DBT), schema-focused therapy, transference-focused
psychotherapy (TFP) and mentalization-based therapy (MBT).

Though the U.S. Food and Drug Administration (FDA) has not approved any particular
medications for the treatment of BPD, your doctor may prescribe you medication to help treat
your symptoms or other disorders you may have along with BPD, such as depression.

Outlook for Patients

Current research shows that if you have been diagnosed with BPD, the outlook for your
future tends to be positive. A lot of the symptoms that can be so debilitating go away within
the first few years of treatment and most patients improve with time. Also, the sooner your
BPD is diagnosed and treated, the more favorable your outcome, so early detection is vital.

https://www.verywellmind.com/how-common-is-bpd-425184

How Common Is Borderline

Personality Disorder?
BPD is much more common than you might imagine. A recent study on the prevalence of
mental health disorders in the U.S. found that about 1.6 percent of the population has BPD.
While that number may sound small, that means that there are more than four million people
with BPD in the U.S. alone. Although many people have never heard of BPD, it is actually
more common than many well-known disorders, such as schizophrenia.
There is a large difference in the prevalence of BPD in women versus men; women are much
more likely to be diagnosed with BPD. In fact, about 75 percent of those diagnosed with BPD
in the U.S. are women. However, it is not known whether women are actually more prone to
develop BPD or whether this is due to gender biases in the diagnosis of BPD. For example, it
may be that men with the symptoms of BPD are just more likely to be misdiagnosed with
other conditions like post-traumatic stress disorder or major depressive disorder.

Misdiagnosis as Bipolar Disorder

In addition, that 1.6 percent statistic may not be accurate because many people with BPD
have not yet been diagnosed or they have been misdiagnosed. In one study from Brown
University, more than forty percent of those with BPD had originally been misdiagnosed as
having bipolar disorder. One hypothesis for this issue is that bipolar disorder is more easily
treated through medication, so it is more commonly diagnosed so that symptoms can be
quickly managed with a prescription.

Misdiagnosis can be a serious problem, as no medications have been approved by the Food
and Drug Administration (FDA) for BPD and medications for bipolar disorder are often
ineffective in treating BPD. BPD patients who have been misdiagnosed may then be exposed
to dangerous side effects from their prescriptions. Some patients have reported issues with
endocrine and cardiac problems after taking these prescriptions.

While bipolar disorder and borderline personality disorder may share some symptoms, they
are very different diseases. Bipolar disorder can cause severe depression or mood swings, but
in between episodes, those with bipolar are able to function normally. Those with BPD may
have a more chronic condition that can cause self-harming behaviors or suicidal tendencies.

When a bipolar disorder patient is rapidly cycling, they can exhibit destructive or harmful
behaviors very similar to BPD, so misdiagnosis is extremely common during these phases.
Another fact that makes defining the two more difficult is that some people can actually have
both diseases. About 20 percent of those with borderline personality disorder have been
found have bipolar disorder as well.

Finally, other patients with BPD go undiagnosed because they refuse to seek treatment.
Whether they feel they don't need help or that counseling will be useless, many people go
without therapy and struggle with BPD on their own.

With these issues in mind, it is likely that the number of people with borderline personality
disorder is much higher than 1.6 percent, but that is the only number researchers have been
able to find evidence to support.

https://www.verywellmind.com/devaluation-and-idealization-in-bpd-425291
Devaluation and
Idealization in BPD
Two Common Defense Mechanisms in BPD

Devaluation and idealization are defense mechanisms that help a person manage their anxiety
as well as internal or external stresses. While this subconscious protection system can be
found in a few personality disorders, it is most often associated with borderline personality
disorder (BPD).

Idealization

Idealization is a psychological or mental process of attributing overly positive qualities to

another person or thing. It's a way of coping with anxiety in which an object or person of
ambivalence is viewed as perfect, or as having exaggerated positive qualities.

For example, it's common with borderline personality disorder for a person to idealize a
friend, family member, or loved one. They feel intense closeness towards that person and
place them on a pedestal. This can quickly and unpredictably change to intense anger toward
that person, a process called devaluation.

Devaluation

In psychiatry and psychology, devaluation is a defense mechanism that is just the opposite of
idealization. It's used when a person attributes themselves, an object, or another person as
completely flawed, worthless, or as having exaggerated negative qualities.

Defense Mechanisms

Both devaluation and idealization are considered to be on a minor image-distorting level on

the Defensive Functioning Scale. This tool is used by doctors to group patient's defense
mechanisms into levels of intensity.

Like most defense mechanisms or coping strategies, many people are not aware they are
engaging in devaluation and idealization. It's done subconsciously as a way to protect
themselves from perceived stress.

In borderline personality disorder, devaluation often alternates with idealization. For instance,
a person with BPD may shift from great admiration for a loved one — idealization of that
person — to an intense anger or dislike towards that person — devaluation of that person.

This wild shift between idealization and devaluation found in BPD is known as splitting,
which signifies a disturbance in both thinking and emotion regulation. Scientific data
suggests that this splitting is linked to activation in the prefrontal cortex — the front part of
your brain associated with personality — and the amygdala — the part of your brain that
controls emotional perception and expression.

Devaluation and Idealization in Other Personality Disorders

Devaluation is not limited to people with borderline personality disorder. It may be seen in
other personality disorders, especially antisocial personality disorder or narcissistic
personality disorder.

Idealization is sometimes also seen in narcissistic personality disorder, especially towards the
self or the treating therapist. Splitting, or the rapid fluctuation between idealization and
devaluation, is classically seen in borderline personality disorder.

What Does This Mean for Me?

Devaluation and idealization are defense mechanisms commonly used in borderline

personality disorder. That said, just because you engage in these defense mechanisms does
not mean you have BPD — it's simply a feature of this disorder.

Speak with your doctor or a therapist if you are concerned that you use coping strategies like
these to deal with emotional conflict or stress.

https://www.verywellmind.com/suicidality-in-borderline-personality-disorder-425485

Suicidality in Borderline
Personality Disorder
Why it's so common and how to help

Suicidal behaviors and completed suicides are very common in people with borderline
personality disorder (BPD). Research has shown that up to 80 percent of people with BPD
will make at least one suicide attempt in their lifetime, and many will make multiple suicide
attempts. People with BPD are also more likely to complete suicide than individuals with any
other psychiatric disorders. Around 9 percent of people with BPD complete suicide, which is
more than 50 times the rate of suicide in the general population.

Why Suicide Is so Common

There are several factors related to BPD that may explain why suicide, self-harm, and suicide
attempts are so common, such as:
  Severe emotional pain: BPD is associated with very intense negative emotional experiences.
These experiences are so painful that many people with BPD report that they would like to
find a way to escape. They may use a number of different strategies to try to reduce their
emotional pain, such as deliberate self-harm or substance use and even suicide.
 Duration: BPD is a chronic condition and usually lasts for years. Conditions that are chronic
may lead to more risk for suicide since they don't tend to get better quickly without treatment.
This may leave people with BPD feeling that there is no other way out, despite the fact that
there are now effective treatments available for BPD.
 Comorbidity: BPD tends to co-occur with other mental disorders, such as bipolar
disorder, major depression, and schizoaffective disorder. When there are other mental
disorders present, the risk of suicide increases.
 Impulsivity: BPD is associated with impulsivity, or a tendency to act quickly without
thinking about consequences. Individuals with BPD may engage in suicidal behaviors in a
moment of intense emotional pain without fully considering the consequences.

 Substance use: BPD often co-occurs with substance use and the use of drugs or alcohol is a
risk factor for suicide all by itself. When substance use issues are combined with BPD, this
may be a particularly lethal combination because substance use can lead to even greater
impulsivity and people who are using substances have access to a means for overdose.
 Brain abnormalities: Brain imaging has shown that compared to healthy people, individuals
with BPD tend to have abnormalities involving the brain's structure, metabolism, and
function. These abnormalities appear to contribute to symptoms of BPD such as impulsivity
and aggression, both of which are associated with suicidal behavior. One study explored the
relationship between impulsivity, aggression, and suicidal behavior in the brain structures of
people with BPD who had attempted suicide. The participants were put into two groups
depending on how lethal their suicide attempts had been. In the group labeled High Lethality,
meaning their suicide attempts had been extremely harmful, there was less gray matter in
multiple areas of the brain than in the Low Lethality group. A similar study also showed a
significantly reduced amount of gray matter in the brains of individuals with BPD when
compared with healthy people. In people with BPD who had attempted suicide, there was less
gray matter in 8 out of 9 areas and in people with BPD who had not attempted suicide, there
was less gray matter in 5 out of 9 areas. And, similar to the other study, the higher lethality
suicide attempters had notably less gray matter than the lower lethality attempters in certain
areas.

If You're Suicidal

If you're at immediate risk of committing suicide, you need to get help now. Call 911 if
you're in the United States or Canada, call the local police, or get yourself to your nearest
emergency room.

If you're not at immediate risk of suicide, but you're having thoughts of suicide and need to
get support, call a helpline to talk about how you're feeling and to find resources near you.
For example, in the United States, you can call the National Suicide Prevention Lifeline at 1-
800-273-8255. It's open 24/7, 365 days a week, and it's free and confidential.

The emotional pain associated with BPD is very intense, and it can leave you feeling as if you
are completely alone and will never feel better. Try to remember that there are people who
know how to treat BPD and want to help you. Treatment can make a huge difference in your
life.
When a Loved One Is Suicidal

If your loved one is at immediate risk of committing suicide, you need to get him or her help
immediately. You can call 911 yourself if you're in the United States or Canada, or call the
police and tell them what's happening. Or, if he or she will let you, take your loved one to the
nearest emergency room.

Sometimes friends or family pick up on signs of suicidality even if their loved one hasn't said
anything about suicide. If you think your loved one may be thinking of suicide, but you're not
sure, talk to him. Let her know that you're worried about her. Ask him whether your concerns
are valid. Offer to help. This can be hard to do because sometimes symptoms can make the
person with BPD very difficult to deal with, but for the time being, the most important thing
is to help your loved one stay safe no matter what. Showing care and concern for your loved
one's safety and well-being can also go a long way.

https://www.verywellmind.com/borderline-personality-disorder-meaning-425191

History of the Term

"Borderline" in Borderline
Personality Disorder
Many wonder how the term borderline came to describe borderline personality disorder. Let's
learn more about the origin of this term, and why its use is debated by some experts today.

History of "Borderline" in Borderline Personality Disorder

The term "borderline" was first introduced in the United States in 1938. It was a term used by
early psychiatrists to describe people who were thought to be on the "border" between
diagnoses, mostly psychosis and neurosis. At the time, people with neurosis were believed to
be treatable, whereas people with psychoses were deemed untreatable.

Then, in the 1970s, a deeper understanding of borderline personality disorder began to

emerge. People with BPD were described as being very emotional, needy, difficult, at risk for
suicide, and to have an overall unstable level of functioning.

Soon, a pattern of symptoms began to emerge to describe those with borderline personality
disorder. These included:

 Rapid shifts from periods of confidence to total despair

 Unstable self-image
  Rapidly fluctuating mood swings
 Fear of abandonment
 Strong tendency for both self-harm and suicidal thinking

In 1980, BPD became an official personality disorder in the Diagnostic and Statistical
Manual of Mental Disorders III or DSM-III.

Borderline Personality Disorder Today

Today far more is known about BPD. The term "neurosis" is no longer used in our diagnostic
system, and BPD is no longer thought of as being a psychotic disorder.

Now BPD is recognized as a disorder characterized by intense emotional experiences and

instability in relationships and behavior that begins in early adulthood and manifests itself in
multiple contexts (for example, at home, and at work).

In addition, experts have recognized that there is a strong genetic component to BPD—
meaning it can run in families.

According to the DSM-5, in order to be diagnosed with BPD, a person must meet these
criteria:

 Have an impairment in either identity (sense of self) or self-direction (for example, life goals).
 Have an impairment in interpersonal functioning with either empathy (unable to recognize
feelings of others) or intimacy (intense, unstable and conflicted relationships).

In addition, a person must have the following pathological personality traits:

 Negative Affectivity: characterized by frequent mood changes, anxiousness, fear of

rejection, feeling down frequently, and suicidal thoughts and behavior
 Disinhibition: characterized by impulsivity and risk-taking (for example, spending sprees,
sex)
 Antagonism: characterized by hostility (for example, anger in response to a minor insult)

The Ongoing Debate

The term borderline is still debated by some people. Many experts are now calling for BPD to
be renamed because they believe the term "borderline" is outdated. Some believe that BPD
should not be classified as a personality disorder, but rather as a mood disorder, or an identity
disorder.

Suggestions for the new name have included:

 Emotion Dysregulation Disorder

 Unstable Personality Disorder
 Impulse Spectrum Disorder
 Complex Posttraumatic Stress Disorder
What Does This Mean for You If You Have BPD?

It's important to not get too hung up on the term "borderline." The term is old and may be
changed in the future. Instead, focus on working with your doctor or therapist in receiving the
proper therapy so you can get healthy.

https://www.verywellmind.com/i-have-bpd-does-this-mean-my-kids-will-get-bpd-too-425161

Will Your Kids Inherit

Borderline Personality
Disorder?
If you have BPD, your children most likely will not get borderline personality disorder. It's
true that if you have BPD, your kids are at greater risk of having the condition themselves.
But, there is also a good chance that they will not have it. And, there are things you can do to
reduce their risk.

Is BPD Inherited?

There is research showing that borderline personality disorder runs in families. This is likely
due to a number of factors. First, some part of BPD is due to genetics; if these are your
biological kids and they have inherited a certain combination of genes from you, they may be
more at risk to develop BPD.

Second, the types of environments that can put children at risk of developing BPD also run in
families. For example, someone who is maltreated as a child is at greater risk to develop
BPD. That person is also at greater risk of having difficulty parenting. It is hard to be an
effective parent when you are struggling with BPD symptoms, and it does not help if you did
not have good parenting models yourself.

However, none of this means that your children will have BPD. While there is nothing you
can do about genetics, if your kids live with you, there is a great deal you can do about
environmental factors. And, there is evidence that environment has a very strong influence on
whether or not people with the genes for BPD actually develop the disorder.

How to Lower the Odds

The first thing that you can do is to get treatment for yourself. People who undergo an
effective treatment for borderline personality disorder under the guidance of a mental health
professional can improve significantly. Some people no longer meet diagnostic criteria for
BPD after they finish treatment. Having fewer symptoms means having more resources
for effective parenting.

Once you are in treatment, you can also express your concerns about your children to your
care provider, and ask them for help. Your provider can help you to evaluate your home
environment and whether your symptoms could be affecting your parenting skills.

Your therapist may even be able to refer you to programs that help people build skills to be
more effective parents. People with borderline personality disorder can be very effective and
nurturing parents, but because the symptoms of BPD can be very intense, for many people
this does take some work.

https://www.verywellmind.com/borderline-personality-and-paranoia-425194

Tips for Easing Paranoia in

Borderline Personality
Disorder
Many people with borderline personality disorder (BPD) experience paranoia or paranoid
thinking under conditions of stress. Paranoia is a term generally used to refer to intense
beliefs of mistrust or the malicious intentions of others. For example, someone with paranoia
may have the belief that the government is listening to their phone calls, or that their spouse
is having an affair.

Paranoid Ideation in Borderline Personality Disorder

Episodes of paranoid thinking, or ideation, can range from mild and short-lived to very severe
and chronic. Some individuals with psychotic disorders, such as schizophrenia or delusional
disorder, tend to have severe, chronic paranoid ideation that has no relationship to reality.

In contrast, while many people with borderline personality disorder do experience paranoia
since it is part of the diagnostic criteria for BPD, it tends to occur only under conditions of
stress or interpersonal conflict.

For example, an adolescent with BPD might see two of his friends talking in the hallway and
develop the paranoid belief that his friends all secretly hate him and are planning to humiliate
him. Or an adult with BPD might misread their partner’s cues that they want some alone time
as a sign that the relationship is being terminated, and dwell on this belief even when a great
deal of evidence to the contrary is presented.

At least one study suggests that while individuals with BPD differ from those with psychotic
disorders in terms of their psychotic reactivity, which is their tendency to have paranoid
ideation and other thinking and perceptual problems under stress, they do not necessarily
differ from patients with psychotic disorders in terms of the intensity of the paranoia or other
psychotic experience. So, while people with BPD have short-term psychotic symptoms, these
symptoms are not necessarily mild.

Stress-Busters to Help Tame Paranoid Ideation in BPD

Because paranoia in BPD is worse when you are under stress, you may find it helpful to find
ways to relax and work through your stress. Some popular stress busters are:

 Deep Breathing: The advantage of deep breathing is you can do it anywhere, anytime. Sit or
lie down, fill up your lungs slowly, and then exhale your breath back out slowly. Repeat.
 Meditation: This practice has been around for centuries and while there are different
techniques, most of them focus on quiet, calm, relaxation and focusing your attention.
Different meditation methods can be found online.
 Yoga: Like mediation, the focus with yoga is on calm, relaxation, quiet, as well as posture
and flexibility. There are many free yoga apps and instructional videos online to instruct you
how to do yoga on your own, or you can sign up for a class at your local gym.
 Tai Chi: Another ancient practice, tai chi was meant for self-defense but is used by many
people now to relax and reduce stress. Like yoga, it involves specific poses, targeted
concentration, slow movements, and focused breathing.
 Biofeedback: In biofeedback, you learn how to control things such as heart rate and certain
muscles by having monitors attached to you so you can visualize and hear what's going on in
your body. By learning how to change your thoughts or emotions in a way to slow these
mechanisms down, you help reduce stress.

https://www.verywellmind.com/what-is-splitting-425210

Splitting and Borderline

Personality Disorder
A defense mechanism where everything is black or white

Splitting is a term used in psychiatry to describe the inability to hold opposing thoughts,
feelings, or beliefs. Some might say that a person who splits sees the world in terms of black
or white, all or nothing. It's a distorted way of thinking in which the positive or negative
attributes of a person or event are neither weighed nor cohesive.
Splitting and Borderline Personality Disorder

Splitting is considered a defense mechanism by which people with borderline personality

disorder (BPD) can view people, events, or even themselves in all or nothing terms. Splitting
allows them to readily discard things they have assigned as "bad" and to embrace things they
consider "good," even if those things are harmful or risky. Splitting is one of the nine criteria
used to diagnose BPD.

Understanding Borderline Personality Disorder

Examples of Splitting

Splitting can interfere with relationships and lead to intense and self-destructive behaviors. A
person who splits will typically frame people or events in terms that are absolute with no
middle ground for discussion. Examples include:

 Things are either "always" or "never"

 People can either be "evil" and "crooked" or "angels" and "perfect"
 Opportunities can either have "no risk" or be a "complete con"
 Science, history, or news is either a "complete fact" or a "complete lie"
 When things go wrong, a person will feel "cheated," "ruined," or "screwed"

What makes splitting all the more confusing is that the belief can sometimes be iron-clad or
shift back-and-forth from one moment to the next.

People who split are often seen to be overly dramatic or overwrought, especially when
declaring that things have either "completely fallen apart" or "completely turned around."
Such behavior can be exhausting to those around them.

Accompanying Features

By itself, splitting may seem almost commonplace, a behavior easily attributed to any
number of individuals we know and maybe even ourselves. However, splitting in BPD is
considered a consistent and distorted behavior usually accompanied by other symptoms, such
as:

 Acting out (acting without consideration to consequences)

 Passive aggression (an indirect expression of hostility)
 Denial (consciously ignoring a fact or reality)
 Projection (assigning an undesirable emotion to someone else)
 Omnipotence (the belief that you possess superiority in intelligence or power)
 Emotional hypochondriasis (trying to get others to understand how severe your emotional
pain is)
 Projective identification (denying your own feelings, projecting them onto someone else, and
then behaving toward that person in a way that forces them to respond to you with the
feelings you projected onto them)
How BPD Is Diagnosed

A BPD diagnosis can only be made by a qualified mental health specialist. To make the
diagnosis, the doctor would need to confirm five of nine symptoms outlined in the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5), including:

 Intense and stormy relationships that involve splitting

 Feeling persistently empty or bored
 A warped view of yourself that affects your emotions, values, moods, and relationships
 Impulsive behavior, such as abusing substances or driving recklessly
 Anger issues, such as violent outbursts followed by extreme guilt and remorse
 Extreme attempts to avoid abandonment or extreme feelings of abandonment
 Suicidal thoughts and/or self-harming behaviors
 Extreme depression, anxiety, or irritability that can persist for hours and days
 Feeling dissociated from yourself, including paranoia and amnesia

Caring for a Loved One With BPD

There is no easy answer on how to deal with a loved one who has BPD, especially when
symptoms are extreme. How you cope depends largely on the nature of your relationship and
the impact your loved one's symptoms are having on your family. However, there are some
guiding principles that may help, including:

 Cultivate empathy. Start by reminding yourself that splitting is part of the disorder. While
certain actions may seem intentional and manipulative, your loved one is not doing any of this
to gain satisfaction. These are simply defense mechanisms he or she turns to whenever he or
she feels defenseless.
 Try to manage your response. If your loved one has BPD, keep in mind that you are in the
better position to control your temper. Yelling or engaging in hostility will only serve to make
the situation even worse.
 Remind your loved one that you care. People with BPD are often terrified of being rejected
or abandoned. Knowing that someone cares often helps reduce the splitting behavior.
 Maintain lines of communication. Discussing a situation when it happens allows you to
isolate that event rather than piling one situation on top of the next. Failure to communicate
only serves to fuel your loved one's rejection anxiety.
 Set boundaries. Dealing with the challenges of BPD is one thing; becoming the object of
abuse is another. Always set limits with a loved one who has BPD. If that line is ever crossed,
explain why you are backing away and try to do so dispassionately. Setting boundaries helps
preserve the relationship rather than challenging it.

 Encourage and support treatment. Your loved one can live a better life with treatment,
which may include medication and/or talk therapy, most likely dialectical behavior therapy
(DBT). Encourage him or her to start or continue with treatment and learn everything you can
about what he or she is going through. If needed, participate in therapy with your loved one.
 Take care of yourself. This may include finding your own therapist to help you balance your
needs along with those of your loved one.

When BPD Harms Your Well-Being

There may be times where you will need to take more drastic action. In the event that the
relationship is harming your family, your work, and your sense of well-being, you may be
faced with the reality that the relationship cannot continue.
While this is an incredibly painful choice for everyone involved, it can also be the most
healthy in some cases. If needed, this decision should be made with the help of a qualified
mental health professional.

https://www.verywellmind.com/borderline-personality-disorder-identity-issues-425488

The Identity Problems of

BPD Patients
Do you ever find yourself asking: Who am I? What do I believe in? What is my place in this
world? If you do, you're not alone. Many people with borderline personality disorder (BPD)
struggle with identity issues—one of the core symptoms of BPD.

Plenty of people without BPD struggle with identity issues, too. But people with BPD often
have a very profound lack of sense of self. If you struggle with the feeling that you have no
idea who you are or what you believe in, this may be a symptom you can relate to.

Understanding Identity

Most experts view identity as your overarching sense and view of yourself. A stable sense of
identity means being able to see yourself as the same person in the past, present, and future.
In addition, a stable sense of self requires the ability to view yourself in one way despite the
fact that sometimes you may behave in contradictory ways.

Identity is quite broad and includes many aspects of the self. Your sense of self or identity is
probably made up of your beliefs, attitudes, abilities, history, ways of behaving, personality,
temperament, knowledge, opinions, and roles. Identity can be thought of as your self-
definition; it’s the glue that holds together all of these diverse aspects of yourself.

Why Identity Is Important

Having a sense of identity serves many different functions. First, if you have a strong
identity, it allows you to develop self-esteem. Without knowing who you are, how can you
develop a sense that you are worthwhile and deserving of respect?

In addition, a strong identity can help you to adapt to changes. While the world around you is
constantly changing, if you have a strong sense of self, you essentially have an anchor to hold
you while you adapt. Without that anchor, changes can feel chaotic and even terrifying.
The Question "Who Am I?" and BPD

One of the symptoms of BPD listed in the "Diagnostic and Statistical Manual of Mental
Disorders" (DSM), the standard for diagnosing mental conditions, is identity disturbance, or
a markedly and persistently unstable self-image or sense of self.

People with BPD often report that they have no idea who they are or what they believe in.
Sometimes they report that they simply feel non-existent. Others even say that they are
almost like a chameleon in terms of identity; they change who they are depending on their
circumstances and what they think others want from them.

For example, you might find yourself being the life of the party at social events, but having a
somber and serious demeanor at work functions. Of course, everyone changes their behavior
to some degree in different contexts, but in BPD this shift is much more profound. Many
people with BPD say that in addition to behavior, their thoughts and feelings change to match
the current situation.

Identity problems in BPD are sometimes called identity diffusion. This refers to difficulties
determining who you are in relation to other people. Some people with BPD may describe
this as having difficulties understanding where you end and the other person begins. As a
result, many people with BPD struggle to set up and maintain healthy personal boundaries
and have difficulties in their interpersonal relationships.

Why People With BPD Have Identity Problems

Unfortunately, there has been very little research on the identity problems associated with
BPD, but there are many theories as to why people with BPD often struggle with identity. For
example, Marsha Linehan, Ph.D., a leading BPD researcher and the founder of dialectical
behavior therapy (DBT), believes you develop an identity by observing your own emotions,
thoughts, and feelings, in addition to others’ reactions to you. If you have BPD and the
associated emotional instability, impulsive behavior, and dichotomous thinking, you may
have difficulty forming a coherent sense of self because your internal experiences and
outward actions are not consistent.

In addition, many people with BPD come from chaotic or abusive backgrounds, which may
contribute to an unstable sense of self. If you determine who you are based on others’
reactions to you, and those reactions have been unpredictable and/or scary, you have no
framework for developing a strong sense of identity.

Another potential factor is being able to think about the mental states of yourself and others
regarding dreams, thoughts, emotions, and goals, known as mentalizing, which is difficult for
those with BPD. One study showed that this problem with mentalizing may play a key role in
why people with BPD struggle so much with identity diffusion and interpersonal
relationships.

How to Find Yourself

So how do you go about answering the question, “Who am I?” Of course, there is no magic
solution for identity problems—these issues are complicated. However, most treatments for
BPD include components that can help you to begin to discover who you are and what you
stand for. The first step in finding yourself is finding a good therapist who can help you work
on identity problems.

In addition, there are ways that you can work on identity issues on your own. You can begin
to discover what you view as meaningful in your life. The act of categorizing and defining
these areas can help you start on a path to discovering what's most important to you, which is
a significant part of your identity.

https://www.verywellmind.com/dissociation-in-borderline-personality-disorder-425482

What Is Dissociation in
Borderline Personality
Disorder (BPD)?
You may be surprised to learn that those times when you zone out, feel unreal, or when
things around you look strange or unfamiliar can mean you're experiencing dissociation. This
is a common occurrence for people with borderline personality disorder (BPD); in fact,
around 75 percent to 80 percent experience dissociation in some form. Though it can be
difficult to understand, in broad terms, dissociation represents a disconnect between your
thoughts, emotions, behaviors, perceptions, memories, and identity.

Symptoms

Dissociation during times of stress is one of the main symptoms of BPD. It's also associated
with acute stress disorder and post-traumatic stress disorder (PTSD), either of which
sometimes cooccur with BPD.

After years of study, researchers are now able to describe the experiences that go along with
dissociation, such as:

 Depersonalization: This is a feeling of separation between yourself and your body. People
who experience depersonalization may say that they feel like they're observing their own
body from the outside, or as if they're in a dream.
 Derealization: Similar to depersonalization, derealization is a feeling of being detached from
the external world, such as from other people or objects. It may cause familiar things to look
strange, unreal, or unfamiliar. Derealization and depersonalization often occur at the same
time.
  Amnesia: Some people who experience dissociation have periods of amnesia or "losing
time." They may have minutes to hours or days when they were awake but can't remember
where they were or what they were doing.
 Identity confusion: This occurs when you experience an inner struggle about who you really
are.
 Identity alteration: When you sense that you act like a different person some of the time,
this is identity alteration. For instance, you may see things in your home that you don't
recognize, perform a skill that you don't remember learning, or others will say you're acting
like a different person. Mild identity alteration is common in the general population; for
instance, changing your name. The key is that it doesn't cause problems with everyday
functioning or relationships. In other words, you're aware of your identity or role change.
Moderate identity alteration is common in BPD and involves changes in mood or behavior
that are not under your control.

If you haven't ever experienced dissociation—and not everyone with BPD does—you may be
puzzled by these descriptions. But even if you don't experience dissociation frequently or it's
not very severe, almost everyone has experienced mild forms of dissociation from time to
time. Common examples of mild dissociation in everyday life are zoning out—when you
can't remember what you were thinking or doing—while you're driving on a highway,
causing you to miss your exit; daydreaming; and getting so caught up in a book or movie that
you're unaware of anything else.

Causes

Dissociation is most often caused by chronic traumatic stress like persistent neglect or abuse,
usually in childhood. It's your brain's way of coping in order to separate yourself from the
trauma so it becomes more bearable. If you learned to dissociate during times of extreme
stress as a child, this likely affected the way your concept of yourself developed and it may
have carried over into how you react to stressful situations as an adult. However, this sort of
trauma doesn't necessarily cause dissociation to develop, nor do you have to have
experienced it to have symptoms of dissociation.

Preliminary research exploring neuroimaging in people with dissociative symptoms in BPD

has shown that there may actually be changes in the way the brain functions and
communicates that contribute to dissociation. Using imaging techniques such as functional
magnetic resonance imaging (fMRI) and positron emission tomography (PET) scans on
people with dissociation and BPD, researchers have found evidence of decreased activity in
the limbic temporal areas of the brain, increased activity in the frontal area of the brain, and
changes in communication between the two areas. Further study in this area may help sort out
which brain processes are related to which dissociative symptoms, as well as make
psychotherapy even more targeted and beneficial for people who experience dissociation.

Treatment

Treatments for BPD such as dialectical behavioral therapy (DBT) often include components
that can help reduce dissociation. Usually, treatment for dissociation is based on building
skills that help you to reconnect with yourself, the present moment, and your current
surroundings.

Grounding is one skill that can be used to reduce dissociation. Grounding exercises involve
using external stimuli and your five senses (sight, hearing, touch, smell, and taste) to
reconnect with the present. For example, in a visual grounding exercise, you're instructed to
observe small details about the environment around you until you are feeling more connected.

Some people respond better to grounding exercises that use sensation. For instance, holding
on to an ice cube for a few moments, chewing a piece of minty gum, or smelling a lemon can
help to bring you back to the present moment.

Dissociative Disorders

There are some mental health disorders that include dissociation as a central feature rather
than a symptom. For example, dissociative identity disorder (DID) is a disorder that is
thought to be the result of very severe dissociation which causes a person to develop different
personalities. The vast majority of people with dissociative identity disorder have
experienced childhood abuse, such as physical and/or sexual abuse, and neglect.

Besides dissociative identity disorder, the two other main dissociative orders according to the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the gold standard for
diagnosing mental health conditions—include:

 Dissociative amnesia
 Depersonalization/derealization disorder

A Word From Verywell

Stress-related dissociative symptoms occur in the majority of people with BPD. Even so,
there is certainly a spectrum of severity, meaning some people with BPD experience minimal
or mild symptoms of dissociation whereas others experience more severe symptoms.
Research suggests that this severity may be linked to each individual's history of abuse and
trauma.

If you or a loved one is being treated for BPD with dissociative symptoms, or a dissociative
disorder, therapy can be challenging and intense, as you or your loved one may have to
remember past trauma. But if you stick with it, therapy can help you take back power over
dissociative symptoms and improve your overall quality of life.

https://www.verywellmind.com/what-is-emotional-validation-425336

What Is Emotional
Validation?
People with borderline personality disorder struggle with emotions
Individuals with borderline personality disorder (BPD) can have very strong emotional
responses to events that seem minor to outside observers. As a result, people with BPD
frequently experience emotional invalidation, that is, others react to their emotions as if those
emotions are not valid or reasonable.

Frankly, if you are the friend or family member of someone with BPD, it can be very hard to
have a validating response to emotions that seem out of proportion to the situation. But
invalidating your loved one’s response probably doesn’t help.

What Is Emotional Validation?

Emotional validation is the process of learning about, understanding and expressing

acceptance of another person’s emotional experience. Emotional validation is distinguished
from emotional invalidation, in which another person’s emotional experiences are rejected,
ignored, or judged.

A few dominant psychological theories of borderline personality disorder (BPD) assert that
many people with BPD did not receive sufficient emotional validation over the course of their
development (see also “emotionally invalidating environment”), which may be one factor in
the development of the emotion dysregulation characteristic of the disorder.

One key to learning to validate others’ emotions is to realize that validating an emotion does
not mean that you agree with the other person, or that you think their emotional response is
warranted. Rather, you communicate to them that you understand what they are feeling,
without trying to talk them out of the feeling or shame them for the feeling.

Step One: Identify and Acknowledge the Emotion

When you validate an emotional response, the first step is to acknowledge the emotion that
the other person is having. This can be hard if the other person has not clearly communicated
their feelings, so you may have to either ask them what they are feeling, or guess and then ask
them if you are right.

Imagine that your loved one is angry with you. You come home from work, and they are
behaving angrily (even if they are not explicitly stating it).

If your loved one has already communicated that they are feeling angry, for example, you can
just acknowledge that they are feeling that way: “I understand you are angry.”

If they haven’t communicated this, but they seem angry, you might say, “You seem really
angry. Is that what’s going on?”

Step Two: Acknowledge the Source of the Emotion

The next step is to identify the situation or cue that triggered the emotion. Ask the person
what it is that is causing their response. For example, you might say, “What is it that is
making you feel that way?”

You loved one may or may not be able to communicate this clearly. They may not even
understand themselves what is going on, or they may be unwilling to articulate what triggered
the emotion. In this case, you may just need to acknowledge that something seems to be
making them upset, and that you’d like to know what’s going on, but that it’s difficult to
without a clear sense of the situation.

Step Three: Validate the Emotion

Imagine that your loved one is able to communicate the source of their emotion: They
respond that they are angry because you are 15 minutes late coming home from work. And
perhaps to you, their level of anger seems unwarranted given the situation. You can still
validate their feelings by communicating that you accept what they are feeling (even if you
don’t follow their reasoning).

For example, you might just say, “I know you are feeling angry because I was 15 minutes late
coming home. It was not my intention to anger you; I was stuck in traffic. But I can see that
waiting for me made you upset.” You do not need to apologize for your behavior if you don’t
feel you did anything wrong. But by acknowledging the feelings your loved one is having,
you may actually diffuse the situation.

Validating Is Not Resignation

Keep in mind that validating someone’s emotions does not mean that you resign yourself to
be treated poorly. If your loved one is behaving inappropriately or aggressively, removing
yourself from the situation is your best bet.

Tell them that you want to be able to talk with them about the situation, but that you can’t do
that productively until they can communicate with you more calmly, so you’ll return later
when it seems like the right time.

Validating Won’t Make the Emotion Go Away

It is also important to keep in mind that validating your loved one’s emotion usually will not
make the emotion go away. It may diffuse the situation, and it will rarely make the situation
worse, but that doesn’t mean your loved one is going to feel better right away.

Remember that it is not your job to make the feeling go away, although you may choose to be
supportive. Rather, acknowledging and validating the person may help them to find their own
way to regulate the emotion.

https://www.verywellmind.com/temperament-101-425119
Temperament and
Borderline Personality
Disorder
Temperament can be an important factor in the development of borderline personality
disorder (BPD). The exact causes of BPD are not known; it is most often thought to be a
combination of genetic (nature) and environmental (nurture) factors. Individual temperaments
can predispose a person to develop BPD.

What Is Temperament?

Temperament refers to our inborn personality traits, which are genetic in nature. The different
ways infants interact with and react to their environment and experiences are reflective of
their temperament, or behavioral style.

Efforts to understand individual differences in personality have occurred throughout history.

Despite this, there is no clear consensus as to what the specific temperament traits are called
or how they should be categorized. However, there have been some efforts to
comprehensively describe temperament; one is the New York Longitudinal Study (NYLS).

New York Longitudinal Study (NYLS)

In 1956, physicians Alexander Thomas and Stella Chess began The New York Longitudinal
Study. Involving 185 children over six years, the authors identified nine distinct temperament
traits present in every individual at birth. These traits as defined can be helpful in better
understanding how personality is impacted by genetic factors (or nature).

According to Thomas and Chess, these traits are areas of behavioral styles found in every
individual. Each temperament listed should be seen as having a range or being a spectrum;
some infants are going to be very distractible, others less distractible, and others even less. In
the end, there are endless combinations of temperaments, making each infant unique at birth.

Nine Temperament Traits

From The Origin of Personality.

 Adaptability
 The ease with which a child adapts to changes in his environment
 Activity Level
 The proportion of active periods to inactive ones
 Approach/Withdrawal
 The response to a new object or person
 Distractibility
  The degree to which extraneous stimuli affect behavior
 Intensity of Reaction
 The energy of response regardless of its quality or direction
 Quality of Mood
 The amount of friendly, pleasant, joyful behavior as contrasted with unpleasant,
unfriendly behavior
 Persistence/Attention Span
 The amount of time devoted to an activity and the effect of distraction on the activity
 Regularity/Rhythmicity
 Regularity of hunger, excretion, sleep, and wakefulness
 Sensory Threshold
 The intensity of stimuli required to evoke a discernible response

Temperament Throughout Development

In general, temperaments exist as they are prior to birth and are a component of an
individual’s personality. Although it is thought that temperaments are genetically determined,
personalities as a whole are a combination of temperaments and experiences that shape and
influence a person’s development.

https://www.verywellmind.com/how-to-identify-triggers-425495

How to Identify Your BPD

Triggers
Use This Exercise to Manage BPD

Many people with borderline personality disorder (BPD) struggle to identify triggers that
exacerbate their symptoms. Sometimes people with BPD feel that their reactions come "out
of the blue," when in fact there are particular situations and events that consistently trigger
symptoms. Triggers can range from minor things like a song or movie to something more
serious, such as an individual.

This exercise will help you identify your unique triggers, helping you manage your
symptoms. Before working on an exercise like this, be sure to talk with your therapist to
make sure he agrees you are prepared for this 20-minute activity.

Identify Your Triggers

1. Take out a piece of paper and a pen or pencil. Find a quiet, private place to record your
thoughts during this exercise. Be aware that this exercise may cause you some distress
because you'll be thinking about situations that trigger your symptoms, so plan to do
something soothing afterward.
 2. On your piece of paper, make three columns. On the top of the first column, write "Trigger."
On the top of the second column, write "Emotion." On the top of the third column, write
"Response to Emotion."
3. Call to mind the last time you had an intense negative emotional response. This could be
intense anger, loneliness, fear, sadness, shame, or emptiness. Under the "Trigger" column,
write whatever event was happening just before you had the emotional response. Remember,
a trigger can be an internal or an external event—it may have been something that happened
in the environment around you, such as a fight with a friend, or it may have been something
that happened in your mind, such as a memory or thought.

1. In the "Emotion" column, write the emotional responses you had to the trigger. It's okay if
you have multiple emotional responses. If you struggle to identify emotions, you can leave
this column blank, but try your best to identify at least one feeling you had in reaction to the
trigger.
2. In the "Response to Emotion" column, write the response you had to the emotions you wrote
in the second column. For example, perhaps you felt intense shame in response to the trigger,
and then you engaged in self-harm. Or, maybe you felt anger but used coping skills to manage
your anger effectively. Whatever your response was to the emotion, record what happened.
3. See if you can identify two or three recent times that you have experienced intense emotional
responses. For each of these episodes, repeat steps three, four, and five.
4. Now, take a look back at the list you have created. In particular, look at the column labeled
"triggers." Do you notice any pattern developing? That is, are there particular types of triggers
that come up repeatedly for you? See if you can identify one or two categories of triggers that
consistently bring up strong emotions. For example, many people with BPD report that
experiences of perceived rejection are a strong trigger for their intense emotional responses.

1. Keep this piece of paper, and after you experience episodes of intense emotion, add to your
list by reflecting on the event that triggered the emotion, the emotional response you had and
what you did in response to that emotion or emotions. See if you can identify other patterns of
triggers.
2. As you add to your list, you will begin to be able to predict situations that trigger you. Having
this knowledge will help you to create a plan for coping with triggers.
3. Share your list with your therapist. He will be able to identify coping skills or strategies you
can practice and use to better handle these triggers.

https://www.verywellmind.com/what-is-axis-ii-425200

Axis II and Borderline

Personality Disorder
he diagnostic system that was typically used to diagnose borderline personality disorder
(BPD) and other personality disorders using axes are now obsolete. BPD and other
personality disorders were diagnosed as Axis II disorders in the last Diagnostic and Statistical
Manual of Mental Disorders, fourth edition (DSM-IV). These axes are no longer used in the
current edition of the DSM.
Diagnosis of BPD in DSM-IV as an Axis II Disorder

Borderline personality disorder (BPD) and other personality disorders are typically diagnosed
using the official guidebook for the diagnosis of psychiatric disorders, the Diagnostic and
Statistical Manual of Mental Disorders (currently in its fifth edition, the DSM-5).

The last DSM, DSM-IV-TR, used a "multi-axial" diagnostic system. This means that when a
diagnosis was made, attention was paid to five different areas, or axes, that could affect the
individual who was being diagnosed.

Axis I was for the diagnosis of clinical disorders, the conditions that people most often think
of when they think of psychiatric disorders. For example, major depressive disorder or post-
traumatic stress disorder would have been diagnosed on Axis I.

Axis II was reserved for long-standing conditions of clinical significance, like personality
disorders and mental retardation. These disorders typically last for years, are present before
adulthood and have a significant impact on functioning.

The Rationale for Putting Personality Disorders on Axis II

In theory, personality disorders were relegated to Axis II because this was a way to make sure
that they did not get overlooked. If a person had multiple clinical disorders on Axis I, coding
the personality disorders on Axis II helped those disorders to stand out.

Another reason that experts decided to put personality disorders on Axis II in DSM-IV relates
to the course of these disorders. Whereas the Axis I disorders tend to be episodic, meaning
they are on-again, off-again, personality disorders are thought of as chronic, meaning they
occur over years.

Diagnosis of BPD in DSM-5

DSM-5 did away with the axis system, relegating everything to one axis to ostensibly make
diagnosing easier. However, diagnosing, assessing and treating personality disorders are
basically the same as in DSM-IV, including the symptoms that need to be present in order to
diagnose BPD.

Symptoms of Borderline Personality Disorder

The hallmark of BPD is emotional instability and frequent mood swings. To be diagnosed
with borderline personality disorder, you must have at least five of the following symptoms:

 Impulsive choices and behaviors that may result in risky behavior, such as gambling,
shopping sprees or engaging in unprotected sex with multiple partners.
 Powerful, changeable emotions and moods that may last from a few hours to a few days.
 A pattern of turbulent and unstable relationships with friends and family.
 Feeling constantly bored and/or empty
 Anger problems, including difficulty controlling anger, intense anger that may not fit the
situation and/or angry outbursts
 A distorted and insecure concept of yourself that affects everything in your life, from
relationships to goals to moods and opinions.
  Suicidal and/or self-harming behavior, like cutting.
 Paranoid thoughts or dissociative feelings, as if you are not a part of your own life or you're
out of your body.
 An irrational fear of being abandoned that causes powerful emotions and going to extremes to
make sure you aren't abandoned.

https://www.verywellmind.com/bpd-and-misdiagnosis-425176

Borderline Personality
Disorder (BPD)
Misdiagnosis
Learn Why BPD Misdiagnosis Happens So Often

Borderline personality disorder (BPD) misdiagnosis appears to be common. You may be

surprised to learn, however, that even though BPD occurs as often as schizophrenia and
bipolar disorder, affecting about 14 million Americans, many people who actually have
BPD are misdiagnosed at first.

In one study, researchers found that nearly 40% of people with BPD in their study sample
had previously received a misdiagnosis of bipolar disorder.

What's the Biggest Reason Why BPD Is Misdiagnosed So Often?

Probably the main reason is that BPD is seldom a person's only mental health problem.
Instead, it often occurs together with other mental health problems such as
depression, bipolar disorder, anxiety disorders, substance abuse, and other types of
personality disorders.

For example, more than 50% of people diagnosed with BPD also have major depressive
disorder.

As a result, the symptoms of BPD may not be recognized at the time a person is diagnosed
with another mental health problem, such as an anxiety disorder.

What Other Factors Can Cause BPD Misdiagnosis?

Additional reasons why BPD misdiagnosis occurs include the following.

The Symptoms Do Not Appear. BPD is unusual in that many people who have it don't
"show" their symptoms, such as anger, instability, and impulsiveness, in the early stages of
relationships with others, including mental health professionals. So the symptoms of BPD
don't appear and can't be diagnosed.

Why does this happen? The person isn't "hiding" the BPD symptoms. They don't emerge
early in therapy because they typically appear only in close or intimate relationships, which
take time to develop.

The Person Drops Out of Treatment, Perhaps Repeatedly. People with BPD tend to drop
out of treatment at fairly high rates. If a person with BPD is not showing symptoms early in
therapy for another mental health disorder and then chooses not to continue treatment, the
therapist has no opportunity to make a BPD diagnosis. This may happen over and over if a
person with undiagnosed BPD repeatedly goes from one therapist to another without staying
long enough for the BPD symptoms to appear.

BPD Symptoms Are Vague and Overlap With Other Diagnoses. BPD symptoms such as
anger, shame, a feeling of emptiness, and suicidal thoughts are common in other mental
health disorders. So a person may be correctly diagnosed with one mental health disorder (for
example, major depression) that has some of the symptoms of BPD, but the co-diagnosis of
BPD may be missed.

Preventing BPD Misdiagnosis and Getting the Treatment You Need

As you can see, correctly diagnosing BPD can be unusually difficult. If you think you or a
loved one may have BPD, it's important to find a mental health professional with a lot of
experience recognizing and treating it. If you're currently in treatment for another mental
health problem, ask your therapist to evaluate you for BPD.

If you're not receiving treatment for your mental health symptoms, look for a therapist who's
experienced in diagnosing BPD as well as other mental health disorders. This Find a BPD
Therapist website can help.

https://www.verywellmind.com/retrospective-research-borderline-personality-425263

Retrospective Research
and Its Use in BPD
One way to obtain scientific data on medical conditions like borderline personality disorder is
through retrospective research — when scientists look backward to form a conclusion.
Let's gain a better understanding of retrospective research through two examples of
retrospective studies in borderline personality disorder.

What Is Retrospective Research?

Retrospective research is a method in which the factors related to the development of a

particular outcome — like an illness or disorder — are studied after the outcome has already
occurred.

This means that data is studied after it was collected for a reason other than for research. This
data may include a whole host of sources including:

 Doctor and nursing notes

 Emergency room reports
 Hospital records, like admission and discharge paperwork
 Lab or imaging test results

Data can also be analyzed from a person's memory or recall of past events — like memories
of trauma or abuse during childhood.

Example of Retrospective Research in Borderline Personality Disorder

An example of retrospective research in borderline personality disorder(BPD) is a 2007 study

in CNS Spectrums. In this study, the charts of 13 females with borderline personality disorder
treated with an anti-seizure medication called Lamictal (lamotrigine) from the year 2003-
2004 were reviewed. These patients all suffered from affective instability — or intense mood
shifts — due to their BPD. The review of the charts showed that for most of the women,
lamotrigine was effective in treating their mood shifts.

Another example is an older study in the American Journal of Psychiatrywhich interviewed

both people with and without borderline personality disorder about major childhood trauma.
Over 80 percent of the people with borderline personality provided a history of childhood
trauma, including physical abuse, sexual abuse, and domestic violence. This was significantly
more than people without borderline personality disorder — suggesting that childhood
trauma is a potential trigger for the development of BPD.
Drawbacks

One drawback of this method — mostly if the data source is a person's memory — is
something called recall bias. That is, the information that is recalled by participants may be
biased by their current condition. In the above example, it may be that participants with BPD,
who experience very intense emotions, are more likely to interpret past events as traumatic
than people without BPD.

In addition, your research data is reliant on someone else's notes or data collection — which
may be incomplete, scattered, and not always contain the information the researcher needs.

Selection bias may be another drawback of retrospective studies. Selection bias means that
the study population has already been chosen and is not randomized in a retrospective trial.
For instance, in the above 2007 study in CNS Spectrums, there was no randomization of
which women with BPD received Lamictal (lamotrigine) and which women did not. These
biases can diminish the validity or accuracy of the study's conclusion.

What Does This Mean for Me?

Retrospective research can provide key information about a variety of health conditions. That
being said, they may be more prone to certain biases or limitations that have to be taken into
consideration when interpreting findings. If you are intrigued by a particular retrospective
study, speak with your doctor to see how it applies to your health care.

https://www.verywellmind.com/bpd-assessment-process-what-to-expect-425173

What to Expect During a

Borderline Personality
Disorder Assessment
If you think you (or a loved one) may have borderline personality disorder (BPD), it's
important to get an accurate diagnosis, which requires a BPD assessment.
Did you know that BPD symptoms often overlap those of other mental health disorders, such
as anxiety and major depression? Following the steps below will keep you on track toward an
accurate diagnosis and proper treatment.

Find a Mental Health Professional

Look for a mental health professional with experience diagnosing and treating people
with BPD.

In addition, if you have health insurance, consider asking the insurance company to give you
the names of nearby mental health professionals with the expertise you're seeking who also
take your insurance. If you get this information, ask how many treatment sessions they'll
cover and how much your co-pay will be.

If you don't have health insurance, you may qualify for public assistance programs or services
through your state or region's department of mental health or social services.

What types of mental health professionals can do a BPD assessment, provide a diagnosis, and
treat you or refer you to a therapist who better matches your treatment needs? They include:

 Psychologists
 Psychiatrists
 Social workers
 Licensed mental health counselors
 Psychiatric-mental health nurses

Generally, psychologists have the most training in psychological assessment. So you may
want to start your search with this group. Most psychologists will have a PhD or PsyD after
their names.

Before you make your first call to a therapist, go online to review his or her education,
training, and experience. That way, you can check off the most promising names on your list
and call them first. Having this information before you call also means you don't have to ask
about it when you schedule your appointment.

Schedule an Assessment

Once you have a list of BPD therapists who appear to meet your requirements, start at the top
and call to schedule an appointment for a BPD assessment.

Besides scheduling your appointment, the person who answers the therapist's phone can
probably tell you what a BPD assessment will cost and whether your insurance is accepted.
Next, ask to speak with the therapist, or, if that's not possible, ask if he or she will call you for
a brief introductory discussion.

If you do get to speak with the therapist, try to get a sense of how comfortable you feel
discussing your symptoms with this person. If you're reasonably satisfied with what you hear
and how you feel, keep the appointment. If you aren't, thank the therapist for speaking with
you, hang up, and call back to cancel the appointment. Then try the next name on your list.
 Start the Assessment Process

When you arrive for your first therapy session, it's normal to feel nervous and uncomfortable,
particularly if you've never done this before. It's not easy to meet a new person and share
private details about your life. However, keep in mind that the more direct and honest you are
during your BPD assessment, the more you will get out of it.

Your BPD assessment may take one session or several sessions. Your therapist will tell you
how long the assessment will take and what types of tests or interviews you will be
completing, if any.

Different providers use different tools to conduct an assessment. Generally, you can expect
the therapist to ask questions about your current and past symptoms, family and work history,
and current life situation. Some therapists will also give you a short questionnaire to fill out
and/or administer a psychological test, which is typically longer and asks more questions.

Receive a Diagnosis

You'll probably receive a diagnosis after your BPD assessment is completed. However, if
your therapist needs more information before making a diagnosis, he or she may refer you to
a specialist or your primary care doctor for further assessment. Reasons for this include:

 Your symptoms may suggest the possibility of a non-BPD diagnosis, and the therapist may
want to get another specialist's evaluation.
 If you've had one or more serious head injuries, you may be referred for a specialist's
assessment of whether some or all of your symptoms are due to this cause rather than a
mental health disorder.
 You may be referred to your primary care doctor for an assessment of any other medical
conditions that could be causing your symptoms.

However, it's more likely you'll receive a diagnosis at the end of your BPD assessment. Your
therapist will also explain more about the problems your symptoms are causing and
recommend treatment options that may help you feel better.

Your therapist may provide some of your treatment or all of it. If necessary, he or she may
refer you for part of your therapy to another mental health professional with special expertise.
For more information on Borderline Personality Disorder, take this quiz.

https://www.verywellmind.com/do-you-have-borderline-personality-disorder-3959026

1. Do you have unstable and intense relationships with alternating extremes of

love and hate?
 Yes, I have nasty fights with family and friends. One minute I love them, the
next I hate them.
 Sometimes, but my feelings for friends and family don't fluctuate – I love them.
 No, I'm pretty good about calmly communicating when disagreements arise.
2. Do you have an unstable self-image or sense of self?
 Yes, I question my self-worth, and it's even caused me to constantly change
my career goals.
 I'd be lying if I didn't admit some days I struggle with accepting myself for who
I am.
 No, I'm confident in who I am and what I want out of life.
3. Do you have impulsive, self-destructive behavior?
 Yes, there are times when I have unprotected sex or use drugs because it
makes me feel good.
 Sometimes I don't make the best decisions, and I'll admit it doesn't make me
feel better about myself.
 No, I like to think before my actions.
4. Do you constantly wrestle with self-mutilating or suicidal thoughts?
 Yes, I've cut myself in the past, and I struggle with thoughts of ending my life.
 I've had suicidal thoughts before, but I don't think I'd actually go through with
it.
 Not at all. I have bad days, but I always look for healthy ways to manage
negative thoughts.
5. Do you experience frantic efforts to avoid abandonment, even when no real
threat exists?
 Yes, I can't stand to be alone, and I'll do anything I can to avoid it.
 Not frantic, but I do try to avoid being alone.
 No, I'm perfectly content with alone time.
6. Do you have frequent, intense mood swings or emotional overeactions?
 Yes, I can go from calm to furious rather quickly. The anger can last hours or
even days.
 If I'm already having a bad day, it's possible for me to quickly go over the
edge, but that's normal, isn't it?
 No, my anger rises gradually, and I don't hold onto it for long. I prefer to let
things go.
7. Do you have chronic feelings of emptiness?
 Yes, nothing fills this void. I feel it all the time.
 Occasionally, I feel like something's missing, but I try to distract myself.
 No, I find fulfillment in family and life's simple pleasures.
8. Do you have inappropriate, intense anger or difficulty controlling anger?
 Yes, if I'm angry, everyone will feel my wrath. It doesn't matter where I am or
who's around.
 Sometimes I'll lash out at friends or family, but I'm aware of my outbursts.
 No, if I feel angry, I like to wait until I calm down to express my feelings.
9. Do you have temporary episodes of paranoia or loss of contact with reality?
 Yes, especially when stressed, I'll have moments when I feel like I'm having
an out-of-body experience.
 Nothing severe, but every now and then if I'm highly stressed, I'll become
slightly paranoid.
 No, I don't recall experiencing episodes of paranoia under any circumstances.

You got: It's Not BPD, but You May Want to Seek Therapy
Not everyone's emotionally stable or has the best relationships with friends and family, but it
doesn't mean you have a serious mental health condition like borderline personality disorder
(BPD). Based on your results, you're far from BPD, but there are some indications of a
mental health problem.

According to the DSM-V, if you possess five or more of the nine BPD symptoms outlined in
this quiz, it may be an indication you have the condition. Since you chose close to five
symptoms, there is cause for concern. If you're feeling depressed or have suicidal thoughts,
you should seek a therapist immediately.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational
purposes only and is not a substitute for professional medical consultation, diagnosis or
treatment.

You got: It's Possible You Have BPD

If you've been averse to seeking help before, consider this your wake-up call. Based on your
results, it's possible you have borderline personality disorder (BPD). According to the DSM-
V, if you possess five or more of the nine BPD symptoms outlined in this quiz, it may be an
indication you have the condition.

You may have noticed emotional instability has led you to have extreme reactions to
abandonment, including panic, depression and rage. You have a history of tumultuous
relationships with friends, family and significant others. You also have suicidal thoughts and
engage in risky, impulsive behaviors, such as unprotected sex and substance abuse. If this
sounds like you, it may be time to seek a therapist and discuss treatment options like
cognitive behavioral therapy. It's never too late to get help!
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational
purposes only and is not a substitute for professional medical consultation, diagnosis or
treatment.

You got: You Don't Appear to Have BPD

No one's saying you don't have occasional outbursts of anger or make risky, impulsive
decisions – some people are more emotionally stable than others. Based on your results,
however, you don't seem to have a serious mental health condition like borderline personality
disorder (BPD).

According to the DSM-V, if you possess five or more of the nine BPD symptoms outlined in
this quiz, it may be an indication you have the condition. Since you do not, you're fine. But
you did choose to take this quiz for a reason. If you feel concerned about your mental health,
it's probably best to seek a therapist.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational
purposes only and is not a substitute for professional medical consultation, diagnosis or
treatment.

https://www.verywellmind.com/a-diagnosis-with-a-bad-rap-2330646

Borderline Personality
Disorder: A Diagnosis With
a Bad Rap
Understanding the Truth About BPD Symptoms

Most of us have heard of borderline personality disorder (BPD) and much of what we hear
seems to be negative. Patients with this disorder have gotten a bad reputation, thanks - in part
- to the movie Fatal Attraction. BPD tends to be poorly misunderstood as it is, so to say that
the main female character in Fatal Attraction represents a typical BPD sufferer is unfair and
unrealistic.

Diagnosing Borderline Personality Disorder

A diagnosis of borderline personality disorder is made by a mental health professional using

the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) criteria
established by the American Psychiatric Association. In order to be diagnosed with BPD, you
must meet five or more of these nine symptoms:
 1. Frantic efforts to avoid abandonment, whether real or imagined, and experiencing extreme
emotions when any abandonment is perceived.
2. Having had unstable and intense interpersonal relationships that involved both extremes
of idealizing the relationship ("He's perfect for me!") and not valuing the relationship ("I can't
stand him!").
3. Not having a stable self-image or identity.
4. Engaging in impulsive and risk-taking behavior such as spending money, having unsafe sex,
substance abuse, reckless driving, binge eating, and the like.
5. Repeated suicidal behavior or threats or self-mutilation.
6. Having extreme and intense moods, such as irritability, anxiety, or depression that last from a
few hours to a few days.
7. Continual feelings of being empty.
8. Having anger issues, including intense anger that is inappropriate for the situation, inability to
control temper, being angry all the time and/or engaging in physical fights.
9. Feeling disconnected from your mind or body and having paranoid thoughts when you're
under stress, leading to potential psychotic episodes.

Who Develops Borderline Personality Disorder?

Recent research has shown that many people diagnosed with BPD are trauma survivors.
Genetics may also play an important role in developing BPD. Studies show that if you have a
parent, sibling, or child with BPD, your chances of developing it yourself are five times
greater. There also appears to be neurological impairment in people with BPD, meaning that
certain areas of the brain do not communicate well with other areas.

Borderline personality disorder usually starts in adolescence or young adulthood. An

estimated 1.6 percent of adults deal with BPD though that number could be significantly
higher. Females are typically the population that is diagnosed, but studies have shown that
males have tended to be misdiagnosed with post-traumatic stress disorder (PTSD) or
depression instead of BPD.

Treatment for BPD

There are several psychotherapy approaches that have been proven to be helpful in borderline
personality disorder. One of these, dialectical behavior therapy (DBT), is an approach that
combines techniques from several approaches and takes advantage of a combination of group
and individual therapy.

Though the Food and Drug Administration (FDA) has not approved the use of any
medications to treat BPD, some physicians prescribe them to BPD patients to help reduce
certain symptoms like depression or anxiety.

Living With Borderline Personality Disorder

Being diagnosed with borderline personality disorder means you have taken your first step to
getting your symptoms under control. Your physician will work with you to develop a
personalized treatment plan that maximizes your quality of life while reducing your
symptoms as much as possible. This can take time and multiple adjustments, so be patient
and keep communication open with your doctor about how you are doing. Surround yourself
with supportive people and learn everything you can about BPD so you can take steps to
increase your mental well-being.
https://www.verywellmind.com/what-is-personality-disorder-not-otherwise-specified-425183

Personality Disorder Not

Otherwise Specified (PD-
NOS)
Personality disorder not otherwise specified (PD-NOS), also referred to as personality
disorder NOS was a diagnostic category in the Diagnostic and Statistical Manual of Mental
Disorders, fourth edition (DSM-IV-TR). This diagnostic category was reserved for a
clinically significant problem in personality functioning that did not fit into any of the other
existing personality disorder categories.

Changes in Personality Disorder NOS in DSM-5

In the new Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5),
personality disorder not otherwise specified has been replaced by personality disorder—trait
specified (PD-TS). This diagnosis is given when you have the characteristics of a personality
disorder, but you don't fully meet the criteria for any specific one. You may even have a
variety of symptoms of several different personality disorders.

Types and Features of Personality Disorders

Personality disorders are characterized by thinking and feeling about yourself and others in a
way that causes significant impairment to your everyday functioning and relationships. There
are ten personality disorders listed in DSM-5. They include:

Borderline Personality Disorder

This disorder is characterized by turbulent relationships with others, paranoid thinking, a

deep-rooted and extreme fear of abandonment, emotional instability, impulsive behaviors and
an unstable sense of self.

Paranoid Personality Disorder

People with paranoid personality disorder may be socially isolated, hostile, have a constant
worry that others have ulterior motives, expect people to use them for their own means and
have trouble working and getting along with others.

Avoidant Personality Disorder

If you have avoidant personality disorder, you may be very shy, easily hurt, see yourself as
not as good as everyone else, avoid situations or jobs that force you to be in contact with
others, not open up in romantic relationships and blow situations out of proportion.
Schizoid Personality Disorder

This disorder may be related to schizophrenia but is not as severe. People with this disorder
may be emotionally unavailable, distant, appear aloof and tend to isolate themselves from
others. They have no desire for close relationships, even with family members.

Obsessive-Compulsive Personality Disorder

Not to be mistaken for obsessive-compulsive disorder (OCD), which is an anxiety disorder,

obsessive-compulsive personality disorder (OCPD) does have many of the same features as
OCD. One of the main differences between the two is that in OCD, people have thoughts they
don't want and in OCPD, people believe their thoughts are correct. This disorder features a
rigid adherence to rules and/or lists, perfectionism, an inability to be flexible, generous or
show affection and being obsessed with work.

Antisocial Personality Disorder

Antisocial personality disorder involves behavior that is often criminal. People with this
disorder tend to manipulate, not care about others' safety, lie, steal, fight, be angry, have no
remorse for their actions, violate others' rights, be charming, engage in substance abuse,
break the law and use other people for their own benefit.

Histrionic Personality Disorder

If you have histrionic personality disorder, you are likely able to function well in life. This
disorder involves needing to be the center of attention and engaging in intense emotional
drama to do so. Other symptoms are having a hard time dealing with criticism, blaming
others for failure, an extreme worry about what others think, impulsive behavior, being
overly concerned about your looks and always needing approval and/or reassurance.

Narcissistic Personality Disorder

In narcissistic personality disorder, people have an inflated sense of themselves and their
importance, are unable to empathize with others and focus almost entirely on themselves and
what they want and need.

Schizotypal Personality Disorder

Unlike people with schizophrenia, if you have schizotypal personality disorder (SPD), you
are in touch with reality and usually don't experience hallucinations or delusions. Symptoms
of SPD include having strange beliefs and/or fears, being uncomfortable in social situations,
not having close friends, having an unusual appearance or behavior and being unable to
express your feelings appropriately.

Dependent Personality Disorder

This disorder is characterized by being too dependent on others for your physical and/or
emotional needs. Symptoms include not wanting to be alone, not being able to make
independent decisions, being unable to express disagreement, becoming passive in
interpersonal relationships, excessive caring about what others think, worry about being
abandoned and an inability to deal with criticism or disapproval.

https://www.verywellmind.com/mclean-screening-instrument-borderline-personality-disorder-
425178

Screening for Borderline

Personality Disorder
The McLean screening instrument, SCID-5-PD and others

There are no specific tests that can diagnose borderline personality disorder (BPD); however,
mental health professionals often use screening instruments to help them identify a particular
diagnosis. Here are several common types of screening tools that may be used to diagnose
BPD.

The McLean Screening Instrument

The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) is a

commonly used 10-item measure to screen for BPD. This measure was developed as a very
brief paper-and-pencil test to detect possible BPD in people who are seeking treatment or
who have a history of treatment.

The MSI-BPD was developed by Dr. Mary Zanarini and her colleagues at McLean Hospital.
The test consists of 10 items that are based on the Diagnostic and Statistical Manual of
Mental Disorders diagnostic criteria for borderline personality disorder. The first eight items
of the MSI-BPD represent the first eight DSM-IV/5 diagnostic criteria for BPD, while the last
two items assess the final DSM-IV/5 criterion, i.e., the paranoia/dissociationcriterion.

Scoring of the MSI-BPD

Each item is rated as a "1" if it is present and a "0" if it is absent, and items are totaled for
possible scores ranging from 0 to 10. A score of 7 has been determined to be a good
diagnostic cut-off, meaning that a score of 7 or higher indicates that you are likely to meet
criteria for borderline personality disorder.
Uses for the MSI-BPD

The MSI-BPD is a useful tool for detecting individuals who may have borderline personality
features. It has not been tested in community samples, so it is not known whether it is good at
detecting BPD in the general population. However, it has shown to be very effective in
detecting possible BPD in people who are seeking treatment or who have a history of
treatment for mental health problems.

Psychometric Properties of the MSI-BPD

The MSI-BPD has demonstrated good psychometric properties. It has adequate internal
consistency and good test and retest reliability. It has also demonstrated good sensitivity and
specificity for detecting borderline personality disorder when a score of 7 is used as a
diagnostic cut-off.

Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD)

This official clinical interview of the American Psychiatric Association (APA) is an update of
the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) but is
very similar. Your mental health professional may use this screening tool to help find your
diagnosis by asking you questions directly related to the criteria for BPD that are listed in the
DSM-5.

This screening instrument also has an optional self-reporting questionnaire with 108
questions that you, the patient, can answer, but not all clinicians who choose the SCID-5-PD
will use this.

Personality Diagnostic Questionnaire, 4th Edition (PDQ-4)

This screening test consists of 99 true or false questions that can help screen for different
personality disorders, including borderline personality disorder.

Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD)

This tool, also developed by Dr. Mary Zanarini, is used for patients who have already been
diagnosed with BPD to see if there have been any changes over time.

Which Tool Is Best?

A recent study using the first three of these screening methods with adolescents and young
adults showed that the screening instrument were all equally effective in predicting a
diagnosis of BPD.

https://www.verywellmind.com/psychometric-properties-425262
Psychometric Properties in
a BPD Test
The psychometric properties of a psychological test relate to the data that has been collected
on the test to determine how well it measures the construct of interest.

In order to develop a good psychological test, the new test is subjected to statistical analyses
to ensure that it has good psychometric properties.

There are two broad types of psychometric properties that a test must have in order to be
considered a good measure of a particular construct: reliability and validity.

Reliability as a Psychometric Property

The first type of psychometric property is called "reliability." This is the psychological test's
ability to measure the construct of interest consistently and in a stable manner. A measure of
something cannot be more valid than it is reliable.

Test-Retest Reliability

If the test is reliable, your results on that test should be very similar if you take the test today
and again in six months. This is called test-retest reliability.

For example, you take a test to determine your likelihood of having borderline personality
disorder (BPD) in January, then again in July, and you should have similar results.

One problem with the reliability of testing the same person twice using the same test is that
the patient could remember the questions from the last time they took the test. This could
have a variety of consequences.

Parallel Forms for Reliability

Parallel forms is another measure of reliability and designed to avoid the issues brought about
by using the same exact test twice.

To increase the reliability of this psychometric property, clinicians administer parallel forms
of a test. In other words, two similar, not exactly the same, versions of a measure.

Other Types of Reliability

There are other types of reliability. Internal consistency refers to the point that all the items in
the test should be measuring the same construct. Inter-rater reliability addresses the protocol
to determine if multiple judges have a high degree of consensus.
Validity as a Psychometric Property

The second broad property that a good test has validity, which refers to how well the test
accurately measures the construct of interest. The results should correspond with what the
researcher stated was the focus of the study.

For example, the results of a good borderline personality test should be highly related to
behavior that is typical of borderline personality disorder (for example, someone with a high
score on a BPD test should also have a lot of problems with emotion regulation).

The two broad categories of validity are internal and external:

 If the study has external validity, it falls in line with previous findings on the same, or similar,
topic.
 Internal validity is about the degree of confidence the researcher has in his own results and is
based on a variety of factors, including characteristics of the sample, measures, and the
research design.

Face Validity

Face validity refers to how valid the person taking the test thinks it is. For example, if the test
taker has a bad attitude toward the test, including finding the layout confusing or the thinking
the test administrator is a jerk, an otherwise valid measurement might produce an erroneous
result.

https://www.verywellmind.com/borderline-personality-disorder-diagnosis-425174

Borderline Personality
Disorder Diagnosis

If you think you or a loved one may have borderline personality disorder (BPD), it can be
very helpful to educate yourself about borderline personality disorder diagnosis. Being armed
with some information can help you to take the next important step: making an appointment
for an assessment with a mental health professional.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM, which is published by the American Psychiatric Association, is the official source
of diagnostic information for psychiatric disorders, including BPD and related conditions. For
each disorder, the DSM provides a list of symptoms and specifies how many symptoms are
needed (and how severe the symptoms must be) to warrant a particular diagnosis.

The current DSM criteria for a BPD diagnosis are summarized below.

The Criteria for a Diagnosis

BPD is a pervasive pattern of instability in interpersonal relationships, self-image, and

emotion, as well as marked impulsivity beginning by early adulthood and present in a variety
of contexts, as indicated by five (or more)of the following:

 Frantic efforts to avoid real or imagined abandonment

 A pattern of unstable and intense interpersonal relationships characterized by extremes
between idealization and devaluation (also known as "splitting")
 Identity disturbance: Markedly or persistently unstable self-image or sense of self
 Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending,
sex, substance abuse, reckless driving, binge eating)
 Recurrent suicidal behavior, gestures, or threats, or self-harming behavior
 Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
 Chronic feelings of emptiness
 Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper,
constant anger, recurrent physical fights)
 Transient, stress-related paranoid ideation or severe dissociative symptoms

How Were the Criteria for BPD Established?

A team of psychologists and psychiatrists who are considered experts in BPD developed the
DSM symptom criteria. Many of the work group members are considered preeminent BPD
researchers, and most also work directly with BPD patients.

The symptom criteria were established based on the best research available. However, it is
important to keep in mind that the symptom criteria are always being fine-tuned as new
research comes out. Currently, the DSM is in its fourth edition and has undergone a text
revision (this is why you will sometimes see it referred to as the DSM-IV-TR). In the next
edition of the DSM (DSM-V), the symptom criteria for BPD may be altered to keep up to
date with new research.

The Assessment Process

There are a number of psychological disorders and even medical problems that can cause
symptoms very similar to those associated with BPD. For this reason, it is very important to
see a licensed clinician (for example, a therapist or doctor) who can listen to your concerns,
conduct a thorough assessment, and make an accurate diagnosis.

A complete assessment for BPD may include several components. Your therapist or doctor
may ask you to participate in an interview, during which they will ask you questions about
your symptoms, physical health, and past and present life situation. He or she may also ask
you to fill out a written questionnaire about BPD symptoms. Finally, if you are willing, your
clinician may ask to talk to family or loved ones to get complete information on the ways that
your symptoms are affecting you.

At the end of the assessment process, your clinician will compile all of the information and
make a diagnosis. Then, they will speak with you at length about the diagnosis and treatment
options.

What Should I Do if I Think I Have BPD?

If you think you may have BPD, the first step is to find a mental health professional to work
with. While they can be hard to find, there are clinicians who are specially trained to treat
BPD.

If you have health insurance, you may want to talk to the insurance company about clinicians
who take your insurance and who have expertise in BPD (you should also ask how many
sessions would be covered and how much the co-pay would be). If you do not have
insurance, you may qualify for public assistance programs or services through your state or
region's department of mental health or social services. You can also ask your primary care
physician for a referral, or look into whether medical centers or universities in your area
offer psychiatric or psychological services.

In addition to working with a clinician, it may help to educate yourself about the variety of
effective treatments available, including medication, psychotherapy, and self-help treatments.
Finally, it is important to know that you are not alone and that with help, people with BPD
lead normal and fulfilling lives.

Was this page helpful?

https://www.verywellmind.com/what-is-multi-axial-diagnosis-425180

Multiaxial Diagnosis Is
Outdated
The most common diagnostic system for psychiatric disorders is the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5), currently in its fifth edition. While the last
DSM, DSM-IV, used multiaxial diagnosis, DSM-5 did away with this system.

What Are the Five Axes in a Multiaxial Diagnosis?

In the DSM-IV-TR system, an individual was diagnosed on five different domains, or "axes."
In a single axis system like DSM-5 is, an individual is diagnosed in just one domain. For
example, a clinical disorder, such as major depressive disorder, would be assigned. The
multiaxial system was thought to give more detail.

Axis I: Clinical Disorders

Major psychiatric disorders were diagnosed on Axis I. When you think of a psychiatric
diagnosis, these are the kinds of disorders that probably come to mind. For example, major
depressive disorder and post-traumatic stress disorder were diagnosed on Axis I. Learning
disorder, such as reading or arithmetic disorders, and developmental disabilities, such
as autistic disorder, were also diagnosed on Axis I.

Axis I tended to be reserved for major disorders that were thought to be somewhat episodic,
meaning they typically have a clear onset and periods of remission or recovery. This was not
true of all Axis I disorders, however. Autistic disorders, for example, are not episodic.

Axis II: Personality Disorders or Mental Retardation

Axis II also included some conditions that we might consider psychiatric disorders, but these
were thought to be longer-standing conditions that were typically present before age 18.

The personality disorders are longstanding, pervasive patterns of thinking and behavior that
usually appear before the age of 18 but are typically diagnosed after 18, when the personality
is considered more fully formed. These disorders are not thought of as episodic; they are
considered stable and chronic.

Mental retardation (MR) is also a long-standing condition that must be present before the age
of 18 and is stable over time. MR refers to significantly below-average intellectual
functioning combined with deficits in adaptive behavior.

One rationale for the diagnosis of personality disorders and MR on Axis II was that these are
chronic conditions that should be separated from Axis I conditions in order to allow them to
be highlighted since they convey important additional diagnostic information. There was
some controversy, however, about whether personality disorders are truly qualitatively
different than Axis I clinical disorders, and whether they should remain on Axis II.

Axis III: Medical or Physical Conditions

Axis III was reserved for medical or physical conditions that may affect or be affected by
mental health issues.

For example, if someone has cancer, and their illness and treatment are affecting their mental
health, that would be important information to be conveyed in the diagnosis. So, the cancer
diagnosis would be included on Axis III.

Alternatively, someone might have a medical condition that is impacted by their mental
health. For example, someone with diabetes might not comply with their medical treatment
regimen if they have a psychiatric disorder that causes impulsive or erratic behavior.
Diagnosing the medical illness on Axis III was to help alert a clinician of a potential problem.

Axis IV: Contributing Environmental or Psychosocial Factors

Often, a psychiatric diagnosis happens in the context of major environmental or social

stressors. For example, job loss, divorce, financial problems or homelessness may contribute
to the development or maintenance of a mental health condition. A psychiatric disorder can
also contribute to the development of these stressors. These important contextual factors were
coded on Axis IV.

Axis V: Global Assessment of Functioning

The last axis, Axis V, was reserved for the global assessment of functioning (GAF). The GAF
is a number between 0 and 100 which was meant to indicate your level of functioning, or
your ability to engage in adaptive daily living.

Lower scores indicated lower functioning, with a score of zero indicating that a person was
incapable of maintaining their own safety or basic hygiene or was an imminent threat to the
safety or welfare of others. Scores near 100 indicated superior functioning.

Why Did DSM-5 Do Away With Multiaxial Diagnosis?

The multiaxial system was intended to help make distinctions between diagnoses, but instead
created confusion and negatively impacted research. DSM-5 has combined the first three axes
into one in order to eliminate the distinctions between diagnoses, which helps clinicians,
researchers and insurance companies streamline information. Clinicians still evaluate patients
for the last two axes, they just do it using different tools.

https://www.verywellmind.com/borderline-personality-disorder-symptoms-425175

Signs and Symptoms of

Borderline Personality
Disorder
Are you worried that you or a loved one have BPD?

Learn about the signs and symptoms of borderline personality disorder.

If you are worried that you or a loved one may have borderline personality disorder (BPD),
it's important to be informed about the illness and its symptoms. While some of the
symptoms of BPD are not easily identified, others are associated with observable behaviors.

Borderline personality disorder symptoms include instability in interpersonal relationships,

self-image, and emotion, as well as a pattern of impulsive behaviors. Individuals with BPD
often first experience these symptoms in young adulthood and the symptoms tend to continue
for many years. BPD may occur in both men and women.

Here are some signs and symptoms that may indicate you or your loved one need to be
evaluated by a healthcare professional:

Fear of Abandonment

People with BPD tend to have difficulties in their relationships. In particular, people with
BPD can be very sensitive to abandonment. They may believe they are being left by someone
when that is not actually the case at all.

Since the fear of abandonment can be so strong and pervasive, people with BPD often engage
in behaviors meant to provide reassurance that the other person still cares about them. For
example, they may call someone on the telephone repeatedly asking for confirmation that the
relationship is still intact or physically cling to others when they attempt to leave.
Unfortunately, this scenario can be a double edged sword. The more a person seeks
reassurance that their relationship with another is "safe," the more likely they are to push that
person away, sabotaging themselves in the process.
Unstable Relationships

BPD is often associated with patterns of very unstable and intense interpersonal relationships.
A pattern of alternating between idealization and devaluation in relationships is common, a
process referred to as "splitting." A relationship may start in the idealization phase with the
person with BPD feeling intensely connected to and positive about the other person and
wanting to spend a lot of time with this person. When the devaluation phase emerges,
however, the person with BPD may see the other person as worthless, mean or uncaring, and
may attempt to distance herself from him or her.

In addition, a relationship with someone with BPD is commonly characterized by lots of

conflict, ups and downs, mistrust, neediness, and frequent arguments. In fact, a person with
BPD often feels disappointment in or even hatred towards loved ones. They also have
difficulty recognizing the feelings of others or empathizing with others.

Impairment in Identity

The same instability in relationships can also apply to self-image or sense of self. A person
with BPD may seem to believe that she is successful one moment, but the next may be
extremely self-denigrating or hard on herself. Her sense of self may also be unstable, which
may lead her to behave differently in different contexts, such as behaving one way around
one group of friends but another way entirely around another group.

In addition, a person with BPD may feel non-existent or unsure about their identity or role
(for example, feeling like you don't know who you really are as a person, or what you believe
in.)

Impulsivity

Many people with BPD exhibit risky impulsive behaviors, such as:

 Spending sprees
 Having promiscuous sex
 Driving recklessly
 Abusing drugs or alcohol
 Binge eating
 Breaking the law (for example, shop lifting)

These impulsive behaviors, in turn, often lead to problems with relationships, physical health,
or legal issues.

Self-Harm or Suicide Behaviors

Some individuals with BPD may engage in self-harming behaviors and some make suicidal
gestures or attempts.

Self-harming behaviors and suicidal gestures are actually separate issues—self-harming

behaviors are not attempts to commit suicide. Self-harming behaviors (self-mutilation) are
attempts to get rid of emotional pain or intensely uncomfortable feelings. People who self-
harm rarely do so when others are present. Yet you may see signs of self-harm, including
scarring or wounds from cutting, burning, or other forms of self-injury.

People with BPD may also threaten suicide and may make suicide attempts. Such threats or
attempts should be taken very seriously. It's thought that roughly 70 percent of people with
borderline personality disorder will make at least one suicide attempt during their life, and for
nearly 10 percent of people with BPD, the attempt will be successful. If you are thinking that
you or a loved one may have BPD, write down the number for the National Suicide
Prevention Hotline before you leave this page.

Emotional Instability

Although this is not always something that can be observed from the outside, people with
BPD tend to have intense and frequent mood changesthat usually occur in response to
something happening in the environment. A person with BPD may go from seemingly
content to feeling upset in a matter of minutes or even seconds. She (or he, as men may have
BPD as well) may also experience intense negative feelings in reaction to day-to-day
situations and/or intense sadness or irritability that can last for hours.

Feelings of Emptiness

A person with BPD often feels a chronic sense of emptiness, like there is nothing inside or
that they are emotionally dead. This chronic feeling that life is of little worth can lead to
behaviors marked by emotional drama (such as hysteria, raging, and more) in order to attract
attention through a crisis. It's important for loved ones to understand the origins of these
behaviors, as common reactions only serve to increase these feelings of hollowness for a
person with BPD.

Intense Anger and Aggressive Behavior

People with BPD tend to feel intense anger that is stronger than the situation warrants. Some
people with BPD experience intense anger that they rarely or never express outwardly. Others
express anger openly, sometimes in the form of physical aggression. Angry behavior, ranging
from sarcastic comments to physical violence against other people, is a common sign of
BPD.

A Word From Verywell

It is important to remember that some of the symptoms described above are experienced by
many people from time to time. However, people with BPD experience several of these
symptoms daily or almost every day for years.

Also, people with BPD experience these symptoms across different contexts. For example,
they will experience instability in many relationships, not just one or two or even three.

If you think you may have BPD, it is important to see a licensed mental health
professional who can listen to your concerns and make an accurate diagnosis. You may feel
discouraged after reading about the signs and symptoms and how they affect nearly every
aspect of a person's life. Treatment with a good mental health professional, however, can help
both those suffering from BPD and their family and friends manage the symptoms and the
underlying basis of the condition.

If You Are Concerned About Yourself

If you are concerned that you may have BPD yourself, please understand that we realize
where the behaviors that are signs and symptoms of BPD originate. Those who are educated
in BPD understand that annoying actions like repeated phone calls are your attempt to cope
with a fear of abandonment. Going from seeing someone as wonderful to despising them may
leave friends confused, yet it is a protective mechanism your mind enacts to try and keep you
from being hurt. Finding a good therapist can make a world of difference for people living
with this condition. Many of the issues that now make you see red can be coped with much
more easily when you recognize them for what they are. A good therapist can help you
discover and learn to cope with your triggers and help you develop healthy coping skills.

If You Are Concerned About a Family Member or Friend

If you landed on this page because you are wondering whether a friend or family member
may have BPD, keep in mind that help is available. That said, if you have watched your
friend value and then devalue other friends, you may be wondering when it will be your turn.
You may be worried that if you open your mouth, you will be the next one to be "devalued"
and labeled the black sheep. Take a moment to learn about how to cope when a loved one
with BPD is "splitting." Family therapy can be very helpful. The important point to make is
that BPD can affect anyone involved, and it's important to care for yourself as well as your
loved one.

https://www.verywellmind.com/is-there-a-borderline-personality-test-425182

Diagnosing and Treating

Borderline Personality
Disorder
Is There a Borderline Personality Disorder Test?

Borderline personality disorder (BPD) is a mental health condition that causes people to have
difficulty regulating their emotions. The primary symptoms of the condition are dramatic
mood swings, impulsive behaviors, poor self-esteem, and persistent difficulties in personal
and professional relationships.
People dealing with borderline personality disorder often experience a different perception of
reality and in particular, may feel a strong sense of abandonment by loved ones. BPD can
lead to additional mental health difficulties, such as self-harm and suicide.

Cause of BPD

It is not yet known exactly what causes BPD, but a combination of genetics, neurological,
and social factors are most likely at play in people with the condition. For example, people
with a first-degree relative who has the condition are about five times more likely to suffer
from BPD. In addition, many people with BPD experienced trauma at some point in their
lives. And imaging studies have shown that people with BPD demonstrate structural and
functional differences in their brains compared to those who don't have the condition.

Diagnosing Borderline Personality Disorder

Only a qualified mental health professional can diagnose BPD. Usually, a diagnosis is made
after a comprehensive assessment, which is much more than a simple test. The process may
include consultations and conversations with previous caregivers, family members, and
friends. Ultimately, a diagnosis requires at least five of the nine primary symptoms of BPD to
be present:

1. Fear of abandonment
2. Difficult interpersonal relationships
3. Uncertainty about self-image or identity
4. Impulsive behavior
5. Self-injurious behavior
6. Emotional changeability or hyperactivity
7. Feelings of emptiness
8. Difficulty controlling intense anger
9. Transient suspiciousness or “disconnectedness”

Often, ordinary activities and events can precipitate symptoms in a person with BPD. For
example, when a close friend or relative takes a vacation or has to cancel plans due to a work
conflict, a person with BPD may become very upset and angry, fearing abandonment.

Treating Borderline Personality Disorder

Treatments plans for BPD typically involve some combination of therapy, medication, and
social support. Therapy may include dialectical behavioral therapy, cognitive behavioral
therapy, and psychodynamic psychotherapy. Medications that may be useful include mood
stabilizers, antidepressants, or antipsychotics. Often, treatment plans need to be adjusted
based on trial and error.

In addition, adhering to some of the following lifestyle modifications may be useful in

recovering from BPD:

 Maintain a regular eating and sleeping schedule

 Exercise regularly
 Spend time with friends and family and build trusting relationships with people you can
confide in
 Inform friends, family, and co-workers about what may trigger symptoms
  Be patient with your progress
 Learn about your condition and stay informed about treatment options
 Avoid alcohol and drugs

https://www.verywellmind.com/borderline-personality-disorder-therapy-425452

Cognitive Behavioral
Therapies for Borderline
Personality Disorder
Traditional CBT and Two Unique Types

Cognitive-behavioral treatments are the cornerstone of therapy for people with borderline
personality disorder. Let's learn about cognitive-behavioral therapy, including two unique
types that are used to help those specifically with BPD adopt healthy coping skills and
achieve a good quality of life.

What Is Cognitive-Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a type of psychotherapy that targets the “cognitive”
(thinking-related) and “behavioral” (action-related) aspects of a mental health condition. The
goal of CBT is to help you to reduce your symptoms by changing the way you think about or
interpret situations, as well as the actions that you take in your daily life.

What to Expect

CBT is very focused on the present, meaning that you do very little talking about your past.
While you may talk to your therapist about how you came to think or behave the way you do,
most of the therapy is focused on how your current ways of thinking/acting are related to
your symptoms, and how to change these patterns.

CBT is also fairly directive, meaning that your therapist will often take an active role in your
therapy session, giving you direct advice and guidance.

Because cognitive behavioral therapists operate under the assumption that your symptoms are
in part related to patterns of thinking and behaving that you have learned over the course of
many years, they believe that one or two hours of therapy each week will not produce any
major change.
For this reason, most CBT therapists assign homework — they want you to work to change
the patterns outside of the therapy session. So don’t be surprised if you leave your CBT
therapy session with handouts to read and homework sheets to complete.

CBT for BPD

While the basic principles of CBT can be helpful for people with borderline personality
disorder (BPD), some experts have noted that the disorder requires specialized CBT
techniques. Two unique cognitive behavioral therapies that have been designed specifically
for BPD are:

 Dialectical Behavior Therapy

 Schema-Focused Therapy

Both dialectical behavior therapy (DBT) and schema-focused therapy have been shown to be
effective in reducing BPD symptoms. DBT consists of both individual and group therapy
sessions, as well as phone coaching sessions, where a person with BPD focuses on behavioral
skills like:

 achieving mindfulness — paying attention to the present or living in the moment

 regulating emotions
 tolerating distress or conflict
 navigating relationships with other people
 achieving motivation to avoid unhealthy coping skills, like self-harm

Schema-focused therapy is based on the idea that personality disorders like BPD develop as a
result of maladaptive thoughts or behaviors early on in life. People then develop unhealthy
coping skills, like avoidance, to avoid triggering those thoughts or behaviors. Schema-
focused therapy is not like traditional cognitive-behavioral therapy in that it's more flexible
and attune to a person's emotions. It also requires a longer treatment period, ranging from one
to four years.

Finding a Cognitive Behavioral Therapist

While CBT has been around for decades, it can be difficult to find a therapist who has been
trained in this approach. If you are interested in finding a CBT therapist in your area, try
the Association for Behavioral and Cognitive Therapy’s Find-A-Therapist Directory.

If you are interested in finding a Dialectical Behavior therapist, try the Behavioral Tech
Clinical Resources Directory. It's also a good idea to speak with your primary doctor or
psychiatrist for a referral to ensure this is the right treatment plan for you.

https://www.verywellmind.com/reuptake-definition-of-reuptake-425323
Reuptake in Medications
Used to Treat BPD
Depression
How Selective Serotonin Reuptake Inhibitors (SSRIs) work

Reuptake is an important medication feature to understand if you have borderline personality

disorder (BPD) or any other mental health problem. Why? Because many medications used to
treat mental health disorders work by altering a number of particular neurotransmitters in the
brain. Reuptake is a key part of this process.

Neurotransmitters are chemical messengers that provide a pathway for transmitting signals
released by nerve cells (neurons) across synapses (the spaces between cells) from one nerve
cell to another. Reuptake is what happens after a signal is transmitted: The neurotransmitter,
its "work" completed, is reabsorbed back into the cell that previously released it.

Why Is Reuptake Important in Treatment for BPD Depression?

Depression in BPD and other mental health disorders are associated with low levels of certain
brain chemicals, including serotonin, dopamine, and norepinephrine.

If you have BPD and are taking medication to treat depression (in other words, an
antidepressant), you may be taking a selective serotonin reuptake inhibitor or SSRI. The most
commonly prescribed antidepressants, SSRIs are often used to treat people with BPD by
reducing the symptoms of moderate to severe depression.

SSRIs increase the amount of the neurotransmitter serotonin in the brain by, as you're now
aware, slowing its reuptake into the cells that transmitted it. As a result, higher-than-normal
levels of serotonin are left to circulate in the brain. Increasing the amount of serotonin in the
brain appears to help brain cells communicate, which in turn helps lift depression and
improve mood. Serotonin has been called the body's natural "feel-good" chemical because it
produces a sense of well-being.

As you can see, SSRIs don't help the body to produce more serotonin. Instead, they help the
body circulate more of the serotonin it has.

Examples of SSRIs

Here are the names of the SSRIs available for your doctor to prescribe:

 Citalopram (Celexa)
 Escitalopram (Lexapro)
 Fluoxetine (Prozac, Sarafem)
 Fluvoxamine (Luvox)
  Paroxetine (Paxil, Paxil XR, Pexeva)
 Sertraline (Zoloft)

A Word of Warning of Serotonin Syndrome

The process of reuptake also plays a role in this rare but dangerous condition, which occurs
when a person takes two medications that increase the level of serotonin in the body. This can
result in dangerously high serotonin levels in the brain.

Medications you should not take together include:

 Antidepressants, including SSRIs

 Certain pain or headache medications
 The herbal supplement St. John's wort

Signs and symptoms of serotonin syndrome include:

 Rapid heart rate

 Anxiety
 Agitation
 Lack of coordination
 Confusion
 Sweating
 Tremors
 Restlessness

If you have any of these signs or symptoms, get medical help immediately.

Serotonin syndrome is more likely to occur when you first start taking a serotonin-boosting
medication or when you increase the dose.

Serotonin syndrome is rare, largely because doctors are very careful about prescribing
medications that could cause it. Nevertheless, because this syndrome is so dangerous, the
FDA has asked the makers of these types of medications to put warning labels on them that
can alert you to this risk.

https://www.verywellmind.com/mood-stabilizers-for-bpd-are-they-effective-425460
Mood Stabilizers for
Borderline Personality
Disorder (BPD)
Curbing impulsive behavior

Mood stabilizers for borderline personality disorder (BPD) can be effective in reducing BPD
symptoms, particularly emotion dysregulation and impulsivity symptoms. These psychiatric
pharmaceutical medications are increasingly prescribed for people with BPD,
although psychotherapy is still considered the most important form of treatment. What are the
benefits and the risks?

What Are Mood Stabilizers?

The term mood stabilizer is used to describe any medication that reduces the frequency of
intense mood shifts, or lability. Different types of medications are prescribed as mood
stabilizers for people with BPD. Medications originally developed to treat seizures, called
“anticonvulsants,” are commonly prescribed for their mood-stabilizing effects. Examples
include:

 Tegretol, Equetro (carbamazepine)

 Lamictal (lamotrigine)
 Trileptal (oxcarbazepine)
 Topamax (topiramate)
 Depakote (valproic acid, divalproex sodium)

Lithobid (lithium carbonate) is an anticonvulsant mood stabilizer that has been a mainstay of
treatment for bipolar disorder for years.

How Effective Are Mood Stabilizers for BPD?

Research is limited, but it does appear that mood stabilizers can treat some BPD symptoms
effectively. The most-studied medication is lithium. Most of those studies focused on the
treatment of impulsivity, but one study showed that lithium can be effective in treating BPD
anger and irritation. Some studies hint that other anticonvulsant mood stabilizers may help
treat mood and emotional symptoms in BPD, and a different type of medication, called
atypical antipsychotics, offers an additional treatment option.

Risks and Side Effects of Mood Stabilizers for BPD

Risks and side effects of these medications can vary depending on the type of mood stabilizer
you're taking. For example, each anticonvulsant mood stabilizer has its own unique side
effect profile.
Lithium carbonate can cause gastrointestinal distress such as nausea and vomiting; weight
gain; acne; tremors (shaking); and cognitive problems (for example, feeling that your
thinking is slowed or fuzzy). Lithium can also affect your kidneys and thyroid gland, so
blood tests are required to monitor their function while you're taking this medication. Lithium
can also be very toxic in high doses, so it is less likely to be prescribed for people with BPD
who are at risk for suicide.

Other possible side effects with anticonvulsants include gastrointestinal complaints, weight
gain, rashes, fatigue, and dizziness. In addition, some of these medications carry a risk of rare
but serious side effects. For example, people taking carbamazepine must be monitored for the
possible development of agranulocytosis, a rare condition marked by a significant decrease in
white blood cells. Toxicity is also a concern with certain anticonvulsant mood stabilizers for
BPD.

Questions to Ask Your Psychiatrist

Talk to your psychiatrist about any concerns you have before you start taking a mood
stabilizer for BPD. Make sure you understand the risks and side effects as well as the
reason(s) you are being prescribed a particular medication. Here are some questions you
might want to ask:

 Which BPD symptoms do you expect this medication to affect?

 Are there particular risks or side effects I should watch for?
 How will this medication interact with other medications I'm taking?
 How long will I need to take this medication before I start to notice its effects?
 How long do you think I'll need to be on this medication?

https://www.verywellmind.com/antipsychotics-for-borderline-personality-disorder-425457

Antipsychotics for Treating

Borderline Personality
Disorder
Medication may help improve thinking and reduce anger

Your psychiatrist may prescribe antipsychotics for one or more of your borderline personality
disorder (BPD) symptoms.
Why Antipsychotics for Borderline Personality Disorder?

The term "borderline" was coined because early psychiatrists believed that the symptoms of
BPD were "on the border" between neurosis and psychosis. For this reason, some of the first
medications tested for BPD were antipsychotics.

Although we now know that BPD does not share features with psychosis (and is not a
psychotic disorder), research has shown that antipsychotic medications may be effective in
reducing some of the symptoms of BPD – specifically, anger and hostility, intense mood
shifts, and cognitive symptoms, like paranoid thinking. That being said, research shows that
antipsychotics are not effective in improving anxiety, depressed mood, and impulsivity in
BPD.

In addition, while the short-term use of antipsychotics may be effective in BPD, the benefit of
frequent and long-term use of antipsychotic is controversial.

Types of Antipsychotics

There are two main types of antipsychotics: typical and atypical.

Typical Antipsychotics. Typical antipsychotics are the older variety of antipsychotic

medications, known as first-generation antipsychotics. They are less commonly used due to
their potential for serious side effects like movement disorders. Some typical antipsychotics
are:

 Haldol (haloperidol)
 Navane (thiothixene)
 Stelazine (trifluoperazine)

Atypical Antipsychotics. Atypical antipsychotics are the newer generation of antipsychotic

medications, and they produce less of the movement related side-effects. The six atypical
antipsychotics are:

 Zyprexa (olanzapine)
 Clozaril (clozapine)
 Seroquel (quetiapine)
 Abilify (aripiprazole)
 Geodon (ziprasidone)
 Risperdal (risperidone)

Side Effects of Antipsychotics

Tardive dyskinesia, a side effect that can occur from the long-term use of antipsychotics,
involves uncontrollable movements of the face, lips, tongue, limbs, and fingers. It's
irreversible, and the risk of developing it is higher with the typical antipsychotics than the
atypical antipsychotics. Other potential side effects are called extrapyramidal symptoms,
like akathisia, an intense sense of restlessness and agitation. Extrapyramidal symptoms are
also more common with the typical than the atypical antipsychotics. Neuroleptic malignant
syndrome is a rare but very serious condition associated with antipsychotics involving high
fever, delirium, and muscle rigidity.
While the atypical antipsychotics are less likely to cause tardive dyskinesia and
extrapyramidal symptoms, they are associated with other side effects like weight gain, new
onset diabetes, a rise in cholesterol, sexual dysfunction, and heart problems. In addition, some
of the individual antipsychotics carry their own unique side effects. For instance, a rare but
potentially fatal side effect of the atypical antipsychotic clozapine is agranulocytosis, a
decrease in white blood cells. Regular monitoring of blood counts is required when this agent
is used.

As shown, there are a number of potential side effects associated with antipsychotics, and
they vary by the type (typical vs atypical) of antipsychotic, as well as the individual
medication. If your doctor prescribes an antipsychotic, be sure to review the side effects with
your doctor and take the medication as directed.

Bottom Line

Treating BPD requires an individualized approach – meaning what works for you is likely
different from what works for someone else. It will take time for you and your doctor to
devise a plan for optimizing your care for your BPD, and this plan may include both
medication and psychotherapy. The good news is that there are excellent treatment
options available that can help you feel better and get well.

https://www.verywellmind.com/therapists-for-borderline-personality-disorder-425344

How to Find Dialectical

Behavior Therapy for BPD
Near You
DBT therapists are extensively trained to deliver dialectical behavior therapyfor borderline
personality disorder (BPD), a unique type of cognitive-behavioral therapy that has been
scientifically shown to reduce distressing symptoms of BPD, including self-harm and suicide
attempts.

DBT focuses on teaching behavioral skills like regulating emotions, living in the moment,
tolerating distress, and managing relationships with other people. DBT is done in both
individual and group therapy sessions, in addition to phone coaching sessions.
Finding a Dialectical Behavior Therapist Near You

DBT therapists can be hard to come by. However, there are a few resources that may help
you with your search.

The best place to begin your search is with the Clinical Resource Directorymaintained by
Behavioral Tech — an organization founded by Marsha Linehan, Ph.D. to train mental health
professionals in DBT. This directory allows you to search for clinicians and programs that
have gone through DBT training with Behavioral Tech, LLC, or the Behavioral Research and
Therapy Clinics at the University of Washington. The treatment programs can be searched for
by state.

You may also want to try the Association for Cognitive and Behavioral Therapies' Find-A-
Therapist directory. This database allows you to search for practitioners by name, location,
population served, and specialty (there is a "DBT" option under specialty). This directory also
includes international listings.

If these databases are not helpful, try calling departments of psychology or psychiatry at local
universities, colleges, or medical centers. Because DBT is an evidence-based approach to
treatment, academic training departments will often include practitioners who have been
trained in DBT. Another option is your local chapter of the National Alliance on Mental
Illness.

In addition, you may try looking up the government agency that addresses mental health
needs in your area. This may be the Department of Social Services, Department of Mental
Health, or a similar agency. These agencies may know of DBT therapists in your area and
may be able to facilitate a referral depending on your needs.

Be Sure to Talk to Your Doctor

It's a good idea to talk with your primary care physician or psychiatrist about your desire to
pursue DBT therapy. Your doctor can provide a referral and help confirm whether this is the
best therapeutic approach for you.

Remember, remain an advocate for your mental health and be sure to choose a therapist that
has proper DBT training and credentials.

https://www.verywellmind.com/emdr-trauma-borderline-personality-425453
Using EMDR to Treat
Trauma in Borderline
Personality Disorder
How eye movements may ease a traumatic memory

EMDR Therapy, or Eye Movement Desensitization and Reprocessing Therapy, is a therapy

designed to reduce distress associated with a traumatic or disturbing memory and to also
rework negative thoughts surrounding the memory.

Let's learn more about this type of therapy and understand why it may be a good option for
some people with borderline personality disorder.

Why is EMDR Used in People with BPD?

While EMDR therapy was originally designed to treat post-traumatic stress disorder (PTSD),
it's now often used to treat a variety of mental health conditions, including anxiety
disorders and depression — when a person with this disorder can identify a certain disturbing
or traumatic memory.

Likewise, since many individuals with borderline personality disorder (BPD) have a history
of one or more traumatic memories, EMDR is sometimes used to ease the memory and the
emotions associated with it.

What Is EMDR Therapy?

EMDR is considered an integrative approach to psychotherapy (i.e., talking therapy). This

means that it draws on a number of different theoretical perspectives of treatment,
like cognitive behavioral and psychodynamicperspectives.

During an EMDR session, an EMDR therapist will ask the client to recall a single traumatic
memory. Then a client will be asked to conjure up a visual image of the memory while
simultaneously describing a negative thought associated with it. The person is also asked to
share their negative emotions, like fear or anger, about the memory, and the physical
sensations associated with these negative emotions.

The client will be asked to replace the negative thought with a positive thought while
attending to a dual attention stimulus at the same time. The most common dual attention
stimulus is lateral eye movements, which is moving the eyes left and right following the
therapist's hand movements.

Dual attention stimuli are believed to facilitate the processing of painful or anxiety-producing
memories, promoting deeper reprocessing of the stored memory. Other forms of dual
stimulation involve the use of tapping of bilateral body parts (e.g., both knees) or tones
stimulating both ears of the client at the same time.

Is EMDR Therapy Effective?

There have been a number of research studies that demonstrate the effectiveness of EMDR in
the treatment of post-traumatic stress disorder. In addition, EMDR it's supported by the
American Psychiatric Association in the treatment of trauma.

Despite the scientific evidence that EMDR is an effective treatment for trauma, this approach
continues to generate some controversy due to the concern over whether eye movements and
other forms of dual attention stimuli are really helpful in processing traumatic memories.

A recent 2013 article in the Journal of Behavioral Therapy and Experimental

Psychiatry analyzed a number of scientific studies on EMDR, and the authors concluded that
eye movements are valuable and do alter the processing of emotional memories.

How Can I Find an EMDR Therapist?

If you are interested in finding an EMDR therapist, you may want to try the therapist
directory provided by the EMDR International Association. You can also try asking your
primary care physician, general practitioner, or psychiatrist for a referral.

https://www.verywellmind.com/anti-anxiety-medications-for-bpd-425455

Anti-Anxiety Medications
for Borderline Personality
Disorder
Can anti-anxiety medications help treat BPD?

To date, there are no medications approved by the Food & Drug Administration (FDA) to
treat borderline personality disorder (BPD). However, some individuals with BPD are
prescribed anti-anxiety medications, also known as “anxiolytics," to treat the intense anxiety
and agitation associated with BPD. This is completely up to your individual doctor and your
unique situation.
Like any medication, however, there are both advantages and drawbacks to treatment with
anti-anxiety medications. Here are some things to keep in mind and to ask your doctor if your
psychiatrist is considering prescribing anti-anxiety medications for your BPD symptoms.

Are Anti-Anxiety Medications for BPD Effective?

Unfortunately, there is very little research to indicate whether anti-anxiety medications for
BPD are actually effective. There are a few published papers that describe patients with BPD
who have found relief from symptoms when taking these medications, but no controlled
clinical trials have examined the usefulness of anti-anxiety medications for BPD.

Research has been mixed on these medications' overall effects. On an individual basis, some
have reported significant improvement in their BPD symptoms. Others reported worsened
symptoms when taking certain drugs like Xanax because it heightened their urges
for impulsive behaviors.

Types of Anti-Anxiety Medications

The most commonly prescribed anti-anxiety medications are called benzodiazepines. Some
examples include:

 Ativan (lorazepam)
 Klonopin (clonazepam)
 Xanax (alprazolam)
 Valium (diazepam)

Unfortunately, these may not be the best choice for individuals with BPD who also have
substance use problems, because benzodiazepines can be habit-forming. There are some non-
benzodiazepine anti-anxiety medications that are not habit-forming, and these may be an
alternative to medications from the benzodiazepine family. These tend to be more frequently
recommended, as they can help you transition as you make progress in your therapy and
recovery.

Risks and Side Effects of Anti-Anxiety Medications

It's important to know that these drugs can have significant side effects, particularly in people
with BPD since they have not been thoroughly tested in that population.

The most common side effect of anti-anxiety medication is feeling sleepy, fatigued or
groggy. Other side effects include impaired coordination and memory problems. You should
not take anti-anxiety medication if you drink, as it can worsen the foggy effect. Many anti-
anxiety medications should not be taken by pregnant women or women trying to become
pregnant.

Medications from the benzodiazepine family should not be mixed with other sedating
medications or with alcohol.
Questions to Ask Your Psychiatrist

You should talk to your psychiatrist before you start taking anti-anxiety medications or any
other type of medication for BPD. If you have any concerns, let them know. Make sure you
understand the risks and side effects and be sure to have an in-depth discussion about the
reasons you are being prescribed a certain medication. Here are some questions you might
want to ask:

 Which symptoms do you expect this medication to address?

 Should I be concerned about developing tolerance to this medication?
 Should I be concerned about the potential for more impulsivity with this medication?
 How long do I need to take this medication before I start to notice effects?
 How long do you think I’ll need to be on this medication?

https://www.verywellmind.com/what-to-expect-during-imaginal-exposure-425469

Imaginal Exposure &

Borderline Personality
Disorder
Imaginal exposure is a technique that has shown promising results

Imaginal exposure is one part of an approach to treatment called cognitive behavioral

therapy (CBT). CBT therapy focuses on the idea that most psychological problems can be
traced back to early learning experiences and those experiences affect how we interpret and
react to things that happen to us later in life.

CBT is an empirically supported treatment - meaning it has been extensively researched and
scientifically proven - for borderline personality disorder. BPD can be related to traumatic
experiences.

Whether it was an experience from when you were a toddler that you have forgotten or
something horrific that happened while a teenager, these incidents may be responsible for
some or all aspects of your BPD.

In the CBT model, part of the reason that traumatic experiences from the past continue to
trouble us today is that we learn to avoid thinking about them. This is natural since past
events can cause very painful emotions and we try not to live in the past. But because we try
to push away thoughts about the occurrences and avoid anything that reminds us of those
experiences, we actually prevent ourselves from learning that the memories won’t harm us
and that we are safe. Imaginal exposure aims to bring these experiences to the surface so that
you can reframe how you think about and react to those memories. By shifting those
reactions, your reactions and behaviors in other situations may also be improved.

How Imaginal Exposure Works

Imaginal exposure is one way that CBT therapists address this problem. In imaginal
exposure, you will be asked to imagine yourself back in one of your traumatic events. You
will be asked to try to “re-live” the event in your mind’s eye, with all of the feelings,
sensations, smells, sights and sounds that happened during the event.

Usually, imaginal exposure is done in your therapy session. Your doctor will guide you
through the process, helping to keep you on track and secure. They will be very careful not to
push you to a point of fear or discomfort, as they understand how awful it can be to think of
these traumatic experiences. It is important to do imaginal exposure under the guidance of a
therapist -- this is not something to attempt on your own or with a friend.

Over time, you may find that you are having less intense reactions to the memories of the past
events. There is a great deal of research demonstrating that imaginal exposure is an effective
way to reduce trauma-related symptoms. It doesn’t work for everyone, but many people have
significantly fewer issues and can better manage their borderline personality disorder after
completing exposure therapy.

https://www.verywellmind.com/empirically-supported-treatments-425246

Empirically Supported
Treatments for
Psychological Disorders
Empirically supported treatments, otherwise known as evidence-based treatments or
evidence-based practices, are treatments and therapies have research-based medical and
scientific evidence showing that they work.

How do doctors know that empirically supported treatments work? That's where the research
comes in. Empirically supported treatments have been tested in scientifically
designed randomized controlled trials.
If you're not sure what a randomized controlled trial is, you're not alone. The following
explanation can help.

What Is a Randomized Clinical Trial?

First, it's important to understand that randomized controlled trials are considered the "gold
standard" for testing new treatments. Every new treatment submitted for FDA approval must
be supported by results from randomized controlled trials demonstrating that it's both safe
and effective.

For instance, when your doctor prescribes a medication for you here in the United States, it's
an empirically supported treatment that the FDA has approved.

The words "randomized," "control," and "trial" have specific meanings in terms of testing
new medical treatments:

Randomized means the participants in the study have been assigned in no particular way to
the groups that will be studied. This is done so that the results of the study won't be skewed
by the participants' or study investigators' knowledge of how they were chosen.

Controlled means that one of the groups studied does not receive the new ("active")
treatment being tested. Instead, they receive a "placebo" or "dummy" that looks like the
tested medication but doesn't contain its active ingredient. The placebo may be a "sugar pill"
or another medication.

This study design allows the researchers to reasonably expect that the health effects they
observe in the "active" group that they don't observe in the control group resulted from the
use of the new treatment.

Trial simply means that the treatment is on trial during the randomized controlled trial. If the
study results are positive for the treatment's safety and effectiveness, and the results lead to
approval of it by the FDA, it's an empirically supported treatment.

Empirically Supported Treatments for BPD

There are currently three treatments for borderline personality disorder (BPD) that are
considered empirically supported: Dialectical Behavior Therapy, Schema-Focused Therapy,
and Transference-Focused Therapy.

Where to Get Additional Information About Empirically Supported Treatments

The Society of Clinical Psychology, a division of the American Psychological Association,

maintains a list of psychotherapy treatments that are considered empirically supported. The
Society also supports an ongoing discussion within the field of psychology about how best to
define and promote the use of empirically supported treatments.

The United States Substance and Mental Health Services Administration (SAMHSA)
maintains the National Registry of Evidence-Based Programs and Practices (NREPP),
another list of empirically supported treatments.
https://www.verywellmind.com/what-is-akathisia-borderline-personality-disorder-425274

What Is Akathisia?
Borderline Personality
Disorder
Learn about Akathisia - its causes and how to stop it

Akathisia is a common side effect of antipsychotic and antidepressant medications used to

treat borderline personality disorder (BPD). Its main symptoms are extreme restlessness and
discomfort. If you have akathisia, you may feel compelled to move, particularly your legs. It
will cause you to constantly want to fidget or shift from one leg to the other. While it may
sound harmless, akathisia can be very irritating and can cause people with BPD to
discontinue their medicine. It's important to recognize symptoms of this side effect and talk to
your doctor about them to get the best medicine for your situation.

What is the Cause of Akathisia?

Scientific understanding of akathisia is currently very limited. While it is recognized as a

common side effect of certain medications, doctors don't understand why or how it causes
symptoms of restlessness. Some researchers suggest that it is caused by a chemical imbalance
caused by the medication. It overstimulates areas of the brain, potentially resulting in the
compulsion to move.

How is Akathisia Recognized?

Recognizing akathisia can be difficult, as it sometimes can appear to be a heightened version

of your BPD symptoms. In some people, it makes them more anxious and nervous. In others,
it is solely evidenced by constant movement of the hands, feet or arms. In some rare cases,
akathisia has caused symptoms like rage, fear, nausea and psychotic symptoms.

The symptoms of akathisia often mimic or overlap with those of other illnesses, such
as general anxiety disorder, depression or mania. In some cases, the sensation of this side
effect is so odd that patients have difficulty explaining how they're feeling, limiting the
possibility for effective treatment.

Because of how easily akathisia can be confused with other illnesses or symptoms, a
consultation with a clinician experienced in this side effect is usually recommended. He or
she will use a tool such as the Barnes Akathisia Rating Scale to determine its presence and
severity.
How Is Akathisia Treated?

Once akathisia has been diagnosed, it is typically treated by discontinuing the use of
whatever antidepressant or antipsychotic medication you are on. Depending on your
situation, your healthcare provider may opt to simply lessen your dose rather than discontinue
its use completely or she may prescribe a new medication.

In some cases, your doctor may also prescribe a beta-blocker to treat the akathisia symptoms.
Beta-blockers prevent certain receptors that encourage increased cardiac activity from being
activated. They are often used to treat high blood pressure or heart issues. Beta-blockers have
been found to decrease or eliminate symptoms of akathisia when taken daily, so they are an
effective treatment option for some people. However, beta-blockers have their own potential
side effects, so talk to your doctor about your options and what sort of signs to look out for.

Bottom Line

While akathisia is a common side effect of medication used to treat BPD, it is treatable and
manageable. If you experience akathisia and are tempted to stop taking your medicine
because of it, talk to your doctor about what you are feeling and your concerns. He will help
you identify a solution that will make you more comfortable while maintaining your path to
recovery.

https://www.verywellmind.com/self-help-for-bpd-425464

Self-Help Strategies for

Borderline Personality
Disorder
Consider supplementing your therapy with self-help

While borderline personality disorder (BPD) is a serious condition that requires treatment by
qualified mental health professionals, there are also sources of self-help (or self-guided
strategies for symptom reduction) for people with BPD.

These self-help strategies should be used in conjunction with formal treatments for
BPD (such as psychotherapy and medication).
Self-Help Education in BPD

It is important to be educated about the BPD diagnosis, the symptoms of BPD, available
treatments, and other facets of the disorder. In fact, most professional treatments for BPD
include a psychoeducation component, and there is evidence that just receiving education
about BPD can reduce symptoms.

In addition to the education that you receive as part of treatment, however, it is possible to
find additional information on your own. There are a variety of good sources of knowledge
about BPD, including websites and books.

It is important to remember, however, that not all sources of information are reliable. For
example, while the internet can be an excellent source of reliable information, there is also
unreliable information on the web.

This website has a number of articles and resources developed to provide education on BPD.
Get started by learning some of the basics of BPD.

 What Is BPD?
 Symptoms of BPD
 How Is BPD Diagnosed?
 Treatments for BPD
 Living with BPD

Self-Help Coping Skills Training in BPD

Another appropriate use of self-help for BPD is in the area of coping skills training. Many
people in treatment for BPD augment their formal skills training with informal self-guided
training. To learn some coping skills that you can start using now, check out these resources.

In addition, there are some very good books available to help you learn healthy coping skills.
Two highly recommended books include:

The Borderline Personality Disorder Survival Guide by Alex Chapman and Kim Gratz, 2007,
New Harbinger Publications.

The Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning
Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance by
Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley, 2007, New Harbinger Publications.

Self-Help Emotional Processing and Expression in BPD

Some people find that processing or expressing emotions on their own can be a very useful
way to engage in self-help. For example, some people write in a journal or blog, others draw
or paint, and some find other creative, healthy ways to express their emotions. There is some
research that suggests that expressive writing can have a variety of positive consequences,
including better physical health and reduced psychological symptoms.

It is important to note that for some people, engaging in these types of strategies can feel
overwhelming or triggering. If you feel you do not have the coping skills needed to manage
the emotions that come from emotional processing activities, then you probably need to start
with some coping skills training. However, if you and your therapist think you are ready to
try emotional processing exercises, you may find that writing in a journal can be a good place
to start.

https://www.verywellmind.com/borderline-personality-disorder-medications-425450

Types of Borderline
Personality Disorder
Medications
Borderline personality disorder is sometimes treated with medications for anxiety or
depression, which have been shown to reduce some of the symptoms of borderline
personality disorder (BPD). While there are currently no medications approved by the FDA
to treat BPD, they have been found to be effective in some cases. Also, medications may be
used to treat psychological conditions that frequently co-occur with BPD, such as major
depressive disorder. Medications may be particularly effective for BPD when they are used in
conjunction with psychotherapy and other treatments.

Antidepressants

While antidepressants were specifically developed for individuals with major depressive
disorder and other disorders characterized by low mood, many individuals with BPD are
treated with these medications.

There are several types of antidepressants that have been studied for use with BPD, including
tricyclic and tetracyclic antidepressants, monoamine oxidase inhibitors (MAOIs),
and selective serotonin reuptake inhibitors(SSRIs). Research has shown that these
medications may help with the sadness, low mood, anxiety, and emotional reactivity often
experienced by people with BPD, but they do not seem to have a strong effect on other
symptoms of the disorder (e.g., anger, impulsivity).

Common antidepressants include:

 Nardil (phenelzine)
 Prozac (fluoxetine)
 Zoloft (sertraline)
 Effexor (venlafaxine)
 Wellbutrin (bupropion)
Antipsychotics

The term "borderline" was coined because early psychiatrists believed that the symptoms of
BPD were "on the border" between neurosis and psychosis. For this reason, some of the first
medications tested for BPD were antipsychotics. Since this time, it has been found that
antipsychotics can have a positive effect on a variety of non-psychotic disorders, including
BPD. Antipsychotics have been shown to reduce anxiety, paranoid thinking, anger/hostility,
and impulsivity in patients with BPD.

Common antipsychotics include:

 Haldol (haloperidol)
 Zyprexa (olanzapine)
 Clozaril (clozapine)
 Seroquel (quetiapine)
 Risperdal (risperidone) (Risperdal)

Mood Stabilizers/Anticonvulsants

Medications with mood stabilizing properties, such as lithium, and some anticonvulsant (anti-
seizure) medications, have been used to treat the impulsive behavior and rapid changes in
emotion that are associated with BPD. There is research to suggest that these classes of drugs
may be useful in BPD.

Common mood stabilizers/anticonvulsants include:

 Lithobid (lithium carbonate)

 Depakote (valproate)
 Lamictal (lamotrigine)
 Tegretol or Carbatrol (carbamazepine)

Anxiolytics (Anti-Anxiety)

Because individuals with BPD also often experience intense anxiety, medications to reduce
anxiety are sometimes prescribed. Unfortunately, there is very little research to support
the use of anti-anxiety medication to treat BPD. Also, there is some evidence that uses of a
particular class of anxiolytics, benzodiazepines (e.g., Ativan, Klonopin), may actually cause a
worsening of symptoms for some individuals with BPD, and should be prescribed with
caution. Benzodiazepines are particularly dangerous for use by individuals with co-occurring
substance use disorders because they can be habit-forming. Buspar, an anxiolytic that is not
habit-forming, is an alternative to medications from the benzodiazepine family.

Common anxiolytics include:

 Ativan (lorazepam)
 Klonopin (clonazepam)
 Xanax (alprazolam)
 Valium (diazepam)
 Buspar (buspirone)
Other Borderline Personality Disorder Medications

As we learn more about the biological causes of BPD, new medications are being developed
and tested for the disorder. For example, findings from a recent study suggest that an omega-
3-fatty acid supplement can lead to decreased aggression and feelings of hostility in people
with BPD.

https://www.verywellmind.com/what-is-phone-coaching-and-how-can-it-help-you-425470

Phone Coaching Can Treat

Borderline Personality
Disorder
Phone coaching is an essential part of your therapy

One important aspect of dialectical behavior therapy (DBT) for borderline personality
disorder is phone coaching. What is phone coaching, and how can it help you cope with
symptoms?

Phone coaching is one of the essential elements of dialectical behavior therapy (DBT), a very
effective form of psychotherapy that is used for borderline personality disorder (BPD). While
there is no cure for BPD, DBT has been proven to decrease the occurrence and severity of
symptoms. When you begin a DBT program, you will have regular sessions with your
therapist, so it's imperative that you feel comfortable with that person.

If you have BPD, you likely have experienced a wide range of symptoms that prevent you
from living a normal life. From addictions to violent mood swings and suicidal thoughts,
BPD is a serious illness that requires a holistic approach to treatment. This makes DBT and
all of its components so important for your recovery during therapy.

In DBT, you will be provided with group skills training, a therapy group in which you will
learn basic skills for managing emotions, maintaining relationships and tolerating distress,
and individual psychotherapy with a therapist. During these sessions, you'll work on
controlling overly intense emotions, reduce self-destructive or harmful behaviors and manage
your pain. It is a problem-solving approach to BPD that can cause significant results for
patients.
The Role of Phone Coaching

One pivotal part of DBT is the role of phone coaching. DBT therapists must be available for
phone coaching throughout the course of your therapy. You will be encouraged to call your
therapist at any time, day or night, when you're in need of help. It's especially helpful if you
often feel ashamed, scared or think your fears go unheard.

During the call, your therapist will talk you through the situation, helping to stop you from
harming yourself or taking part in destructive or dangerous actions. He will work with you
through phone coaching to use the skills you've learned to handle the situation or crisis
appropriately, without hurting yourself. Beyond preventing self-harming behaviors, phone
coaching will help you navigate difficult experiences and will provide encouragement during
these times.

Through coaching, your skills will be reinforced. Just like coaching helps an athlete, phone
coaching allows you to master the techniques you've learned and apply them to real life. This
empowers you to handle these situations confidently and eventually be able to get through
them alone.

Phone coaching should be used thoughtfully, but you should never hesitate to call your
therapist if you're in distress. While your therapist won't want you to use phone coaching
inappropriately, such as if you're refusing to use the skills you've learned, you are encouraged
to call whenever you feel in need of help. Many BPD patients don't call because they feel as
if they aren't worth the effort and don't want to disturb anyone, but it's essential that you trust
and confide in your therapist to help your progress.

https://www.verywellmind.com/transference-focused-therapy-borderline-personality-425467

Transference-Focused
Therapy for Borderline
Personality Disorder
Is transference-focused therapy right for you?

Transference-focused therapy for borderline personality disorder (BPD) is

a psychotherapy that focuses on using your relationship with your therapist to change how
you relate to people in the world.
What Is Transference?

Transference is the theoretical process by which emotions are transferred from one person to
another. Transference is a key concept in psychodynamic psychotherapies. In these types of
therapies, it is presumed that your feelings about important people in your life, such as your
parents or siblings, are transferred onto the therapist. You then come to feel about and react to
the therapist as you would to these important figures in their lives. It is believed that through
transference, the therapist can see how you interact with people and the therapist uses this
information to help you build healthier relationships.

Therapists who practice transference focused therapy for BPD believe that the key cause of
BPD is related to dysfunctional relationships in childhood that continue to
impact adolescent and adult relationship functioning. The theory is that through interactions
with our caregivers in early childhood, we develop a sense of self as well as mental
representations of others. If something goes wrong during this development, we may have
difficulty forming a solid sense of self or have problems in how we relate to other people.

Because there is evidence that childhood maltreatment or early loss of caregivers is

associated with increased risk of BPD and because the symptoms of BPD include significant
problems in relationships and instability in sense of self, some experts have proposed that
BPD needs to be treated by building healthier relationships through the use of transference.

What to Expect in Transference-Focused Therapy for BPD

In transference focused therapy for BPD, the focus is on the interaction between you and the
therapist. The therapist rarely gives advice or instructs you on what to do. Instead, the
therapist will likely ask you many questions and help you explore your reactions during
sessions.

In transference focused therapy, an emphasis is placed on the current moment rather than the
past. Instead of talking about how you related to your caregivers, you will spend more time
talking about how you are relating to your therapist. The therapist also tends to remain neutral
in this type of therapy and will avoid giving his opinion and is unavailable outside the therapy
session except during emergencies.

Research Support for Transference-Focused Therapy for BPD

Preliminary research supports the use of transference focused therapy for BPD. A
randomized controlled study, one of the most rigorous forms of research, demonstrated that
transference-focused therapy was equivalent to dialectical behavior therapy (DBT) in
reducing some of the symptoms of BPD, such as thoughts of suicide, and was better than
DBT in reducing other symptoms like impulsive behaviors or anger.

While this is promising preliminary support for the effectiveness of this treatment, it is
important to note a major limitation of this study: Patients in the transference-focused therapy
group received more individual psychotherapy than those in the DBT condition. While it is
possible that transference-focused therapy is as good if not better than DBT at reducing
symptoms of BPD, it is also possible that the improvements were due to the patients
receiving more therapy. More research is needed to examine the success of this treatment.
While more studies are being done, you may consider talking to your therapist about whether
or not transference-focused therapy might work for you. He will talk you through the benefits
and drawbacks of this kind of therapy and can give you a recommendation based on your
unique situation.

https://www.verywellmind.com/want-to-quit-therapy-425341

What to Consider Before

You Quit Therapy for BPD
If you have borderline personality disorder (BPD), it's very common to feel like you want to
quit therapy. In fact, it is quite natural to get frustrated with therapy or your therapist or to
feel like psychotherapy is not working anymore. But many people leave therapy before they
have reached their treatment goals—research shows that about 47 percent of people with
BPD leave treatment prematurely. Quitting therapy is a big decision, so think through your
reasons and your treatment goals.

What Are Your Reasons?

Before dropping out of therapy, think about your reasons for wanting to leave; you may find
it helpful to write a list. Common causes include:

 You don’t feel like the therapy is working

 You don’t like your therapist
 You don’t have time to attend sessions
 You think you've gotten better and are ready to go it alone
 The things you talk about in session are too emotional/intense
 You don’t think your therapist likes you
 You will never get better no matter what you do
 You believe your therapist is incompetent
 You don’t have enough money to pay for sessions

Talking to Your Therapist

Now that you have a list of your reasons for wanting to quit therapy, put a star next to the
biggest reasons so that you can discuss them with your therapist.

Perhaps you are embarrassed to discuss dropping out with your therapist because you don’t
want to disappoint or offend him. Or maybe you don’t trust her enough to discuss it with her.
Whatever your reason, addressing your concerns about therapy with your counselor may
help.
For instance, if you want to quit because of money or because of your schedule, your
therapist could perhaps work out a payment plan or agree to meet you after her main office
hours. She can also give you a referral to another therapist if you feel like you're not clicking
with her or making enough progress.

Don't be afraid to begin this discussion. It's highly unlikely that your therapist has not had a
discussion such as this before. Therapy brings up many emotions, and it's very common for
people to want to give up or to feel that nothing will really help. Be as honest as you can be.
Keep in mind that your therapist does what she does because she wants to help people.

Is It the Disorder Talking?

In some cases, the symptoms of BPD can convince you to quit therapy. If you
experience splitting, you may view your therapist with suspicion or dislike which could cause
you to drop out of therapy too early. People with depression as part of BPD can have periods
of hopelessness and extremely low motivation, which can make them want to drop out of
therapy as well. In both of these cases, a therapist can help you think through what is in your
best interest versus what your disorder is “telling you” to do.

What Are the Pros and Cons?

Another technique that can help you decide whether to drop out of therapy is called the pros
and cons tool. This is a tool that is taught in dialectical behavior therapy and can be a great
way of thinking through many different kinds of decisions.

Once you complete the pros and cons tool, think more about what direction you want to head
in. Does quitting therapy still seem like a good idea? Or, is it becoming clearer that another
path might make more sense? If quitting therapy still seems like the right choice, does this
mean quitting therapy outright, or just changing therapists or the type of therapy you are
receiving? Think through all of your options to make the best decision for you.

The Bottom Line

The bottom line is that there are many reasons that people drop out of therapy and sometimes
these are unavoidable. But sometimes people drop out of therapy prematurely without
thinking it through and talking to their therapists about it. If you are sure that you need to
drop out, consider other avenues of treatment. And, whether you choose to continue working
with a therapist or not, continue to work on your skills for coping with borderline personality
disorder.

Finally, before leaving therapy, make sure you have a safety plan for BPD in place.

https://www.verywellmind.com/mentalization-therapy-for-bpd-425459
Mentalization Based
Therapy for BPD
Is this a treatment option for you?

Mentalization-based is a type of psychotherapy for borderline personality disorder (BPD) that

focuses on your ability to recognize thoughts, feelings, wishes, and desires to see how they
are linked to behavior.

What Is Mentalization?

Mentalization is a term for your ability to recognize your own mental state as well as others'
emotions, separate from actions. It includes being able to think about feelings and understand
that these thoughts may have an impact on the actions that you and others take.

For example, imagine that you are meeting up with a friend after her salon appointment.
When she arrives, you mention that you don't think her new haircut is flattering. Your
conversation continues and then minutes later she ends the conversation abruptly, saying she
needs to go and leaves after a curt goodbye. Mentalization about this situation would lead you
to think about your friend’s internal state and how it relates to her behavior. While she never
said she was hurt, by recognizing others' emotions and feelings, you may recognize that your
words affected her negatively.

How Is Mentalization Related to BPD?

Anthony Bateman and Peter Fonagy, the developers of mentalization-based therapy for BPD,
believe that people with BPD are not able to mentalize adequately due to problems that
occurred within their childhood relationships. They propose that the capacity to mentalize is
learned in early childhood through interactions between the child and caregiver and if the
child and caregiver relationship is disrupted in some way, appropriate development of
mentalization is interrupted. This theory is supported by evidence that childhood
maltreatment or the early loss of caregivers is associated with increased risk of developing
BPD.

What to Expect

Mentalization-based therapy for BPD is a psychodynamic psychotherapy, which means that

the focus of the therapy is on the interaction between the patient and the therapist. In this
therapy, the therapist will focus on the present rather than the past and will work with you to
enhance your emotional recognition and connection. To do this, the therapist may ask you
questions about how your thoughts relate to your behavior during the session. In
mentalization-based therapy, the therapist will not usually give you advice or an opinion.
Instead, your therapist will coach you to explore your internal states and help you form new
ways of mentalizing.
Research Support

Some research has supported the effectiveness of mentalization-based therapy for BPD.
Researchers conducted one randomized controlled study, one of the most rigorous forms of
studies, in which people with BPD were assigned to either an intensive program that used
mentalization-based treatment strategies or the typical treatment plan for BPD. That study
showed that patients in the mentalization-based therapy program had larger reductions in
deliberate self-harm, suicide attempts, anxiety, depression and learned to better handle social
functioning than the patients who received standard treatment

While this study supports the potential of mentalization-based therapy for BPD, there is still
limited research showing the success of mentalization-based therapy. Before switching
therapists or treatment methods, you should consult with your current therapist and medical
help to discuss your options and unique needs.

https://www.verywellmind.com/what-to-look-for-when-choosing-a-therapist-425212

What to Look for in a Great

Therapist
How to find the right therapist for borderline personality disorder

If you are coping with a mental illness like borderline personality disorder (BPD), finding the
right therapist is essential to your health and well-being. Not every psychologist is capable
of treating BPD and you may not click with the first healthcare provider you meet. It's
important that you keep looking for the right person that shares your treatment goals, as you
will be spending a lot of time with that individual.

7 Qualities to Look for in a Therapist

When looking for the right therapist, these are a few qualities to keep in mind:

1. EstablishedIf you do a quick internet search for therapists, thousands of results will come up.
Some of those people are life coaches or professional advisors but don't have any medical
education or professional certifications to treat disorders like borderline personality disorder.
It is important that you choose a therapist who is licensed to practice independently, so look
for titles after the person's name like LCPC, LPCC, LSCW, LISW, PhD or MD. Reputable
psychologists and psychiatrists state their credentials upfront. Look for a therapist trained in
“talk-therapy” who also has some knowledge of medication. While only a licensed MD can
prescribe medications, a certified clinician can identify the need for medication options and
can refer you to an appropriate doctor if necessary.
2. ReassuringWhile you may be nervous for your first visit or two, your therapist should never
make you feel scared or intimidated. Instead, they should provide you with a comforting,
 nurturing environment where you are able to relax. The practitioner herself should not be
authoritative or condescending, but engaging and encouraging. While you may talk about
uncomfortable subjects during some sessions, you should always feel welcomed and accepted
rather than shamed or judged.

1. AdaptableWhile many psychologists have their own favorite clinical approaches, good
therapists know that every client has different needs.The therapist should not try to fit the
client to his preferred line of study. A good counselor works to figure out what works for each
person and tailors the sessions to that person.
2. DiscreetIf you are just starting counseling, you may be worried about running into your
clinician outside of your sessions. While it may happen, a good therapist will be completely
discreet if he runs into you at Starbucks. He should hold your confidentiality and privacy as
paramount and give you specific information about what you can expect in these situations. It
is important that you do not end up feeling uncomfortable due to a coincidental meeting.
3. Open-mindedSome therapists will pigeon-hole you and your behaviors according to your
diagnosis, rather than viewing you for who you are as a unique person. Even when dealing
with borderline personality disorder, you want the therapist to allow you to be an individual
and not assume that they know everything about you.

1. AppropriateAlthough the therapist should be flexible and approachable, it is important that

she consistently maintain appropriate boundaries with every client. There should be no sexual
overtures or innuendos, no business offers and no touching that makes you feel
uncomfortable.
2. ReceptiveYour therapist should be open to your feedback regarding therapy and how you
perceive the progress you have made. Therapy can be difficult at times and you may become
frustrated with the whole process. By talking through these issues with your counselor, you
can get a better idea of how you're doing and what the next steps will be.

The Bottom Line

By looking for a therapist with these qualities, you can ensure a productive therapeutic
relationship that will give you the help, care and guidance you need. With trust and an open
dialogue, you can make significant progress in your treatment.

https://www.verywellmind.com/psychotropic-drugs-425321

A Guide to Psychotropic
Drugs
Medications That Affect Your Central Nervous System

Psychotropic drugs are medications that affect your central nervous system, changing how
your brain processes information, such as altering your mood, thoughts, perceptions,
emotions, and behaviors. Most psychotropic drugs are prescribed by your therapist or health
care provider to treat a diagnosed mental illness, such as bipolar disorder or borderline
personality disorder. Other psychotropics, such as marijuana or cocaine, are taken illegally
for recreational purposes.

The different types of psychotropic drugs include antipsychotics, anti-depressants, anti-

obsessive agents, antianxiety agents, mood stabilizers, stimulants, and anti-panic agents.
They work in different ways to address symptoms and causes of various disorders.

Why Are Psychotropic Drugs Prescribed?

One in three patients currently in psychotherapy takes a psychotropic medication.

Medications should not be used by everyone and should only be used in consult with a
doctor.

For those with disorders like borderline personality disorder, appropriate medications can be
a useful tool during therapy. If you have trouble handling daily tasks or getting out of bed,
medication may even be a necessity for you.

The National Institute of Mental Health found that patients with depression who were
prescribed a psychotropic drug showed more recovery in two months than other patients who
went without treatment showed their whole lives. They can be an important tool in helping
you feel better.

Psychotropic drugs are not meant to be a crutch or instant solution; they are intended to be an
adjunct to continual therapy. If you're struggling with intense mood swings or violent
episodes, it can be difficult to focus on your therapy. Psychotropic medications just take the
edge off so you can begin working on your coping skills and better manage your symptoms.

What are the Side Effects of Psychotropic Drugs?

Psychotropic drugs can have significant side effects. While they can be useful, they carry the
risk of minor annoyances like dizziness, fatigue or weight gain. More severe side effects are
possible as well, such as cardiac issues, stroke, and even death. That's why it is so important
to only take medications under the direction and observation of a licensed healthcare
provider.

Before taking a drug, be sure to share with your therapist any known medical issues, such as
heart conditions, diabetes or high blood pressure. That information can help her choose an
effective medication that won't aggravate these preexisting conditions.

What Do I Need to Know Before Taking These Drugs?

When you first start taking psychotropic drugs, you may expect it to work instantly, and you
might get frustrated when you don't notice a difference. Some medications take several weeks
to begin to work effectively, so be patient and keep your therapist updated on how you're
feeling. Since every person is different and may respond to medications differently, many
people have to try several different medications before they find the right fit.

While psychotropic drugs can help regulate your emotions and mood, it can negatively
impact your emotions as well. Some people report having difficulty crying when they are
truly sad or laughing when they're happy. Others report a loss of sexual interest and
decreased interest in favorite hobbies. If the medication makes you feel just not like yourself,
share this information with your doctor so she can help identify an appropriate alternative.

https://www.verywellmind.com/is-there-a-cure-for-borderline-personality-disorder-425468

Borderline Personality
Disorder Recovery and
Remission
What to Expect If Faced With a BPD Diagnosis

If you or someone you love has been diagnosed with borderline personality disorder (BPD),
your first question will likely be whether the condition can be cured. The good news is that
BPD, a condition that affects 1.6 percent of Americans, is absolutely treatable. In fact, with
the right treatment approach, you can be well on the road to recovery and remission.

While remission and recovery are not a "cure" per se, both constitute the successful treatment
of BPD. By definition:

 Remission is the stage by which you are able to sustain significant relief from your BPD
symptoms, so much so that you no longer meet the criteria for a BPD diagnosis.
 Recovery is less well-defined but suggests that you are able to function in all aspects of your
life for an extended period of time. This includes holding down a job and maintaining
meaningful relationships.

Treatment Goals

In the past, many doctors believed that BPD was untreatable and lumped it together with
other hard-to-treat conditions like antisocial personality disorder (ASPD). As scientists have
gained greater insights about the disorder, newer treatment approaches have helped many
achieve lasting remission from BPD, in some cases without the use of drugs.

Results can differ, with some responding better than others. But for the most part, with
informed and individualized treatment, BPD can be controlled in the same way as diabetes or
other chronic conditions. The disease may not go away, but it can be managed in a way that
affords you a better quality of life.

Remission Rates

Studies have consistently shown that most people with BPD will no longer meet the
diagnostic criteria for the condition by their middle years. By all accounts, most people will
eventually "outgrow" their symptoms and achieve remission as part of the natural course of
the disease.

One study from Maclean Hospital in Massachusetts followed up 290 people with BP every
two years for up to 16 years. What they found was that remission tended to occur
spontaneously within two to eight years of the diagnosis and initial treatment. After 16 years,
99 percent had achieved a two-year remission, while 78 percent had experienced an eight-
year remission.

The same study revealed that after two years, 35 percent had experienced an extended
remission period (defined as two years or more), increasing to 91 percent after 10 years.
Symptom relapses tended to wane over time as well, from a high of 36 percent after two
years to around 10 percent by eight years.

It is important to note, however, that the statistics are based on people who were diagnosed
and treated for BPD. The results did not include what types of treatment were provided or
what maintenance therapies may have been used. As such, it not clear how much the various
treatments influenced remission rates or if undiagnosed people will automatically "outgrow"
the disease as well.

Treatment Approaches

The treatment of BPD can vary based on the severity of your symptoms and/or any co-
occurring disorders. The tools for treatment typically include psychotherapy and medications.

Psychotherapy

The backbone treatment for borderline personality disorder is psychotherapy, also known as
talk therapy. Among the various approaches:

 Cognitive behavioral therapy (CBT) is the foundational structured approach to talk therapy
incorporated into all other forms of psychotherapy.
 Dialectical behavior therapy (DBT) aims to identify and change negative thinking patterns,
incorporating skills training to control emotions and tolerate distress.
 Mentalization-based therapy (MBT) aims to improve mentalization (the process by which we
make sense of each other and ourselves, implicitly and explicitly) by essentially thinking
before we speak.
 Schema-focused therapy (SFT) aims to identify and change deeply held patterns associated
with our past (usually those we cling to for emotional survival).
 Transference-focused therapy (TFT), aims to prevent negative feelings about past experiences
and people being transferred to current experiences and people.
 Systems training for emotional predictability and problem solving (STEPPS) is a 20-week
group program involving family members and others, typically conducted alongside one-on-
one therapy.

All of these therapies are appropriate for BPD treatment, approaching the disease in slightly
different ways. There is not one that is inherently better than the others. The choice depends
largely on the effectiveness of your interactions with your therapist and your openness to the
technique.
Never be afraid to ask why the therapist has chosen a specific therapeutic practice. It can help
you better understand the aims of the treatment and decide whether it is the right approach for
you.

Medications

Medications can be helpful in treating some of the symptoms of BPD. While drugs are not
always needed, some of the more commonly prescribed include:

 Antidepressants, including selective serotonin reuptake inhibitors (SSRI) commonly used in

first-line therapy
 Antipsychotics, such as Zyprexa (olanzapine) which is known to reduce impulsivity,
hostility, and psychotic symptoms of BPD
 Mood stabilizers, including Topamax (topiramate), Lamictal(lamotrigine), and Depakote
(valproate semisodium) which may be useful in treating BPD aggression
 Anti-anxiety medications,
including Ativan (lorazepam), Klonopin (clonazepam), Xanax (alprazolam),
and Valium (diazepam)

Co-Occurring Conditions

According to a report from the National Institute of Mental Health (NIMH), 85 percent of
people with BPD will have at least one other mental health disorder, most commonly major
depressive disorder (MDD), bipolar disorder(BP), an anxiety disorder (like post-traumatic
stress disorder), a substance use disorder, or an eating disorder (like bulimia).

People with BPD will often meet the criteria for other personality disordersas well. The
average number of co-occurring conditions in BPD is three.

These co-occurring conditions (also known as comorbidities) can make treatment far more
complex and result in delayed or missed diagnoses due to the overlapping symptoms.

When a dual diagnosis is made, treatment is usually staged so that the symptom with the
greatest likelihood of success is treated first. For instance, if you also have MDD, a common
BPD comorbidity, you would be prescribed an antidepressant to reduce depression symptoms
common to both MDD and BPD.

Coping

If you think that you have BPD or have been diagnosed with the condition, there are steps
you can take to better cope as you explore treatment options. As a general rule of thumb:

 Never panic. Remember that your chances of remission are good. As with all mental health
disorders, early diagnosis and treatment will almost invariably afford better results than a
delayed diagnosis and treatment.
 Seek specialists experienced in BPD. This not only avoids missed diagnoses and
comorbidities, but it also improves your chance of receiving the most up-to-date treatment,
ideally with the fewest side effects and complications.
 Find the right therapist for you. Therapy relies heavily on trust and open interaction. Take
the time to interview several therapists, zeroing in on someone with whom you feel safe,
comfortable, and supported.
  Educate yourself. Take the time to learn about your condition and become an advocate in
your own care. You will feel more empowered by doing so and be better equipped to
participate as a partner rather than a follower.
 Apply new skills. Your treatment should never be solely confined to medications or therapy
sessions. There are plenty of self-help strategiesyou can incorporate into your life to help
express and sort out your emotions. These include journaling, expressive writing, art therapy,
and mindfulness meditation.

 Involve your family. A BPD diagnosis affects the entire family. Treatment is often more
successful if others participate as it helps repair emotional fractures that compound your
illness. Family therapy can not only help you recover from BPD, but it can also help your
family as well.

https://www.verywellmind.com/is-electroconvulsive-therapy-a-treatment-option-for-bpd-425196

Is Electroconvulsive
Therapy Used for BPD?
A Look at This Psychiatric Treatment With a Controversial History

Electroconvulsive therapy (or ECT) is a psychiatric treatment with a long and controversial
history. The treatment involves briefly passing an electrical current through the brain. This
procedure is not used to treat borderline personality disorder (BPD), but it is used to treat
severe depression that has not responded to adequate medication trials and under other
clinical circumstances.

Since many people with borderline personality disorder also suffer from depression, some
people who receive electroconvulsive therapy have BPD.

Is ECT Effective for Borderline Personality Disorder?

Even though electroconvulsive therapy is used to treat severe depression in people who have
borderline personality disorder, there is research that suggests that ECT is not as effective
in treating depression for people who also have BPD.

One study, published in 2004, looked at the effects of ECT in 139 patients, all of whom had
major depression and 20 of whom also had borderline personality disorder. The study found
that eight days following treatment, those with borderline personality disorder didn't score as
well on a depression symptom measurement scale as those who didn't have a personality
disorder or those who had a different type of personality disorder.

The patients in that study who had borderline personality disorder were more likely to be
women, to be younger, and to have medication-resistant depression, but the study authors
noted that these factors didn't account for their poorer response to electroconvulsive therapy.
Other researchers have agreed that ECT doesn't seem to work as well in patients with
borderline personality disorder, although the reasons for this aren't clear.

The Bottom Line

The research literature in this area is small and inconsistent, so it does not mean that people
who have both depression and borderline personality disorder should not receive ECT.
However, it is something to consider when you are weighing the risks and benefits.

While ECT does have a long and controversial history, it is recognized as an effective
treatment for severe depression by the American Psychiatric Association (APA). The APA
has issued guidelines for the use of ECT that ensure that the procedures are carried out with
your safety and well-being in mind.

Some people do experience unwanted side effects from electroconvulsive therapy (for
example, memory loss), so you should talk about the risks and benefits with your provider if
you are considering ECT.

https://www.verywellmind.com/cbt-dbt-treating-borderline-personality-disorder-425195

Dialectical vs. Cognitive

Behavioral Therapy for
Treating BPD
If you have borderline personality disorder, you have probably heard of both cognitive-
behavioral therapy and dialectical behavior therapy. Are these modes of treatment different or
simply variations of each other? Let's take a closer look at these types of behavioral therapies,
and how they are related.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy, or CBT, is a form of therapy that aims to restructure and

change the way a person thinks and behaves. Whether or not this therapy is beneficial
depends strongly on the relationship between the patient and her therapist, and the patient's
willingness to make a change.

Examples of techniques used by a cognitive-behavioral therapist include cognitive

restructuring and behavioral changes, like reducing self-defeating behaviors and learning how
to respond to problems in a healthy, adaptive manner. In cognitive restructuring, a patient is
taught to identify negative reactive thoughts and modify them.

Dialectical Behavior Therapy

Dialectical behavioral therapy, or DBT, is a modified type of CBT that was uniquely
developed to treat borderline personality disorder. It focuses on skills like mindfulness, or
living in the present, regulating emotions, tolerating distress, and effectively managing
relationships with others. DBT is composed of 4 elements provided over a year or more:

 Individual DBT therapy — uses techniques like cognitive restructure and exposure to change
behavior and improve quality of life
 Group therapy — uses skills training to teach patients how to respond well to difficult
problems or situations
 Phone calls — applying learned skills to life outside therapy
 Weekly consultation meetings among the DBT therapists — a means of support for the
therapists and to ensure they are following the DBT treatment model

How Dialectical Behavioral Therapy Differs From Cognitive Behavioral Therapy

DBT is simply a modified form of CBT that uses traditional cognitive-behavioral techniques,
but also implements other skills like mindfulness, acceptance, and tolerating distress. The
good news is that DBT has been found to be considerably more effective in treating people
with borderline personality disorder.

It's interesting to note that some cognitive-behavioral therapists incorporate certain elements
of the DBT model into their treatments sessions. Also, other forms of CBT have developed
that use the elements of DBT. For instance, mindfulness-based cognitive therapy utilizes
traditional cognitive-behavioral techniques with mindfulness to treat depression.

How to Decide Which BPD Treatment Is Right for You

If you have BPD, there are great therapies out there for you. Please speak with your doctor
about finding the right therapist and treatment model for you so you can feel better and
improve your quality of life.

https://www.verywellmind.com/inpatient-treatment-for-borderline-personality-disorder-425458

What to Expect From

Inpatient Treatment for
BPD
What to Expect During a Hospitalization

Borderline personality disorder (BPD) is a serious condition that sometimes requires

intensive inpatient treatment at a psychiatric hospital. The idea of being hospitalized is very
frightening for most people, but knowing what to expect can reduce your anxiety.

Duration

Most inpatient hospitalizations occur due to concern that the patient may be at risk of
harming herself or someone else, and the patient is discharged once that risk has passed.

In the past, inpatient treatment for BPD may have lasted months or even years, but now
inpatient treatment is generally much shorter, depending on the needs of the individual
involved.

Some hospitals do offer longer-term, voluntary intensive treatments for BPD, which may last
for weeks or months. In general, however, research has shown that very long psychiatric
hospitalizations are not helpful for people with borderline personality disorder.

Voluntary vs. Involuntary

A psychiatric inpatient hospitalization may occur voluntarily or involuntarily. A voluntary

hospitalization occurs when the patient recognizes that he is in need of more help than can be
provided through outpatient treatment.

For example, he may recognize that he is having a period of very strong symptoms that he
cannot handle on his own and that he needs more than once or twice-a-week therapy to keep
himself safe. In this case, the patient and the therapist may decide together that inpatient
treatment is best.

An involuntary hospitalization occurs when the patient is not willing to be admitted to the
hospital, but the treatment providers have deemed this level of care necessary. For example,
if someone is expressing intent to commit suicide, but refuses to be hospitalized for safety,
her treatment providers are required to pursue involuntary hospitalization (also called
“commitment”).

What the Experience Is Like

What should you expect if you are going for inpatient treatment? This varies depending on
the hospital and the treatment program.

In most cases, the purpose of inpatient hospitalization is to keep the person with borderline
personality disorder safe during a mental health crisis and to get that person stabilized.

As the patient, usually, you will be provided with some individual or group psychotherapy, as
well as medication management. Once you're stable, you will be discharged either to a partial
psychiatric hospital program or to outpatient treatment.
A partial psychiatric hospital program, also known as a day hospital, is a step down from
inpatient hospitalization. In these programs, you generally attend the treatment program only
during the day but do not stay there overnight. The partial hospital provides a more gradual
transition back to the normal daily routine and is intended to help get the person back on
track.

There are also longer-term inpatient hospital programs that focus on providing more
comprehensive treatment. Rather than just focusing on getting you stabilized, these programs
may provide intensive psychotherapy (such as dialectical behavior therapy), and may last for
a few weeks or months. These longer-term programs are generally voluntary and may include
group, individual, and family therapy.

Payment Options

Who will pay for your inpatient treatment? This depends on a lot of factors.

If you have insurance, your policy may cover the bill. If not, Medicare, Medicaid, or your
state’s department of mental health may pay for your treatment.

Some programs are very expensive and are rarely covered by insurance. If, like most people,
you are worried about the cost of your treatment, talk to your health insurance company or
contact your state’s public health insurance program.

How to Find a Program

If you think you may need to be admitted to an inpatient treatment program (or you believe a
loved one may need this type of program), the best place to start is to ask your or your loved
one’s current therapist or psychiatrist about a potential referral.

Most inpatient treatment facilities accept patients only through referrals or in cases of
emergencies. For voluntary treatment, there may be a waiting list to get into a specialized
program, so keep this in mind and start your search early.

If you or a loved one is in a mental health crisis (actively suicidal or homicidal, for example),
call 911 or go to the nearest emergency room. If the mental health staff at the hospital feel
that inpatient treatment is necessary, you (or your loved one) may be transferred to the
psychiatric unit of the hospital. If there is no psychiatric unit, you may be transported to a
different hospital with a psychiatric program.

https://www.verywellmind.com/schema-focused-therapy-425463

How Schema-Focused
Therapy Works for BPD
Schema-focused therapy for borderline personality disorder (BPD) is a type
of psychotherapy that focuses on identifying and changing specific unhealthy ways of
thinking. The therapy includes some elements that are traditional parts of cognitive-
behavioral therapy (CBT) but also includes some elements of other types of psychotherapy.

Childhood Needs and Maladaptive Schemas

The theory underlying schema-focused therapy presumes that when our basic childhood
needs (such as needs for safety, acceptance, and love) are met inadequately, we develop
unhealthy ways of interpreting and interacting with the world, which is called maladaptive
early schemas.

Schemas are broad and pervasive patterns of thinking and behavior. These are more than just
beliefs; schemas are deeply held patterns that are closely related to our sense of self and view
of the world.

Schema theory proposes that schemas are triggered when events happening in our current life
resemble those from our past that were related to the formation of the schema. If we have
developed unhealthy schemas because of difficult experiences in our childhood, we will
resort to unhealthy ways of thinking and behave in response to this new situation.

Schema theory proposes that many of the symptoms of BPD are caused by difficult childhood
experiences (such as maltreatment or early separation from caregivers), which lead to the
formation of maladaptive early schemas.

Goals

The initial goals of schema-focused therapy for borderline personality disorder are to identify
the patient’s relevant schemas and to link these schemas to past events and current symptoms.

Following this initial work, the therapist and patient then work on ways of processing
emotions related to the schemas and altering unhealthy coping styles that are the result of
maladaptive schemas (unhealthy schemas that could be causing symptoms in BPD). For
example, the therapist and client may conduct exercises focused on venting anger, breaking
unhealthy patterns of behavior, and changing unhelpful ways of thinking.

Research Support

While there has not yet been extensive research on schema-focused therapy, one study has
been published to date which suggests that patients randomly assigned to receive schema-
focused therapy had significantly larger reductions in borderline personality disorder
symptoms than those assigned to receive psychodynamic therapy. While this is preliminary
evidence of the effectiveness of schema-focused therapy, it suggests that this therapy shows
promise in treating BPD.

In addition, an analysis of multiple research studies on psychological therapy for borderline

personality disorder also concluded that schema-focused therapy appears effective, but the
authors also said more research is needed.
https://www.verywellmind.com/antidepressants-for-bpd-425456

Antidepressants for BPD

While psychotherapy is considered the central aspect of treatment for borderline personality
disorder (BPD), many people are prescribed antidepressants for BPD. No medication is FDA
approved to treat BPD, but many have proven to be effective in reducing some of the
symptoms of BPD.

Antidepressants are one of the most commonly prescribed classes of medications for BPD.
While antidepressants alone will not produce a full recovery from BPD, they may help you
get your symptoms under enough control that psychotherapy will be more helpful to you.

Antidepressants for BPD may be recommended if you have a comorbiddepression or if your

psychiatrist expects that they with help with your mood symptoms related to the BPD.

Types of Antidepressants

There are many different types of antidepressants. The most commonly prescribed
antidepressants are called "selective serotonin reuptake inhibitors" or SSRIs. These
medications work by altering the availability of the neurotransmitter serotonin in your brain.
Some examples include:

 Celexa (citalopram)
 Lexapro (escitalopram)
 Prozac (fluoxetine)
 Zoloft (sertraline)
 Paxil (paroxetine)

Other types of antidepressants that are prescribed include the "tricyclics" and the
"monoamine oxidase inhibitors," or MAOIs. These medications are older and have more
serious side effects, so they are less commonly prescribed.

Some tricyclics include:

 Elavil (amitriptyline)
 Anafranil (clomipramine)
 Tofranil (imipramine)

Some MAOIs include:

 Nardil (phenelzine)
 Parnate (tranylcypromine)
Finally, there are other types of antidepressants that are commonly prescribed, including:

 Wellbutrin (bupropion)
 Cymbalta (duloxetine)
 Effexor (venlafaxine)

Are Antidepressants Effective for BPD?

A number of research studies have demonstrated that certain types of antidepressants are
effective in treating specific symptoms of BPD. For example, SSRIs can reduce emotional
instability, impulsivity, self-harm behaviors, and anger. MAOIs have also been shown to
effectively treat emotional instability.

There is less consistent evidence that tricyclic antidepressants are helpful for people with
BPD. While there is evidence that some people with BPD respond well to this type of
antidepressant, one research study found that people with BPD who took tricyclics
experienced an increase in suicidal thinking and paranoid ideation.

Risks and Side Effects of Antidepressants

Risks and side effects of antidepressants can vary depending on the type of antidepressant
you are taking. SSRIs tend to have the least serious side effects but can produce effects such
as decreased appetite, headaches, insomnia, sedation, and sexual dysfunction.

Tricyclic antidepressants can also produce dry mouth, blurred vision, weight gain, seizures,
and heart problems. For those taking MAOIs, certain foods that are high in the amino acid
tyramine (e.g., soy sauce, aged cheese) must be avoided due to a risk of severely elevated
blood pressure. In addition, there are several types of medications that have serious
interactions with MAOIs, so always discuss your current medications with your doctor and
pharmacist.

Questions for Your Psychiatrist

You should talk to your psychiatrist before you start taking any type of medication for BPD.
If you have any concerns (including some of those discussed above), let he or she know.
Make sure you understand the risks and side effects and be sure to have an in-depth
discussion about the reasons you are being prescribed a certain medication. Here are some
questions you might want to ask:

 Which symptoms do you expect this medication to address?

 Are there particular risks or side effects I should be watching for?
 How will this medication interact with other medications I am taking?
 How long do I need to take this medication before I start to notice effects?
 How long do you think I'll need to be on this medication?

https://www.verywellmind.com/dialectical-behavior-therapy-dbt-for-bpd-425454
Dialectical Behavior
Therapy for Borderline
Personality Disorder
Dialectical behavior therapy (DBT), developed by Marsha Linehan, Ph.D., at the University
of Washington, is a type of psychotherapy, sometimes called "talk therapy," used to
treat borderline personality disorder (BPD). DBT is a form of cognitive behavioral
therapy (CBT), meaning it's a therapy that focuses on the role of cognition, which refers to
thoughts and beliefs, and behavior, or actions, in the development and treatment of BPD.
DBT includes some changes to the traditional cognitive behavioral elements of therapy.
These changes are intended to specifically help reduce the symptoms of BPD.

Research Support

DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical
trials, the most rigorous type of clinical research. While DBT is no longer the only therapy to
have shown effectiveness in controlled trials, it has grown a large evidence base and is
considered one of the best treatments for BPD in terms of documented success rates.

Theoretical Basis

DBT is based on Dr. Linehan's theory that the core problem in BPD is emotion dysregulation,
which results from mixing biology, including genetic and other biological risk factors, and an
emotionally unstable childhood environment, for instance where caregivers punish, trivialize
or respond erratically to the child's expression of emotion, together. The focus of DBT is on
helping the client learn and apply skills that will decrease emotion dysregulation and
unhealthy attempts to cope with strong emotions.

What to Expect in Dialectical Behavior Therapy

Usually, DBT includes a combination of group skills training, individual psychotherapy,

and phone coaching, although there are exceptions. Patients in DBT are asked to monitor
their symptoms and use of learned skills daily while their progress is tracked throughout
therapy.

There are four main types of skills that are covered in DBT skills training. These are:

 Mindfulness Meditation Skills. These skills center on learning to observe, describe and
participate in all experiences, including thoughts, sensations, emotions and things happening
externally in the environment, without judging these experiences as "good" or "bad." These
are considered core skills that are necessary in order to implement the other DBT skills
successfully.
  Interpersonal Effectiveness Skills. The focus of this skill module is on learning to
successfully assert your needs and to manage conflict in relationships.
 Distress Tolerance Skills. The distress tolerance skills module promotes learning ways to
accept and tolerate distress without doing anything that will make the distress worse in the
long run, for instance, engaging in self-harm.
 Emotion Regulation Skills. In this module, patients learn to identify and manage emotional
reactions.

Resources

If you are interested in learning more about DBT, there are a number of resources available
on the Behavioral Tech website. Visit the resources page to learn more about the basics of
DBT and Dr. Linehan. The clinical resources directory can help you find DBT providers in
your area.

Alternatively, you can ask your therapist, physician or other mental health professional for a
referral to someone who specializes in DBT.

The Difference Between DBT and Didactic Therapy

Didactic therapy is a group therapy most often used for those with substance use disorders to
teach them the facts and help educate them, while DBT is typically for use in the treatment of
borderline personality disorder.

https://www.verywellmind.com/borderline-personality-disorder-treatment-425451

Borderline Personality
Disorder Treatment
Psychotherapy, Medications, Hospitalization, and Self-Help

There are a variety of effective treatments for borderline personality disorder (BPD). What
treatments seem to work best, and what should I know about the options available?

Overview

Usually, BPD is treated with a combination of medication and psychotherapy, although

during times of crisis, individuals with BPD may require brief periods of hospitalization to
remain safe. More recently, self-help tools have been developed to supplement traditional
treatments for BPD.
Psychotherapy

Long-term outpatient psychotherapy, or "talk therapy," is an important part of any treatment

for BPD. Research has shown that several types of psychotherapy are effective in reducing
the symptoms of BPD, including:

 Dialectical Behavior Therapy (DBT)

 Dialectical behavior therapy (DBT) was the first form of psychotherapy found to be
effective for people with borderline personality disorder (BPD.) DBT is a form
of cognitive behavior therapy which focuses on how thoughts and beliefs can lead to
actions and behaviors. In this therapy, people learn how to manage conflict, and learn
skills to help them cope with strong emotions. Mindfulness meditation is also often
included.
 Schema Focused Therapy
 Schema focused therapy is also a form of cognitive behavior therapy for BPD.
Schema focused therapy operates with the thought that unmet needs from childhood
can lead to unhealthy ways of thinking about the world. This therapy focuses on
confronting these maladaptive beliefs and behaviors and instead focus on healthy
ways of thinking and coping.
 Mentalization Based Therapy
 Mentalization based therapy has been studied to some degree for BPD and may help
with anxiety and depression as well as social functioning. This therapy focuses on
helping the client to recognize mental states—her own thoughts and feelings, as well
as the thoughts and feelings of others she communicates with. Through recognition,
she is then able to see how these thoughts contribute to her behavior or the behavior
of others.

 Transference Focused Psychotherapy

 Transference focused psychotherapy has been studied for BPD and may be as good or
better than dialectical behavior therapy according to these studies. This therapy uses
the concept of transference—transferring emotions from one person to another, which
is a key concept in psychodyamic therapies. Transference focused psychotherapy
utilizes the relationship between the client and the therapist so that the therapist can
see how a client relates to others. The therapist can then use this awareness to help a
person respond more effectively in their other relationships.

Medications

Although there are currently no medications for borderline personality disorder approved by
the FDA, research has shown that some medications do reduce certain symptoms of the
disorder. Medication may be particularly effective for BPD when it is used in conjunction
with psychotherapy. In addition to helping with BPD symptoms, medications may help with
co-existing mental health conditions such as anxiety or depression.

Some of the most commonly prescribed medications for BPD include:

 Antidepressants - Antidepressants may help with feelings such as sadness, but do not appear
to be helpful for symptoms such as anger.
 Antipsychotics - Antipsychotics were some of the first medications used to treat BPD and
may be particularly helpful for some of the more problematic symptoms of BPD such as
anger, impulsivity, and paranoid thinking.
  Anxiolytics (anti-anxiety medicaitons) - Anxiety can go hand in hand with BPD making some
of these medications helpful, yet some of these are a double-edged sword due to their
addictive potential.
 Mood stabilizers/anticonvulsants - Mood stabilizers may help with the impulsive thinking
common with BPD.

Other potential treatments, such as omega-3-fatty acids, are also being explored. In fact,
studies to date have not found significant benefit from most medications for BPD with the
exception of atypical antipsychotics (second generations antipsychotics), mood stabilizers,
and omega-3-fatty acids.

Hospitalization

Borderline personality disorder is associated with very intense emotional experiences. As a

result, people with BPD may need intensive BPD treatment. Sometimes people with BPD are
admitted to a psychiatric hospital for intensive inpatient treatment. Inpatient treatment
requires you to stay overnight in the hospital.

Another treatment option is partial hospitalization or day treatment. These are programs that
are more intensive than traditional outpatient psychotherapy but do not require you to stay
overnight. You may be enrolled in a partial hospital or day program if you may be headed
toward a crisis, or if you have just been discharged from inpatient hospitalization and need a
period of more intensive treatment to make sure the crisis does not reemerge.

Self Help

Self-help strategies for BPD are an essential part of any treatment program. Of course, these
should be used to supplement care from a qualified therapist and not alone. An ideal plan
includes learning as much as you can about your disorder through self-help education,
learning healthy coping skills for BPD, and finding ways to help you express and manage
your emotions.

There are valuable self-help resources available for BPD that can be used in conjunction with
more traditional forms of treatment. Books and online resources offer information about BPD
and suggest ways to cope with the symptoms.

What to Do in an Emergency

If you or someone you love is experiencing a mental health emergency, it is critical that you
get help immediately. Call 911 or go to your nearest emergency room. If there is evidence
that you (or your loved one) are a danger to yourself or others, you may be admitted for a
brief hospital stay on an inpatient psychiatric unit until the crisis has passed. It's
recommended that anyone living with BPD put together a safety plan for BPD. In this plan,
you can anticipate a crisis and make a plan about exactly how you will address your feelings
before they become an emergency.

https://www.verywellmind.com/how-to-find-a-therapist-425340
How to Find a Therapist
If you've ever tried to find a therapist, you know that it is no easy task. With so many
different types of providers to choose from, it can be confusing, time-consuming, and
frustrating. But, armed with a little bit of information, you can start psychotherapy with
someone who is just right for you.

Know What You Are Looking For

Before you even try to find a therapist, the first step is knowing exactly what you are looking
for. Spend some time researching and thinking about each of the factors listed below. Make
sure to jot down notes so that you can communicate your needs effectively when you start to
actively search. Here are some factors to consider:

Your Needs
First, consider where you are in your process of seeking treatment and what you need right
now. If you are seeking help because you are in a crisis (you are having thoughts of harming
yourself or someone else, for example), disregard the rest of this list, and either call 911, go
to the nearest emergency room, or call the National Suicide Hotline at 1-800-273-TALK (if
you are in the United States.)

If you are not in a crisis but have never seen a mental health provider before, you will need to
first see someone for a full assessment to understand your diagnosis and develop a clear
treatment plan. If you have already had a diagnosis, maybe you are looking for someone who
can do long-term psychotherapy. Or, maybe you already have a long-term therapist and just
want to find a therapist for some short-term work on a very particular issue; if the latter, you
should also talk to your current therapist about it if this.

Location and Availability

Make sure that the therapist has availability that matches with your schedule. Also, consider
his location. How far are you willing to travel? Do you need a therapist who is accessible by
public transportation? Are you willing to travel farther for a therapist who has special
expertise or is an especially good match personality wise? Or, is the convenience of the
utmost importance? Remember, therapy only works if you are able to make it to
appointments consistently, so scheduling and location may be more important than you think.

Therapist Payment
Psychotherapists can accept different payment options, so it is important to know how and
how much you would like to pay. If you have health insurance, start by calling your insurance
company and inquiring about your mental health benefits. Do they cover outpatient
treatment? Is there a co-payment involved? How many sessions are covered? If your
insurance only covers certain therapists, the insurance company will be able to provide you
with a list of approved providers.
Some therapists only accept patients who are paying out-of-pocket. In this case, most will
provide a receipt so that you can submit it to your insurance company for reimbursement, if
possible. You can inquire about whether they will consider a lower fee if the cost is above
your means.

Type and Level of Expertise

Another factor to consider before you set out to find a therapist is what type and level of
expertise you are looking for. Think about the problems you want help with. There may be
therapists who specialize in these concerns. If you're not sure of exactly what you want to
work on (and this is something a therapist can help you figure out), try to have a general idea
of your goals for therapy. You should know, though, that expertise can often be related to
higher costs of service. Although this is not always the case, you should expect to pay more if
you are only willing to work with a therapist of very high-level expertise.

When considering the level of expertise, remember that there are a wide variety of types of
mental health providers with different types of training. More training does not necessarily
mean that a therapist is more skillful, but consider whether you have a preference, and learn
more about the types of mental health providers available.

Therapist Orientation
Different therapists come from different schools of thought about how therapy works and
what methods produce the best outcomes. These schools of thought are called "orientations."
For example, someone with a cognitive-behavioral orientation believes that thoughts and
behaviors are tied to symptoms, and will conduct therapy aimed at changing problematic
behaviors and ways of thinking directly (usually through homework and in-session
exercises). In contrast, someone with a psychodynamic orientation believes that symptoms
are related to processes outside of the patient's awareness that comes to light through
interactions with the therapist.

There are many other orientations, and some therapists subscribe to more than one. Think a
little about what might be most comfortable or the best match for you, and be sure to ask any
potential therapist about their orientation and how they would describe their approach to
therapy.

Start Your Search

Once you have a good idea about what you are looking for, it is time to find a therapist. In
addition to your insurance company, you can ask for referrals from friends, family, your
primary care physician, or other treatment providers. There are excellent online resources to
help you find a therapist, including UCompare Healthcare Psychiatrist Search,
the Association for Behavioral and Cognitive Therapies, and the American Psychological
Association.

When you call potential therapists, have your prepared list of questions/notes on hand. Try to
ask all of the questions, even if you are feeling intimidated. Don't forget to ask about fee
payment, scheduling, training, expertise, and experience in the area you would like to work
on, etc.
Therapist "Shopping"

It is important to remember that it does take the time to find a therapist. You need to talk to
several potential candidates on the phone and get a feel for whether they meet your needs.
You may also need to meet with several therapists before you find the one that will work best
for you. Many people don't know that therapist "shopping" is a perfectly acceptable practice.
You must choose the therapist that is right for you.

https://www.verywellmind.com/how-to-find-bpd-support-425342

How to Find BPD Support

Most websites for people with borderline personality disorder (BPD) will tell you how
important it is to find BPD support. This is because social support is an important predictor of
mental health. But, research suggests that people with BPD have difficulties developing good
support networks. It is not easy to find support if you have strained relationships with friends
and family. So, where can you find support? Here are some ideas.

BPD Support From Family

Yes, many people with BPD have strained relationships with family, either because of past
trauma or because the symptoms of BPD can interfere with family relationships (or a
combination of both). But, look a little closer. Maybe you can’t get support from your
immediate family, but are there aunts, uncles, cousins, step-siblings, or other extended family
members that you can get support from?

BPD Support From Friends

Some people with BPD have few friends because the symptoms of the disorder have gotten in
the way of friendships. Others have friends but have difficulty reaching out to them for
support. If you don’t have enough friends, keep reading for ideas on how to find and build
friendships. But, if you do have some friends, consider leaning on them for support
occasionally if you don’t already.

BPD Support From Professionals

If you have BPD (or care about someone who does), the importance of professional support
cannot be underestimated. People with BPD need professional treatment; the symptoms of
this disorder are very intense and you should not go it alone. If you don’t already have a
mental health professional that you work with, read this article on finding a therapist.
BPD Support Groups

In addition to online groups, there are support groups in most communities for people with
mental health issues. For example, the National Alliance for Mental Illness runs support
groups. See the NAMI website for details on where to find one near you. But, if you can’t
find a support group focused on mental health issues, you can always attend groups such
as Alcoholics Anonymous if you just need to be around people. You don’t even need to talk
to feel supported sometimes!

Social Groups

Sometimes joining social groups that are not focused on support can help you make
connections and friendships that can then turn into sources of support. For example, join a ski
club, a hobby club, a book club, or a church group. Starting here will help you build a social
network that you can turn to in times of need.

Hotlines

Sometimes the best source of support in a pinch is a telephone or online hotline. These are
completely confidential and available twenty-four hours a day, something that is not always
true for friends or other sources of support. One great hotline is the National Suicide Hotline
(1-800-273-8255), but there are also online hotlines you can use (e.g., the RAINN hotline,
which is a sexual assault and abuse hotline.)

Other Sources of Support

There are hundreds of other ways to find support, but it can be hard to come up with ideas
when you are dealing with a crisis. Instead of trying to find support when you are under
stress, make it a priority to think of ways to build support when you are not in a crisis. Where
can you meet caring people who might make good friends?

For example, consider volunteering, or other activities where you will meet people who care
about the well-being of others. Once you have some ideas, push yourself to actually try some
of these activities. You will be surprised at how quickly you can start to build a social support
network when you push yourself to get to know people.

https://www.verywellmind.com/a-definition-of-therapeutic-alliance-425276

Therapeutic Alliance in
Borderline Personality
Disorder
If you have a mental illness like borderline personality disorder (BPD), you are likely used to
a whole way of feeling and reacting. For those with BPD, that may mean intense emotions,
destructive actions, rapid mood swings, and feelings of abandonment. You may have gone
years feeling this way and do not know any other way of living.

If you are considering going to therapy, it can be overwhelming, scary, and

frustrating. Psychotherapy sessions ask you to completely change how you think and
rationalize behaviors. It can be a stressful and emotional experience, but a strong therapeutic
alliance can help you through it.

What Is a Therapeutic Alliance?

The foundation for any course of therapy is the therapeutic alliance, the strong bond designed
to help you through your recovery. It is the relationship you have with your therapist and the
level of trust you have in her. This is what keeps you moving during therapy, even when it's
difficult or painful, because you know she has your best interests in mind. This connection
may be hard to build but involves the following components:

 Genuine interest: A good therapist gives you her undivided attention. She listens to what you
have to say and asks clarifying questions. She does not seem preoccupied, does not sift
through email,s and she doesn't only give you her thoughts or opinions.
 Specialization: Your therapist needs to have an understanding of what you're going through
in order to help you. This means she should have a background studying BPD and working
with patients who have BPD.
 Comfort: You need to be comfortable telling your therapist anything, even if it's
embarrassing. She should put you at ease and ensure you know your conversations are
confidential.
 Common Goals: You both should have the same goals so that you are working towards the
same endpoint.

Building a Therapeutic Alliance

A strong therapeutic alliance does not happen overnight and may not be possible with just
any therapist. Many people with BPD will visit several healthcare providers or psychiatrists
before they find one they can "click" with.

When you are beginning therapy, it's perfectly okay to have consultations with several mental
health professionals. Ask questions about their approaches to therapy, what techniques and
theories they often use, and their background in treating BPD and other personality disorders.
It's also a good idea to inquire how available they are—many people with BPD who engage
in self-harm or have suicidal thoughts will often need to be able to call their therapist at odd
hours during an emergency.

Your potential therapist should be happy to answer your questions. If he seems annoyed,
impatient, defensive, or keeps checking his watch, it's time to move on and find someone
else. A good therapist is worth the extra homework in order to help you on the path to long-
term recovery.
A Word From Verywell

If you're having trouble finding a therapist with a background with BPD, talk to your general
practitioner or primary care physician to see if he has any recommendations. He will likely
have many different therapists, counselors, psychiatrists, and psychologists on file he can
refer you to.

https://www.verywellmind.com/borderline-personality-disorder-and-sex-425370

Borderline Personality
Disorder and Your Sex Life
Borderline personality disorder (BPD) symptoms can affect your emotional state,
your relationships, and your ability to control your behavior. So it's not surprising that BPD
can also have a major impact on your sex life. While very few researchers have studied BPD
and its effects on sexuality, more and more work is suggesting that people with BPD can
experience several key difficulties with sex.

Attitudes About Sex

Research has demonstrated that women with BPD tend to have more negative attitudes about
sex. For example, women with BPD report having a greater number of mixed feelings about
sexual relations, and are also more likely to feel pressured to have sex with their sexual
partners. In addition, women with BPD report more general sexual dissatisfaction. Much less
is known about how BPD affects men’s attitudes about sex.

There may be a number of reasons for these more negative attitudes toward sex. First, many
women with BPD are survivors of child abuse, which may contribute to overall negative
reactions to adult sexual experiences. Also, women with BPD are more likely to experience a
great deal of conflict in their relationships, so they may feel less positive about sex.

Reckless Sex

Impulsive behavior is one of the symptoms of BPD listed in the DSM-IV. In the case of
sexuality, a trend toward impulsive behavior may lead to reckless sexual behavior as well.

People with BPD are most at risk of engaging in impulsive acts when they are experiencing
intense emotional responses, or when they are disinhibitedby alcohol or other substances.
Intense sadness, fear, jealousy or positive emotions may also lead to impulsive sexuality.
Promiscuity

In addition to engaging in reckless or impulsive sex, there is evidence that people with BPD
are more prone to sexually promiscuity. This differs from impulsive sex in that promiscuity is
the act of intentionally having multiple sexual partners (rather than having casual sex on a
whim).

Why might people with BPD be more promiscuous? One possibility is that they use sex to
combat feelings of emptiness that are associated with the disorder. When feeling empty,
numb, lonely, or bored, sex may generate positive emotional responses.

Avoidance of Sex

While some studies have shown an increase in sexual behavior in people with BPD, there is
also evidence that some actually avoid sex. For example, in a 2003 study, Dr. Mary Zanarini
and colleagues found that people with BPD reported avoidance of sex for fear of
experiencing an exacerbation of their symptoms.

Your Sex Life

While the research is far from conclusive (and is particularly sparse with regard to men with
BPD), there is evidence to suggest that people with BPD can experience a variety of sexual
difficulties. It is likely that the impact of BPD symptoms on sex can vary substantially from
person to person, and can take very different forms. How your symptoms impact your sex life
may warrant some reflection or even a discussion with your therapist or partner.

https://www.verywellmind.com/learning-to-identify-emotions-425360

Why People With BPD

Have Trouble Identifying
Emotions
Many people with borderline personality disorder (BPD) struggle to identify emotions. This
is not surprising; being able to identify your emotions is thought to be a key aspect
of emotion regulation, and many researchers consider BPD to be a disorder of emotion
regulation. In fact, some experts have proposed changing the name BPD to “Emotion
Dysregulation Disorder.” The lack of ability to identify emotions can have significant
consequences on social interactions and relationships.
Why Can’t People With BPD Identify Emotions?

While scientists aren't positive about why many people with BPD have trouble at identifying
emotions, they have hypothesized several potential causes. First, BPD is often linked
to childhood maltreatment, such as child abuse or neglect. The ability to identify emotions is
something we develop quite early in life and our caregivers play an integral role in helping us
learn what we are feeling.

Children who have abusive or neglectful caregivers can miss out on this lesson. Instead of
learning what they are feeling, maltreated children may instead learn to be afraid of their
emotions because emotional expressions can trigger abuse or that their emotions don’t matter
because they are ignored by neglectful parents.

However, many people with BPD were never maltreated as children. Why might they have
trouble identifying emotions? It may be that some people with BPD are genetically
predisposed to have very intense emotional responses.

In this case, caregivers may have trouble helping their child understand their emotions
because the responses seem so intense. This may also trigger the development of an
emotionally invalidating environment, as parents struggle to acknowledge emotions that seem
to be out of proportion with the triggering event.

Why Is It Important to Be Able to Identify Emotions?

Emotions are very important to our daily functioning because they help guide our decisions,
help us connect with other people and keep us out of harm’s way.

For example, imagine if you were not able to identify the emotion of “fear.” Without an
ability to recognize fear signals, you might find yourself in dangerous situations. However, if
you can pick up on your fear cues, you are more likely to stay away from people or things
that might harm you. Fear, while it is sometimes an unpleasant emotion, is actually critical to
our well-being.

Another reason it is important to be able to identify emotions is that when we can’t identify
our feelings, we often end up with a vague, confusing internal experience that some call
“muddy emotions.” Some people who have trouble recognizing their emotions will say things
like, “I just feel awful!” Awful is not an emotion, but it is probably a muddled experience
generated by a confusing mix of emotions. It is much more comfortable to be able to identify
the emotions that are there like “I feel sad, fearful, and ashamed” than to experience muddy
emotions.

How to Identify Emotions

If you have trouble identifying emotions, there is good news. Even if you didn’t have a
chance to learn this skill as a child, it is never too late to learn to identify what you are
feeling.

Of course, this skill takes a great deal of practice—as children, we learn to do this over the
course of years, with many practice trials each day. You can learn this as an adolescent or
adult as well, but expect to practice daily for months before you begin to notice a change in
your ability to identify emotions.

A therapist specializing in borderline personality disorder can help you develop emotional
skills and empower you to identify emotions appropriately. This can have a significant impact
in how you communicate with others.

https://www.verywellmind.com/bpd-and-career-choices-425401

Borderline Personality
Disorder and Careers
If you have been diagnosed with borderline personality disorder (BPD), it's common to be
frightened and worried about how this disorder may impact your life, especially in terms of
your career. While BPD symptoms can make things more complicated, many people with
BPD go on to have very successful careers.

BPD and Job Performance

It is quite possible to have BPD and career success. In fact, some maintain strong careers
even when they are struggling in other areas of their lives. On the other hand, some people
with BPD have lots of trouble in their careers and are either unemployed, underemployed or
very unhappy in their jobs. There is no one path for someone with BPD and is very much
dependent on the individual situation.

BPD can affect your career in a few different ways. First, you may suffer from identity
problems, which can make it hard to settle on one career path. You may feel unclear about
who you are and what your passions are. This can cause you to jump from job to job without
ever committing to one career and building success in that area. This can put you behind in
terms of job growth since you may miss out on promotions or opportunities linked to
seniority.

In addition, you may engage in a lot of dichotomous thinking, or "all or nothing" thinking.
This means you start what you think is a dream job and think it's perfect. You may idealize it
until something happens, like a poor performance review or a mistake. Then you can feel
completely let down and demoralized, causing you to quit because it no longer seems like a
dream job. This can cause people with BPD to engage in even more "job hopping."

Symptoms of BPD can also interfere with concentration, which can lead to poor work
performance. For example, if you dissociate a lot, you may have trouble focusing on tasks
which can harm your productivity.
Finally, most careers include some element of interpersonal interaction. You may have
trouble at work if you have difficulty maintaining stable relationships. For example, people
with BPD are sometimes fired from their jobs because they don't get along well with
colleagues, have trouble maintaining appropriate boundaries or generate a lot of conflict in
the workplace.

Building a Strong Career

These are all things to keep in mind as you choose a career. It may be that you experience
problems in all of these areas, or just one or two. Think about how these symptoms might
impact your ability to function daily in the career you choose. For example, if you have
problems with significant stress, choosing a career in a very fast-paced or high-stress industry
may be ill-advised. A quiet, calm or more soothing environment may be better for you.

At the same time, don't let your BPD diagnosis completely govern or limit your job choices.
There are people with BPD who have been successful in every possible profession. Keep
your symptoms in mind as you evaluate your strengths and weaknesses, but also, keep in
mind that you are a person separate from your diagnosis.

If you're worried about how your symptoms will impact your career, speak with your
therapist. He or she may be able to give you some useful strategies to manage your symptoms
and suggestions for potential career paths that match your talents.

https://www.verywellmind.com/when-your-loved-one-is-refusing-treatment-425198

Why Won't My Loved One

Get Help For Borderline
Personality Disorder?
Many people with borderline personality disorder refuse treatment

It is quite common for people with mental health problems to be resistant to the idea of
seeking out treatment. Borderline personality disorder (BPD) is very treatable, yet many
people with BPD deny that they have a problem or avoid getting help.

Why Won't My Loved One Seek Help When She Is Clearly Suffering?

There are so many reasons that people refuse to get help. Many are afraid of the stigma
attached to mental health issues. Others feel they cannot commit the time and/or financial
resources required to engage in therapy. Some may not be willing to admit that they have a
problem in the first place, or may not think that treatment will work for them (despite clear
research evidence to the contrary; we now have a number of effective treatments for BPD and
a host of other mental health conditions).

Whatever the reasons may be, being the loved one of someone who is engaging in self-
destructive behavior, hurting and manipulating others with their outbursts and volatility,
and refusing to take steps toward change can be a heart-wrenching, defeating, and painful
experience. In this position, many loved ones feel the need to do something that will convince
their loved one to get help—for the sake of that person and themselves.

The fact is, if your loved one is an adult, you have no control over what they do or don't do at
the end of the day. This lack of control naturally leaves many loved ones feeling desperate
and helpless—but it doesn't have to. Whether it’s your spouse, child, parent, sibling, or friend
who is exhibiting symptoms of BPD, there are steps you can take to set boundaries in your
relationship and improve your own quality of life, even if the person with BPD isn’t ready to
acknowledge the problem. All the while, you can continue to encourage your loved one to
seek professional help.

How You Can Support Your Loved One's Recovery—And Protect Yourself

There are several things you can do to support your loved one's recovery, and many of them
include setting your own boundaries and not enabling your loved one's abusive behavior.
Here are some tips:

 Make clear the kinds of behavior you will not tolerate, focusing on yourself. You might say,
"If you can't speak calmly/stop being verbally abusive right now, I'm going to remove myself
from the conversation."
 Bring the entire family into the discussion about setting boundaries with your loved one. If
the person with BPD is raging or emotionally volatile with any of you, agree on the steps you
will all that situation, such as walking out of the room.
 If you believe your loved one is engaging in self-destructive behavior or is in danger of
suicide, don't leave them alone—and call either your loved one's therapist, 911, or
the National Suicide Prevention Lifeline at 1-800-273-TALK.
 Do not tolerate verbal abuse or physical violence. If your loved one tries to harm you, call the
police.
 Join support groups and seek out resources for loved ones of people with BPD. Getting
involved in these groups and educating yourself about the disorder can help you better
understand BPD and make choices about how you want to live your life in relation to your
BPD loved one. Your energy is probably better spent on these activities, which are in your
control, than on changing your loved one's behavior, which is not in your control.

 Remember that, though you love your family member very much, your own safety and self-
care should always be your priority. If your loved one continues to cross boundaries or make
you feel unsafe, you may need to find an alternate living arrangement or, if you don't live
together, simply keep your distance from this person. Allowing their abuse to continue does
much more harm than good—and not only for you but also for them.
https://www.verywellmind.com/are-people-with-bpd-more-likely-to-cheat-425228

Borderline Personality
Disorder and Cheating
People With BPD Often Struggle With Impulsive Behaviors

Being in a relationship with someone with borderline personality disorder(BPD) can be an

overwhelming and frustrating situation. Any relationship has its ups and downs, but BPD-
related issues can make typical relationship problems even worse. However, being with
someone with BPD doesn't mean your relationship is destined to fail. Many people have
strong relationships with someone who has BPD.

BPD and Cheating

Some people have negative associations between BPD and infidelity, but there is currently no
research that shows a connection between BPD and an increased likelihood of cheating. The
rates of infidelity in those with BPD is approximately the same as for other individuals.
However, studies in the prevalence of cheating show that up to 70 percent of married men
and women have cheated on their partners, so it's quite likely that some people with BPD will
have cheated as well.

Two of the key features of borderline personality are problems in relationships and problems
with impulsive behavior. These symptoms can make any potential cheating an even more
emotional experience with severe consequences.

People with BPD often have an intense need to feel loved and accepted, along with a lot of
ups and downs in their relationships. And, when they are feeling abandoned or rejected, they
may engage in impulsive or risky behaviors. This means that they might choose these
behaviors without considering the consequences of their actions in order to try to feel better
in the short term. Certainly, infidelity could fall into this category.

BPD and Worry About Partner Cheating

While those with BPD have the same likelihood of cheating as others, they do have a higher
likelihood of suspecting their partners are cheating. One of BPD's symptoms is an assumption
that others are going to cause hurt. Due to low self-esteem, they have difficulty believing that
someone could love them and remain faithful to them. As such, they are more likely to
assume that their partner will cause them pain in some way.

Also, because of the overwhelming fear of abandonment that's a hallmark trait of BPD, they
can be more suspicious and distrustful, assuming or even truly believing that their partners
are messing around behind their backs. In turn, this negatively affects their loved ones and
their relationships.
If your partner with BPD accuses you wrongfully of cheating, you are likely to be angry,
emotional, and you may even think about ending the relationship. In this sense, BPD can
worsen relationship issues since this distrustful, accusing behavior actually encourages the
relationship to end.

Couples Therapy May Be Helpful

While having BPD does not necessarily increase the risk of infidelity, BPD can be a huge
strain on relationships for both people involved. If you or your loved one is struggling with
symptoms of BPD, contact a mental health provider or therapist. While anyone with BPD can
greatly benefit from treatment, going to therapy additionally as a couple can help you work
through relationship issues and understand where your partner is coming from. Through your
sessions, you'll both learn essential communication and coping skills that can help you
through tough times and strengthen your relationship.

https://www.verywellmind.com/how-you-vent-anger-may-not-be-good-for-bpd-425393

Is Venting Your Anger a

Good Idea?
Many people with borderline personality disorder (BPD) struggle to learn how to vent anger
in a way that is healthy and not destructive. If you have struggled with bouts of anger in the
past, you may have been encouraged to let it all out. But new research shows that venting
may not be as healthy as once thought.

Is Venting Healthy If You Have BPD?

Many people with BPD experience intense anger which is sometimes called "borderline
rage." When this happens to you, you may be struck by such intense emotions you have to
lash out, either through yelling, self-harm or other dangerous behaviors. This extreme anger
comes in response to perceived interpersonal slights, such as feeling like you failed at
something or feeling rejected by a loved one.

If you experience this kind of anger, you may have a hard time controlling it. Past therapists
may have advised you to manage your anger by venting or "letting off steam." Sometimes
this takes the form of relatively benign behaviors like punching a pillow or yelling in the
shower. However, sometimes venting can escalate to the point where it causes physical harm
to others, yourself or damage to property.

The idea that letting off steam can help you manage your anger is not a new one; for many
decades mental health professionals thought that this type of venting was essential to anger
management. The release of intense emotions was described by healthcare providers
as catharsis.

Does Venting Help Manage Anger?

Becoming physically aggressive in harmful ways is a bad strategy, one that could lead to
serious consequences for yourself and other people. In some cases, it could also cause lasting
legal issues for you. But what about the more harmless form of venting, like punching a
pillow?

Research suggests that letting off steam, even in its most harmless forms, is not an effective
way to control your anger. In fact, these supposedly harmless forms of venting have been
shown to increase aggressive behavior later on. It actually trains your body to use violence as
a way to manage your BPD symptoms. So, while you may temporarily feel better, the act of
venting can lead you to have more difficulty with your anger down the road.

In the past, therapists have advised people to do things like punch a pillow, but we now know
that this isn't always the best advice; it's an unsustainable solution with potentially negative
consequences.

What to Do Instead

Rather than venting, talk to your therapist about methods to better cope with your symptoms.
There are some techniques that will allow you to manage your anger:

 Take a break: Give yourself some time away from what angers you. Whether it's an ex-
partner or a former friend, stepping outside or leaving a party early to avoid them can help
prevent the rage from starting in the first place.
 Exercise: Take a walk or hit the gym. That will allow you to get out your energy without
engaging in any harmful behaviors.
 Write it down: Jot down how you're feeling in a journal or on your personal blog. By letting
out your thoughts and reflecting on your feelings, you can get a better handle on your
emotions.

If you're looking for more ways to control your emotions and outbursts, try these tips
for healthy ways to manage your anger.

https://www.verywellmind.com/is-avoiding-triggers-a-good-idea-425395
How to Avoid Triggers With
Borderline Personality
Disorder
We know that with borderline personality disorder (BPD), symptoms are often made worse
by certain situations, people, or events. For example, many people with BPD find that their
symptoms are triggered by criticism from loved ones, reminders of traumatic events, or
perceived episodes of abandonment or rejection. These memories or actions can bring
on symptoms of BPD, such as extreme emotional reactions and poor impulse control.

Avoiding Triggers

One strategy you can use to manage your BPD symptoms is to avoid triggers altogether. This
is often recommended in the early stages of BPD treatment plans as you begin to get a handle
on your symptoms. Avoiding triggers can be an important step to get you more stabilized
while you learn essential coping skills during therapy. By staying away from things that set
off your symptoms, you have time to practice your skills in situations that are low risk for
you. If you jump into trigger situations before you have a solid foundation from therapy, you
are likely to be unprepared to handle them and will likely experience your usual BPD
symptoms or outbursts.

Understanding Triggers

BPD triggers are situations, people, or events that can worsen your BPD symptoms. While
specific BPD triggers vary from person to person, there are some that are very common. They
can be either external, happening in the world around you, or internal, occurring only in your
thoughts.

The things that trigger you will depend on your history. For example, if you experienced
abuse as a child, things that could bring those memories to the forefront might include a news
report of child abuse, an article in the paper, or even a movie.

Identifying Your Triggers

If you haven't done so previously, take a moment to learn how to identify your BPD triggers.
If you're not sure where to start, try to think of times in the recent past when you felt intense
emotion, impulsivity, or felt a desire to self-harm. Then look back to the events that preceded
the emotion. Therapists often recommend writing down a list of triggers, followed by the
emotion they triggered, and the reaction you had to that emotion.
How to Avoid Triggers With BPD

Early on in treatment, it may help to design your life in a way in which you can minimize
triggers. Some people find that they need to eliminate watching the news from their day, and
possibly eliminate many forms of media in general. If there are people in your life who
trigger you, you may need to go low contact or no contact while you work through the initial
stages of your BPD.

There are some triggers that your therapist may recommend you continue to avoid even later
into your treatment plan. If a certain movie scene reminds you of a traumatic childhood
event, there's no point in watching it or forcing yourself through it; it will only cause
unnecessary pain. From movies to sad songs, these are the types of small triggers you can
avoid without disrupting your life.

Other Strategies for Coping

Avoiding triggers is not always possible or even advisable, and therefore learning other ways
to cope with BPD triggers is important as well.

Avoiding triggers is only one option for your recovery and not a long-term solution for every
trigger. While it can be extremely helpful as you begin to work with a therapist, you need to
exercise this strategy in moderation. Avoiding triggers can be very useful when the trigger
you are avoiding is predictable and avoiding it doesn't limit your life in significant ways. But
if the trigger is unpredictable or involves very large parts of your life, avoiding it isn't
realistic or sustainable.

For example, many people with BPD are triggered by conflict in their relationships. The only
way to avoid conflict in relationships completely, however, is to have no relationships at all,
since conflict is an inevitable part of all relationships. Unfortunately, many people with BPD
find themselves pushing away loved ones for this very reason; they may become avoidant of
relationships altogether in order to avoid exacerbating their symptoms. This strategy doesn't
work. It only makes feelings of rejection and loneliness worse, bringing on severe symptoms.

Deciding How to Handle Triggers

It's important to work with your therapist or doctor when deciding how to handle triggers. He
or she will help you navigate whether or not it's practical to avoid them. If avoiding a trigger
will disrupt your life in some way, such as keeping you from going to work or ignoring your
partner, avoidance isn't a viable option for you. Your therapist will instead help you find
another way to cope with the trigger, such as developing a trigger action plan.

Bottom Line

Triggers can set off or exacerbate the symptoms of borderline personality disorder. If you're
living with BPD, learning to identify those triggers is an important part of managing your
symptoms. Avoiding triggers can sometimes be helpful, especially early on when you're
learning to navigate your condition. With time, however, other methods of coping with
triggers become very important in order to develop and improve your relationships with
others.