Borderline Personality Disorder (BPD) is a complicated psychological disorder that is more common than many believe. This personality disorder involves irregular emotion and behavior and a severe lack in mental awareness/reasoning. Because of the vast and acute criteria it takes to be diagnosed as a person with BPD, these patients are looked on to be some of the most difficult patients to treat. To date, there is no medication that has been assigned to BPD. For this reason, many clinicians turn away patients with BPD because they are unskilled in their knowledge in how to treat BPD and because of the grueling time and commitment it takes. Not only are clinicians hesitant to take on a patient with BPD, the patient is often unwilling to stick with the process of management of their personality disorder for numerous reasons (O’connell & Dowling, 2014).
It is thought that persons with BPD suffered with emotional vulnerability at very young ages, which lead to powerful emotional anguish and pain in their adult years. This pain and distress is often followed by passionate and uncontrollable anger, manipulation, and a desire for attention (O’Connell & Dowling, 2014).
BDP can be classified mainly as psychosocial instability in many different faucets. Psychosocial instability takes its form in the inability to maintain friendships and relationships. Although there is a desire to be loved and accepted, most times these people reject others because of their fear of being rejected. In the same way, may people who are in relationships, be it friends, family, or significant others, cannot take the burden of dealing with a person suffering from such a complicated personality disorder. Not only are personal relationships hard to maintain, jobs are also hard for a person with BPD to maintain. Because of this, poverty is prevalent among those who suffer with BPD. All of these factors lead to identity issues that can lead to the abuse of drugs and/or alcohol and eating disorders. Because of the deep emotional pain that is present, most of the times BPD patients struggle with self-harm, eventually leading to suicide. It is safe to say all aspects these people’s lives are at a high risk for being completely instable (Jorgensen et al., 2013).
One crucial part of being a person who has BPD is that there is a high level of fear of being abandoned or alone in life. If there is an interpersonal relationship, it is usually very intense (Levy et al., 2006). This is another reason that clinicians are weary of treating a person with BPD. The patient might become overly attached to the clinician and the clinician might unintentionally let his or her patient down, causing even more emotional pain and distress. So many factors come into play when it comes to setting a plan to treat someone with BPD, which is why there is no set model, only theories that are still being tested.
Cognitive Behavioral Therapy (CBT) is one that is widely used among clinicians to treat many and most psychological disorders and even can help just to problem solve. CBT is used to help a patient identify his or her problem(s), identify and change thinking that should ultimately lead to changed behavior and finally changed emotional responses. Another primary focus of CBT is to help change the beliefs of his or herself and of others. This type of therapy must take place with a high level of cooperation from the patient and the clinician.
Some researchers of BPD came up with the idea that the most immediate cause for treatment for those with BPD was the suicide rates and harmful drastic accidents due to such instable behavior. In a research article by Davidson, K., Norrie, J., Tyrer, P., Gumley, A., Tata, P., Murray, H., & Palmer, S (2006), patients between the ages of 18-65 were used in a study to determine the if emergency related accidents, hospitalization for psychiatrics, and suicidal acts would be lessened by the use of CBT combined with treatment as usual (TAU) and just TAU on people who fit the qualifications of BPD. TAU involved in and outpatient programs, nurses and other clinical services to treat the patients. Another outcome that was looked for that was considered secondary was to see id self-harm acts and behaviors not caused by accidents were lessened.
Interestingly, the primary outcome showed no significant differences in using CBT combined with TAU and just TAU. There was, however, a great reduction in suicidal acts by the method of CBT combined with TAU. The secondary outcome of the study only showed that there were only some significant differences between CBT combined with TAU and just TAU. Although this study was not able to show drastic differences, since the time of this study there have been more to prove that CBT does in fact reduce anxiety and suicidal behavior. Because this particular study was unable to prove much, it was determined that more research needs to be done how treatments may be most effective (Davidson et al., 2006).
CBT can take place in many forms. In addition, there can be branches of CBT. One of the branches is Dialectical Behavior Therapy (DBT). The use of dialectics is the show that there are to different points of view that may be opposing at hand at all times. The process that DBT uses is to bring the two opposing points of view together and make the patient aware of these two opposing views and some how combine them. This helps a person by realizing that there is more emotions and thoughts involves than just his or her own. The reason that a person with BPD may have a problem doing this on his or her own is because they are emotionally vulnerable and have been at one point in his or her life or another combined with a living environment that declined to acknowledge these emotions. The key to DBT is emotional validation (Harned, Banawan, & Lynch, 2006).
One of the main focuses of DBT is using mindfulness. Mindfulness is a skill used to teach people to experience his or her thoughts, emotions, or environment without judging one way or another. This skill can help a person with BPD become more accepting of not only his or herself, but of their surroundings. This can reduce anxiety levels as well as reaction time. Best of all, it validates his or her emotions.
The part of DBT that is similar to CBT is that DBT uses opposite action. Opposite action is the combination of behavioral exposure and cognitive modification. The way these work together is by making the patient aware when an emotion is present and instead of acting on that emotion, use an opposite action to that emotion. The end result of this type of skill is to change the behavior and the emotion, just like what the crux of CBT teaches.
In a study conducted by O’Connell, B., & Dowling, M. (2014), DBT was used to teach new skills to those with BPD. The purpose of the study was to focus on five of the personality traits of those with BPD, openness to experience, agreeableness, conscientiousness, extraversion, and neuroticism. Two groups of people with BPD were chosen. The first group was patients with BPD who just began their 8-week DBT model, and the second group was those who had already finished the model in the past three years. All the participants who were involved were to fill out a questionnaire about the five focused personality traits. The study resulted in showing that those who already did the 8-week DBT model scored lower in neuroticism and higher in consciousness than those who had not completed the model. Since there were no other significant changes, it was again determined that there needed to be further studies done to find a treatment or to even prove the effectiveness of DBT for those who suffer with BPD.
Another branch off of CBT is a form of therapy known as Schema Focused Therapy (SFT). It is a combination of CBT, the use and knowledge of attachment theory, and it uses Gestalt’s techniques. SFT may prove to work well because it uses the knowledge of attachment theory unlike the CBT and one of its branches, DBT. As explained before, those who sufferer with BPD are likely to be unable to sustain relationships and jobs because they feel a strong sense of loneliness, fear of abandonment and lack of stability in themselves. Attachment problems are thought to have started at a young age of a person who now suffers with BPD. The Gestalt technique that is used in SFT comes into play here by then having the patient confront emotional damages of the past (Nadort et al., 2009).
Although studies in the past have shown that SFT resulted in fewer acts of self harm, suicides, and an improvement in personality, a study done by Nadort, M., Arntz, A., Smit, J. H., Giesen-Bloo, J., Eikelenboom, M., Spinhoven, P., van Dyck, R. (2009) wanted to study the effectiveness of SFT further by adding a crisis support group that worked longer and extra hours to be readily available whenever a patient needed help. This particular study was done with 60 participants between the ages of 18-60 years of age and 30 therapists. Therapy was held for 45 minutes twice every day for each patient. It lasted 18 months and data was collected at the 6 month, 12 month, and 18 month mark and then once three years after the study was final. The change in each patient was recorded in ranges of behavioral and cognitive techniques within the therapist-patient relationship and with outside activities, relationships, and the emotional recovery of past traumas. The study showed to be effective, however the evidence was not motivating enough to keep therapists on call after regular hours (Nadort et al., 2009).