People with BPD feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event. This difficulty can lead to poor self-image and stormy relationships. Struggling with self-regulation can also result in dangerous behaviors such as self-harm (e.g. cutting). They often feel empty inside and cut-off from themselves and have an intense fear of abandonment and thus may have difficulty tolerating being alone. They often experience painful moods, such as panic, depression, and anger.
Someone with BPD experiences paranoid thinking characterized by extreme worry about the malicious intentions of others. There are clear associations between childhood neglect and physical or emotional trauma with the development of borderline personality disorder. Untreated, this condition can take a huge toll on a person’s ability to function well at school or work and/or maintain close relationships.
There are many misconceptions about BPD —namely that the person is seeking attention, that their suicidal threats are manipulative, that they can control their behaviors, and/or that they are not treatable. However, patients who achieve a good working alliance with their therapist or psychiatrist can achieve excellent outcomes.
Establishing an accurate diagnosis is essential, as there are often co-occurring conditions that might also need to be addressed with treatment, such as: major depressive disorder, anxiety disorder, bipolar disorder, and substance abuse. Although antidepressant medications tend to have minimal benefits, mood stabilizers in low doses may be helpful in addressing emotional instability.
Psychotherapy is the most commonly used treatment for BPD. Dialectical behavior therapy (DBT) is a modality of psychotherapy that focuses on mindfulness, or paying attention to the present feeling. DBT teaches techniques for managing intense emotions, reducing self-destructive behavior, coping with suffering, and improving relationships. It attempts to strike a balance between accepting and modifying behavior. This proactive, problem-solving method was created specifically for the treatment of BPD. Individual therapy sessions, group skills training, and phone coaching are all part of the treatment plan. DBT is the most researched and efficacious treatment for BPD. Medication can be particularly beneficial to treat comorbid conditions like depression and anxiety.