Table of ContentsView AllTable of ContentsUnderstanding the Causes of BPDCognitive Behavioral TherapyPsychodynamic TherapyMedicationsSTEPPS ProgramPrognosis
Table of ContentsView All
View All
Table of Contents
Understanding the Causes of BPD
Cognitive Behavioral Therapy
Psychodynamic Therapy
Medications
STEPPS Program
Prognosis
Klaus Vedfelt / Getty Images
Risk factors of BPD overlap with those of other mental disorders that commonly co-occur with borderline personality disorder, including mood disorders like bipolar disorder, anxiety disorder, eating disorders (particularly bulimia), substance abuse, and post-traumatic stress disorder.
Symptomatically, these conditions also overlap with BPD. For example, a person with borderline personality disorder may have symptoms that meet the diagnosis of major depression, including chronic feelings of emptiness, suicidal thoughts and behaviors, and self-harm.
These factors make seeking treatment much more challenging, and that is why a multifaceted approach to treating BPD is required.
Cognitive behavioral therapy (CBT) is a form of psychotherapy (talk therapy) that targets and alters conscious thoughts and observable behaviors while also making a person become more aware of them. Several forms of CBT are specifically designed for treating BPD.
The very nature of borderline personality disorder can make it difficult for people with the disorder to maintain a comfortable and trusting bond with their therapist.
Dialectical Behavior Therapy
Dialectical behavior therapy (DBT) is a form of CBT that aims to help remedy the apparent contradictions that plague a person with BPD without invalidating personal experience. “Dialectical” means the interaction of conflicting ideas. In DBT, that means integration of both acceptance and change as necessities for improvement.
The four modules of DBT in a skills training group include:
Individual DBT sessions may involve six areas of focus: parasuicidal behaviors, therapy-interfering behaviors, behaviors that interfere with quality of life, behavioral skills acquisition, posttraumatic stress behaviors, and self-respect behaviors.
DBT is effective at reducing self-harm behaviors and suicide attempts, as well as the number of days spent in psychiatric hospitals.One study found at the end of the first treatment year, 77% of patients no longer met criteria for BPD diagnosis.
Overall response rates have been measured at around 45%, with 31% remaining unchanged and 11% deteriorating. Approximately 15% showed a symptom level equivalent to that of the general population.
Schema-Focused Therapy
Schema-focused therapy works on the premise that people with BPD have four maladaptive life schemas or worldviews that originate in childhood: abandoned/abused child, angry/impulsive child, detached protector, and punitive parent.
Schema-focused therapy takes place in three stages:
The aim is to educate the patient about how these schemas came about during a person’s life and subsequently influence their life patterns, and to replace these unhealthy schemas using four core techniques, including limited reparenting, experiential imagery and dialogue work, cognitive restructuring and education, and behavioral pattern breaking, to help a person with BPD confront daily experiences and past traumatic events.
Reported improvements following one two-year-long schema-focused therapy program included increased insight, better connection with one’s emotions, increased self-confidence, increased cognitive flexibility in terms of taking alternative perspectives and being less harsh to oneself.
Dynamic Deconstructive Psychotherapy
Dynamic deconstructive psychotherapy (DDP) is a newer option for treatment-resistant BPD. It is a 12-month treatment program that combines translational neuroscience, object relations theory, and deconstruction philosophy in its approach to help people with BPD heal from a negative self-image and maladaptive processing of emotionally charged experiences.
Neuroscience research suggests that individuals having complex behavior problems deactivate the regions of the brain responsible for verbalizing emotional experiences, attaining a sense of self, and differentiating self from other, and instead activate the regions of the brain contributing to hyperarousal and impulsivity. DDP helps people with BPD connect with their experiences and develop authentic and fulfilling connections with others.
This form of therapy works through integrating and verbalizing emotional experiences as well as enhancing interpersonal identity and interactions through greater differentiation of the self and other.
According to one study, approximately 90% of people who undergo a full year of DDP treatment will achieve clinically meaningful improvement, and recovery usually progresses after treatment ends.
Psychodynamic therapy targets the unconscious thought patterns that drive unhealthy conscious thoughts and behaviors. While CBT focuses on thoughts and beliefs, psychodynamic therapy encourages a patient to explore and talk about emotions as well, including those that are contradictory, threatening, or not immediately apparent.The focus is on using therapy to gain emotional, as well as intellectual, insight.
Other issues that psychodynamic therapy aims to tackle include:
Like CBT, a few forms of psychodynamic therapy are designed specifically for treating BPD.
Mentalization-Based Therapy
Mentalization-based therapy (MBT) works on the premise that symptoms of BPD stem from an inability or difficulty to mentalize, or the way a person makes sense of themselves and the world around them. A fragile mentalizing capacity vulnerable to social and interpersonal interaction is considered a core feature of BPD. The goal of MBT is to help people with BDP regulate their thoughts and feelings, which allows them to form and maintain interpersonal relationships.
Response rates after a year of treatment have been extremely positive, with patients experiencing general reduction in symptoms and increased psychosocial functioning and overall quality of life. General happiness was also improved and inpatient treatment days were significantly reduced.
Transference-Based Psychotherapy
Transference-based psychotherapy was developed based on the theory that a core feature of BPD is an inability to integrate positive and negative images of self and others, otherwise known assplitting. This form of therapy seeks to help patients see the grey areas in their black-and-white views of both themselves and others.
It has shown notable improvements in symptoms, including suicidality, depression and anxiety, and psychosocial functioning, as well as personality organization and psychiatric in-patient admissions.
Drug used to treat BPD symptoms include:
Systems Training for Emotional Predictability and Problem Solving, or simply STEPPS, is a two-person-led cognitive behavioral skills group program designed to be used in conjunction with other treatment methods like psychotherapy and medication for BPD.
Group sessions include up to 12 BPD patients, and take place over 20 weeks with meetings once a week for 2.5 hours in four areas of education meant to help BPD patients understand their diagnosis and develop coping skills. The four areas are psychoeducation, emotion regulation skills, behavioral skills, and emotion handling. It has proven to be an effective intervention with noticeable benefits in impulsivity, negative affectivity, mood, and global functioning achieved after six months.
While improvements in BPD were previously seen as rather rare and prognosis for BPD was considered poor, this has changed over the past two decades. Research now shows many of the most distressing and disabling symptoms of BPD improve during the first few years post-onset.As with other mental illnesses, early detection and intervention have a positive impact on recovery rates and duration.
Now it is well accepted that BPD can have a positive trajectory over time and the rate of remission tends to increase with each subsequent year of treatment. However, functional recovery is more difficult to attain, and many people with BPD will need to revisit treatment options.
Sustained remission, rather than recovery, is substantially more common, and rates have been shown as high as 78% to 99% in some studies.
According to a 2015 review in theCanadian Journal of Psychiatry,the risk of relapse decreases the longer the remission lasts, dropping to as low as 10% after eight years.
A Word From Verywell
Vast improvements in the way BPD treatment is understood and approached and a strong lean towards combination therapies have greatly improved overall prognosis. Sustained remission is highly possible with treatment. Remember that borderline personality disorder did not develop overnight and treatment may take a long time, but its efficacy makes it a worthwhile pursuit. You should talk to your healthcare provider to find the right combination of treatments for you.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ellison WD, Rosenstein LK, Morgan TA, Zimmerman M.Community and Clinical Epidemiology of Borderline Personality Disorder.Psychiatr Clin North Am. 2018 Dec;41(4):561-573. doi: 10.1016/j.psc.2018.07.008
Ng FYY, Townsend ML, Miller CE, Jewell M, Grenyer BFS.The lived experience of recovery in borderline personality disorder: a qualitative study.Borderline Personal Disord Emot Dysregul. 2019 May 22;6:10. doi: 10.1186/s40479-019-0107-2
National Institute on Mental Health.Borderline Personality Disorder.
May JM, Richardi TM, Barth KS.Dialectical behavior therapy as treatment for borderline personality disorder.Ment Health Clin. 2016 Mar 8;6(2):62-67. doi: 10.9740/mhc.2016.03.62
Stiglmayr C, Stecher-Mohr J, Wagner T, et al.Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study.Borderline Personal Disord Emot Dysregul. 2014;1:20. doi:10.1186/2051-6673-1-20.x
Kröger C, Harbeck S, Armbrust M, Kliem S.Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting.Behav Res Ther. 2013;51(8):411-416. doi:10.1016/j.brat.2013.04.008.x
Tan YM, Lee CW, Averbeck LE, et al.Schema therapy for borderline personality disorder: A qualitative study of patients' perceptions.PLoS One. 2018;13(11):e0206039. doi:10.1371/journal.pone.0206039.x
Upstate Medical University.Dynamic Deconstructive Psychotherapy.
National Library of Medicine.Psychodynamic Therapy.
Ripoll LH.Psychopharmacologic treatment of borderline personality disorder.
Riemann G, Weisscher N, Goossens PJ, Draijer N, Apenhorst-Hol M, Kupka RW.The addition of STEPPS in the treatment of patients with bipolar disorder and comorbid borderline personality features: a protocol for a randomized controlled trial.BMC Psychiatry. 2014;14:172. doi:10.1186/1471-244X-14-172.x
Biskin RS.The Lifetime Course of Borderline Personality Disorder.Can J Psychiatry. 2015;60(7):303-308. doi:10.1177/070674371506000702.x
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
