What is Borderline Personality Disorder?

Understanding and Compassion for Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental health condition characterized by intense and unstable emotions, relationships, self-image, and behavior. People with BPD often experience rapid mood swings, difficulty in managing their emotions, impulsive actions, and frequent highly charged and erratic feelings towards others, leading to intense bouts of conflict. It’s hard to have BPD.

Key Symptoms of BPD

  • Emotional Instability: People with BPD experience intense emotional responses to events, which can change rapidly. These mood swings can include feelings of extreme anger, anxiety, powerlessness, or deep sadness.
  • Impulsive Behaviors: BPD can lead to impulsive choices such as substance abuse, binge eating, risky driving, or self-harm. These behaviors are often attempts to cope with emotional distress.
  • Unstable Relationships: Individuals with BPD may have difficulty maintaining stable relationships. They might swing between idealizing others (seeing them as such great people) and devaluing them (seeing them as awful and wanting to punish them), often leading to arguments, passive aggressive exchanges, and frequent breakups.
  • Fear of Abandonment: A common feature of BPD is an intense fear of being abandoned or rejected. These feelings can lead to frantic attempts to avoid real or perceived abandonment.
  • Distorted Self-Image: People with BPD often have an unstable or unclear sense of self. They may struggle with feelings of worthlessness or a lack of identity and seek a sense of self through their engagement with others, acting like others, or idealizing others.
  • Chronic Feelings of Emptiness: Many individuals with BPD report feeling empty, lonely, or disconnected from themselves and others.
  • Anger and Aggression: Intense and inappropriate anger or difficulty controlling anger is common. This can result in verbal outbursts, passive aggressive behavior, or physical aggression.
  • Paranoia or Dissociative Symptoms: In stressful situations, some may experience paranoid thoughts (feeling as though others are trying to harm them), suspect that others have bad intentions, read feedback as personal criticisms, or dissociate in response to overwhelm (feeling detached from reality).

Prevalence of Borderline Personality Disorder

You’re Not The Only One

Borderline Personality Disorder (BPD) is relatively common in the general population. It is estimated that approximately 1.6% to 2.7% of the adult population in the United States may have BPD, though some studies suggest the prevalence could be as high as 5.9% when considering subclinical cases.

BPD is more frequently diagnosed in women, but this might be due in part to gender biases in diagnosis and who is more willing to ask for help, as well as differences in how symptoms manifest between genders. Research indicates that men may be equally affected but are often misdiagnosed with other conditions, such as anti-social personality disorder, post-traumatic stress disorder (PTSD), complex PTSD, or depression.

Despite its prevalence, BPD is often misunderstood and is commonly misdiagnosed as bipolar disorder or not diagnosed at all, highlighting the importance of awareness and accurate diagnosis.

Borderline Personality Disorder Treatment

BPD & Comorbidity

It Can Be A Lot

Borderline Personality Disorder (BPD) often occurs alongside other mental health conditions, known as comorbidities. These comorbidities can complicate diagnosis and treatment. Some common comorbidities with BPD include:

  • Mood Disorders: Depression and bipolar disorder are frequently found in individuals with BPD. People with BPD may experience intense mood swings that can be mistaken for or coincide with mood disorders.

  • Anxiety Disorders: Generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) are commonly associated with BPD. These anxiety disorders can exacerbate symptoms of BPD, such as emotional instability and fear of abandonment, a feeling that no one cares, or obsessive catastrophizing.

  • Substance Use Disorders: Individuals with BPD often struggle with alcohol or drug abuse as a way to cope with emotional pain, impulsivity, and mood swings and can make risky decisions about the quantity or combinations of substances based on current emotional states.

  • Eating Disorders: Conditions like bulimia nervosa and binge eating disorder are also common in those with BPD. The impulsivity and emotional dysregulation associated with BPD can contribute to disordered eating behaviors as a way to turn off or distract from painful thoughts and feelings.a

  • Other Personality Disorders: People with BPD may also meet criteria for other personality disorders, such as narcissistic personality disorder or histrionic personality disorder, making diagnosis and treatment more complex.

  • Attention-Deficit/Hyperactivity Disorder (ADHD): Symptoms of impulsivity and emotional dysregulation in BPD can overlap with those of ADHD, leading to a frequent co-occurrence, misunderstanding from mental health providers, and difficulty for patients implementing treatment strategies.

  • Self-Harm and Suicidal Behaviors: Although not a separate disorder, self-harm (e.g., cutting) and suicidal ideation and attempts are particularly common in individuals with BPD. This is often a response to intense emotional pain or fear of abandonment and must be addressed with urgency and great care.

Recognizing these comorbid conditions is crucial for providing a comprehensive treatment plan tailored to the individual’s needs.

How Can Therapy for BPD Help?

If you have BPD, therapy can effectively help you manage symptoms, attain healthier relationships, and improve your overall daily living. Here’s how therapy can help:

Managing Emotions

Dialectical Behavior Therapy (DBT), one of the most effective therapies for BPD, focuses on teaching skills for managing intense emotions, reducing impulsive behaviors, and improving relationships, the main challenges likely experienced. DBT will help you with skills such as emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness.

DBT also helps to identify and label emotions accurately so you can have better control over your emotional responses. Control over emotions brings great relief!

Improving Interpersonal Relationships

Therapy for DBT helps individuals understand their patterns of interacting with others. With BPD, relationships can often be intense, unpredictable, and unstable due to sudden fears of abandonment and a shifting tendency to idealize and devalue the people you care about.

Interpersonal effectiveness skills (often taught in DBT) teaches methods to express your needs candidly and directly, set boundaries and hold them, and to navigate conflicts peacefully. You can learn to address interpersonal issues without blowouts or arguments and even like each other better as a result.

Building Self-Identity

A common issue in BPD is an unstable sense of self or identity. Through therapy, for those of you with BPD, we can explore your values, interests, and personal goals, and foster a clearer, more stable and positive sense of identity. We will help you “know” yourself and ultimately like who you are. You might even develop pride for who you are.

South Asian woman in front of a laptop getting online therapy for BPD in Glendale, NY

Learning Coping Skills

Therapists teach practical skills for dealing with stress, anxiety, and triggers. Techniques such as mindfulness, grounding exercises, and relaxation techniques are often used to help individuals stay present and manage overwhelming situations.

Reducing Symptoms of Co-Occurring Disorders

BPD often coexists with other mental health conditions like depression, anxiety, or PTSD (for a more complete list, see below). Therapy for those of you with BPD will address these overlapping symptoms, providing you with a more holistic approach to mental health. And often, working on symptoms for one diagnosis tends to have positive effects on the symptoms of other diagnoses.

Increasing Self-Awareness and Insight

Through therapy, for individuals with BPD, you will gain insight into the origins of your behaviors and emotions, such as understanding how past traumas or attachment issues may contribute to current challenges. This self-awareness can empower you to make conscious choices about how to respond to situations and to reduce automatic and impulsive reactions.

Types of Therapy for BPD

Empathy and Insight into Your BPD Experience

Dialectical Behavior Therapy (DBT)

Specifically designed for BPD, DBT focuses on emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness. It is effective both in group format and with an individual clinician. Approximately 50% of individuals with BPD who receive comprehensive treatment show marked improvement within a year, and up to 80% experience remission of symptoms within 10 years.

Cognitive Behavioral Therapy (CBT)

CBT helps identify and change negative thinking patterns and behaviors. This often involves homework with a strong focus on behavioral analyses.

Mentalization-Based Therapy (MBT)

MBT aims to improve the ability to understand one’s own and others’ mental states, enhancing self-awareness and reducing emotional reactivity. With MBT, you learn to identify emotional states, how to interpret their significance, and determine strategies to address them.

Transference-Focused Psychotherapy (TFP)

TFP focuses on understanding and improving patterns of thinking, feeling, and interacting with others, especially as they relate to past relationships.

Interpersonal Psychotherapy (IPT)

IPT addresses the underlying emotional and relational difficulties that are often central to the disorder.

Medication

While there is no medication specifically for BPD, certain medications like antidepressants, antipsychotics, or mood stabilizers can help manage symptoms such as mood swings, obsessive thinking, depression, or anxiety.

Overall, therapy offers a structured, supportive environment for individuals with BPD to learn new skills, gain insight, and work towards a more stable and fulfilling life.

Treating BPD at Marsh: Interpersonal Psychotherapy

We Get You

Interpersonal Psychotherapy (IPT) combines psychodynamic and interpersonal approaches to explore the connections between a person’s relationships, emotional experiences, and underlying psychological processes. It emphasizes how past and present interpersonal dynamics contribute to emotional difficulties, helping individuals identify and change maladaptive patterns in their behavior.

The therapeutic relationship is central in IPT, providing a supportive space to examine the client’s interactions and emotional responses. IPT addresses emotional conflicts, promotes self-awareness, and encourages healthier ways of relating to others, making it effective for conditions like depression, anxiety, and personality disorders.

Black woman writing in a journal after Borderline Personality Treatment

The Benefits of IPT for Borderline Personality Disorder

  • Exploring Unconscious Processes: IPT focuses on exploring unconscious thoughts, feelings, and patterns that influence behavior and emotions. In BPD, individuals often struggle with intense emotions and relational difficulties rooted in past experiences. IPT helps bring these underlying patterns into consciousness, allowing individuals to gain insight into how their past impacts their current emotions and relationships.
  • Understanding Interpersonal Relationships: A core aspect of IPT is examining how an individual relates to others. For someone with BPD, interpersonal relationships can be tumultuous and marked by fear of abandonment, emotional volatility, and idealization-devaluation cycles. IPT provides a safe space to explore these relational dynamics and understand how they impact self-esteem and interactions with others.
  • Addressing Core Conflicts: Individuals with BPD often experience internal conflicts, such as desires for closeness clashing with fears of rejection. IPT helps individuals identify and work through these conflicts, aiming to develop healthier ways of relating to themselves and others.
  • Emotional Regulation: By exploring the roots of emotional distress in a therapeutic relationship, IPT allows individuals to better understand their feelings and develop more effective strategies for managing intense emotions. This can be particularly beneficial for BPD patients who often experience rapid mood shifts and emotional dysregulation.
  • Improving Self-Perception: Many individuals with BPD have a fragile sense of self and may struggle with self-criticism or self-doubt. IPT helps explore how past relationships and experiences have shaped their self-image, offering opportunities to reframe negative self-perceptions and foster a more stable sense of identity.

While IPT can be valuable for treating BPD, it’s often recommended alongside other therapeutic modalities, like Dialectical Behavior Therapy (DBT), which focuses on teaching practical skills for emotion regulation, mindfulness, and interpersonal effectiveness. At Marsh, we combine IPT, DBT, and Creative Arts Therapy to treat BPD.

Integrating IPT, DBT Principles, and Creative Arts

Our approach to Borderline Personality Disorder (BPD) treatment incorporates the valuable principles of Dialectical Behavior Therapy (DBT) alongside Interpersonal Psychotherapy (IPT) and creative arts techniques. This integrated method is tailored to address the specific aspects of BPD, focusing on:

  • Mindfulness Through Creative Arts: We employ creative art therapies to teach mindfulness, helping you to become more attuned to your feelings. Techniques like movement, breathing, and artistic expression are used to develop a present-moment awareness and acceptance of your emotional state.

  • Emotion Regulation and Distress Tolerance: Our therapists blend behavioral strategies from DBT with creative arts interventions to enhance your ability to regulate intense emotions and tolerate distress. This approach is aimed at reducing emotional instability and building resilience.

  • Interpersonal Effectiveness with a IPT Perspective: Enhancing your skills for healthier relationships, our therapy focuses on improving communication and understanding personal needs while respecting others, all viewed through the lens of interpersonal dynamics as understood by IPT.

Young black man practicing mindfulness during a session to treat borderline personality disorder

Treatment Success Rates

Short-term remission: Within one year of DBT treatment, approximately 50% of individuals with BPD experience significant reductions in symptoms, including decreased self-harm, suicidal behaviors, and emotional dysregulation. Many patients no longer meet the full diagnostic criteria for BPD after one year of DBT.

Long-term remission: Longitudinal studies indicate that up to 80% of individuals achieve remission within 10 years when receiving comprehensive treatment, including DBT. Continuous use of DBT skills is associated with sustained improvements, such as stable interpersonal relationships, better emotional regulation, and improved quality of life.

Your Path to Stability and Growth

Young woman on a laptop for online therapy session for Borderline Personality Disorder Therapy in NY

At Marsh Psychotherapy, we believe in your ability to navigate the complexities of BPD. Our supportive environment combines the principles of DBT and IPT with creative arts therapies, offering a compassionate and holistic approach to your therapy.

We are committed to walking alongside you on your journey towards emotional balance and healthier relationships. If you’re ready to embark on a path to a more stable and fulfilling life, we invite you to begin your journey with us.

What People Are Saying

“I left every session experiencing personal growth and positive change.”

Together, We Can Achieve More 

Join us at Marsh Psychotherapy, where we combine professional expertise with a nurturing environment. Here, profound emotional growth and meaningful change are not just goals; they are realities we achieve. Take the first step towards a life of balance, self-awareness, and emotional resilience.