Borderline Personality Disorder (BPD) Treatment

What Is Borderline Personality Disorder (BPD)?

Borderline personality disorder is a mental health condition marked by extreme mood swings, unstable relationships, and difficulty regulating emotions. Those with BPD often experience feelings of emptiness and increased fear of abandonment and have an increased risk of suicide and self-harm.

Those with BPD are more likely to have co-occurring conditions like anxiety, depression, or eating disorders. Persistent emotional instability and difficulty managing distressing emotions can also impact daily functioning, making it difficult to maintain positive relationships.

Signs and Symptoms of BPD

Emotional Symptoms

If you have borderline personality disorder, you may experience a pattern of emotional instability, including:

• Rage.
• Sorrow.
• Shame.
• Panic.
• Terror.
• Long-term feelings of loneliness and emptiness.

Emotional symptoms also include extreme reactions and unpredictable mood swings. For example, experiencing suicidal feelings and positive feelings a few hours later is common.

If you or a loved one experiences suicidal thoughts, call Beach House Center for Recovery for help. If self-harm or overdose is a factor, call 9-1-1 for immediate assistance.

Behavioral Symptoms

If you have BPD, you may frequently experience the following impulses and find them extremely difficult to control:

• Self-harm (e.g., cutting your arms with razors, burning your skin with cigarettes).
• Reckless, irresponsible, and impulsive behaviors (e.g., binge drinking, drug misuse, gambling, or unprotected sex with strangers).
• Suicidal thoughts and behaviors.
• Dissociation (e.g., detaching from oneself or reality).

Cognitive Symptoms

Cognitive symptoms of BPD often include:

• Assuming or expecting the worst possible outcome consistently.
• Believing emotions reflect reality.
• Assuming to know what others are thinking or feeling.
• Believing there are hidden meanings in the words and actions of others.
• Difficulty understanding the mental state of others.
• Believing the world is hostile and untrustworthy.
• Experiencing hallucinations or delusions.

If you are experiencing one or more of these symptoms, seek immediate behavioral and medical treatment.

Interpersonal Symptoms

Interpersonal symptoms of BPD include the following:

• A pattern of intense, unhealthy relationships.
• Intense feelings of fear, anger, and self-harm.
• An unstable sense of self and self-worth.
• A tendency to act impulsively.
• Regular feelings of paranoia, especially when they feel rejected.

Causes and Risk Factors of BPD

Genetic Influences: Neurochemical Imbalances

Low dopamine and serotonin levels, common neurotransmitters, are associated with mood dysregulation, hypersensitivity to emotional stimuli, and difficulties with impulse control and aggression.

Brain Structure and Functioning

Many cases of BPD are linked to abnormalities in the prefrontal cortex and amygdala. The prefrontal cortex is responsible for emotional regulation, decision-making, and impulse control, while the amygdala helps process emotions like fear and aggression.

Childhood Trauma

Childhood trauma like abuse, neglect, chronic invalidation, parentification, and instability can trigger borderline personality disorder. These factors negatively impact a child’s ability to develop healthy emotional and social skills.

Environmental factors

Several environmental factors may also increase the risk of BPD, including:

• Family history of mental health or personality disorders.
• Exposure to regular or repeated traumatic events (e.g., bullying, abandonment, significant loss).
• Exposure to domestic violence or conflict within the home.

Psychological Factors

Up to 70% of those diagnosed with borderline personality disorder have experienced sexual, emotional, or physical abuse as a child. This may also include:

• Emotional neglect.
• Inconsistent caregiving.
• Early separation from parents.

Diagnosing Borderline Personality Disorder

BPD Diagnostic Criteria

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person must have five out of nine of the following criteria:

1. Impulsiveness in two potentially damaging areas of life (e.g., sex, substance misuse, gambling, etc.)
2. Mood instability due to heightened reactivity.
3. Paranoia or dissociation while under stress.
4. Unstable self-image.
5. Labile intense relationships.
6. Suicidal thoughts or actions.
7. Inappropriate or misplaced anger.
8. Vulnerability to and fear of abandonment.
9. Emptiness and loneliness.

Note: The word IMPULSIVE is an easy way to remember these criteria.

Assessment and Diagnostic Tools

While no definitive test exists for diagnosing borderline personality disorder, a licensed clinician or psychiatric provider at Beach House Center for Recovery may use a variety of tools to assess and evaluate you for BPD. These may include:

Structured Clinical Interview & Comprehensive Clinical Evaluation
A structured clinical interview combined with a comprehensive clinical evaluation helps identify key BPD traits and behavioral patterns over time. These are typically used along with one or more of the following diagnostic methods:

• McLean Screening Instrument for BPD (MSI-BPD).
• Personality Diagnostic Questionnaire 4^th Edition—BPD Scale.

Behavioral Checklists
Standardized questionnaires, like the Diagnostic Interview for Borderlines (DIB), and tools like the Borderline Personality Disorder Severity Index (BPDSI) help assess specific BPD behaviors and symptoms over time.

If you are diagnosed with borderline personality disorder, treatments such as dialectical behavior therapy (DBT) and medication can help manage your symptoms and improve overall functioning.

Treatment Options for BPD

Dialectical Behavior Therapy (DBT)

DBT is a specialized form of cognitive behavioral (CBT) therapy. It is widely recognized as the ‘gold standard’ for treating borderline personality disorder. DBT focuses on balancing acceptance with change and helps reduce:

• Psychiatric hospitalization.
• Substance misuse.
• Suicidal behavior.
• Treatment dropout rates.
• Intense emotions (e.g., anger and fear).
• Interpersonal difficulties.

Cognitive Behavioral Therapy (CBT)

CBT is a therapeutic approach that helps individuals identify and challenge negative thought patterns and behaviors. It is an effective approach for treating symptoms of BPD. DBT is a specific type of CBT, but traditional CBT offers valuable stand-alone benefits, including:

• Improved emotional regulation.
• Reduced impulsivity.
• Enhanced coping skills for stress.
• Improved coping skills for negative thought patterns and self-criticism.

Medication for BPD

While there is no specific medication for borderline personality disorder, antidepressant, antipsychotic, and mood stabilizer medications may help manage symptoms. Your Beach House Center for Recovery clinician will prescribe medicines based on your unique needs, symptoms, and severity.

Group Therapy and Peer Support

You may also benefit from regular individual, group, and family therapy sessions to help manage symptoms, improve communication skills, and strengthen relationships.

Expert BPD Treatment at Beach House Center for Recovery

At Beach House Center for Recovery, we provide compassionate, mental health and borderline personality disorder therapies to ensure you get the exact care you need.

Our skilled team is ready to help you manage your personality disorder symptoms and support any co-occurring conditions. Contact our caring admissions counselors for more information and to start your recovery journey.