In his article “Plunging where angels fear to tread” in Contemporary Psychology (vol. 40), J. Norcoss describes Borderline Personality Disorder (BPD) as one that leaves the clinician feeling inadequate and produces “downright fear” in practicing psychologists. Treatment for BPD often entails long-term therapy that can challenge even the most experienced clinician.
Symptoms of Borderline Personality Disorder
The essential feature of BPD is an extensive pattern of difficulty with interpersonal relationships, self-image, and affects, and marked impulsivity that is evident by early adulthood. People with BPD become irrational when faced with changes in routine and Credit: Source: Wikimedia Commonsreal or imagined separation. They perceive separation as rejection and link abandonment to their self-inadequacy; thus they make frantic efforts to avoid separation at any cost.
BPD individuals initially engage in relationships in an intense manner. They often idealize the other person; demanding much attention and sharing of themselves within the first one or two meetings. They insist upon spending lots of time with the other person. However, they often quickly shift views from idealizing to devaluing the other person. They claim that the other person doesn’t really are about them; that the other person isn’t “there” enough for them. They can empathize and nurture others, but only to the extent that others reciprocate and meet their demands.
Those with BPD may display marked and persistent unstable sense of self. There may be sudden changes in their opinions, plans, and goals about career, sexual identity, values and types of friends. BPD individuals usually have a self-image that is bad or evil. Sometimes they may feel that they don’t exist and may have problems in unstructured work or school environments.
BPD display impulsivity in at least two life arenas that are potentially self-damaging. This may manifest in:
- substance abuse
- recurrent suicidal behaviors
These acts are often what bring the BPD individual in for treatment. Recurrent suicidality is often the result of threats of separation or rejection. Self-mutilation may occurCredit: Source: Wikimedia Commons during dissociative episodes.
BPD may exhibit extreme, irrational, and uncontrollable anger. They may display affective instability that is caused by reactions of moods such as intense episodic ill-feelings or anxiety that usually last a few hours. They are easily bored and may constantly seek something to do. During extreme stress, BPD may have a dissociative episode. These usually occur in response to real or perceived abandonment and may last minutes or hours.
Treatment for Borderline Personality Disorder
A treatment plan for the BPD individual can include several aspects of therapy. One method used is a five stage overlapping approach. The therapist begins with constructing a working relationship with the client; moves to symptom management; then to modification of thinking errors; processing of trauma and schema changes and finally to termination of therapy. This final stage is often the most difficult as BPD clients generally desire the relationship to continue indefinitely.
Often BPD co-exists with other diagnoses. Individual therapy may be supported by a medication regime. The treating therapist must commit to a long-term therapeutic relationship in order to treat the BPD client. The course of the treatment plan will depend upon the therapist’s treatment style. Other symptoms may need to be addressed first; such as whether or not anti-depressants are necessary.
Treating individuals with Borderline Personality Disorder can be extremely taxing for therapists. Management of a BPD case therefore, needs to include an element of support for the treating therapist. This is usually accomplished with mentors and therapist consultations. Furthermore, therapists who work with BPD individuals often engage in their own therapy to address their own issues that arise from sessions with the BPD client.
The copyright of the article Overview of Borderline Personality Disorder Symptoms and Treatment is owned by Cheryl Weldon and permission to republish in print or online must be granted by the author in writing.
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