Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Borderline personality disorder (BPD) is a serious mental health issue that is characterized by unstable relationships, behaviors, moods, and emotions. Left untreated, BPD can cause significant issues in a person’s life disrupting their work, school, day-to-day events, and their relationships with others.
Like many psychological disorders, the causes of BPD are complex and not fully known. But with appropriate help and treatment, people diagnosed with BPD can live a better quality of life and reduce their symptoms.
Although the exact cause of BPD is unknown, researchers believe that genetic, biological, and environmental factors play a role in this complex disorder. For instance, there is strong evidence that childhood trauma such as abuse and neglect may be associated with BPD.
Similar to many other psychiatric disorders, there is evidence that BPD is highly heritable. People who have a first-degree relative with BPD have an increased risk of developing the condition, but this fact does not guarantee they will be diagnosed.
To diagnose someone with BPD, mental health clinicians ascertain if a person has displayed five or more of the criteria for BPD such as emotional instability, impulsive behavior, unstable self-image, inappropriate anger, idealization and devaluation in relationships, suicidal or self-harming behaviors, transient stress related paranoid ideation or dissociative symptoms.
In most cases, BPD is treated with a combination of medications and psychotherapy. However, there are times when a person with BPD may be hospitalized to protect themselves and others. There are several evidence based psychotherapies often used in the treatment of BPD including Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy (MBT), and Transference-Focused Psychotherapy (TFP).
A mental illness is often diagnosed when a person experiences disturbances in their thought patterns, feelings, or behaviors. Typically, these disturbances impact a person’s life by causing distress for them at work, at school, or in their relationships and activities.
A psychological evaluation consists of a series of interviews, tests, and assessments to measure a person’s behaviors, thoughts, and emotions and help mental health professionals arrive at a diagnosis. These evaluations are also used to help guide a person’s treatment.
DBT is a type of cognitive-behavioral therapy designed to teach people how to live with the intense and challenging emotions that accompany BPD. Developed in the late 1980s, DBT helps people learn how to regulate their emotions and behaviors, improve their relationships, and develop mindful ways of coping with stress.
MBT is an evidence-based treatment option for people with BPD in which they learn how to engage in mentalizing. Mentalizing, which involves being able to separate one's emotional state from that of others, helps people with BPD learn how to think before they react to their emotions or the perceived feelings of others.
TFP is an evidence-based psychotherapy approach for people with BPD. It uses the idea of transference—the concept that people will bring their problematic emotional reactions into the therapy relationship itself. The therapist utilizes these interactions to bring attention to aspects of the patient's mind they may not be fully aware of. This can lead to potential emotional and relationship growth.
American Psychological Association. Understanding psychological testing and assessment.
Bateman A, Fonagy P. Mentalization based treatment for borderline personality disorder. World Psychiatry. 2010;9(1):11-15. doi:10.1002/j.2051-5545.2010.tb00255.x
Society of Clinical Psychology. Transference-focused psychotherapy for borderline personality disorder.
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