Borderline personality disorder

Compared to issues like depression, panic, eating or substance use disorders, and anxiety, where the names themselves say something about the type of problem, the name Borderline Personality Disorder, or BPD for short, offers very little information about the problem. In some ways, this is unfortunate since we know that more than 12 million people in our country suffer with BPD, and far too few get the needed and appropriate treatment. So what exactly is BPD? More then anything, BPD is a problem caused by exceptional sensitivity to extremes of emotions, or "emotional vulnerability." Everyone experiences emotional discomfort or turmoil in their lifetime. Feeling emotions such as sadness, loss, anxiety, worry, loneliness, love, anger, and guilt are just part of being human. Unfortunately, some people are born more vulnerable than others to experiencing intense emotion. These people are told from a very early age in words, actions (or both!) that their feelings are wrong, unjustified or just plain crazy. This "invalidation" usually leads people to try to ignore or suppress their feelings as long as they can, but sometimes the emotions explode even larger than ever. Most of the time, these "eruptions" just lead to more "invalidation," but every once in a while, they get the longed-for response. This interaction between emotional vulnerability and invalidation leads to BPD, according to Marsha Linehan, Ph.D. Instead of occasionally experiencing these "normal" emotions, people with BPD experience them either: (1) very frequently, (2) uncomfortably intensely, (3) for a horribly long time, or (4) any combination of the above. They also become extremely sensitive to "invalidation" and may feel it acutely when others would hardly notice it.  


Understandably, people do not want to feel this way and search for relief from their distress. The "solutions" most available to people with BPD are often the "problems" that lead them to seek treatment or cause those who care about them to insist on treatment. Self-injury; losing control of food intake, drugs, alcohol or temper; abruptly ending relationships; and using up relationships are examples of behaviors that often occur because they provide momentary relief from intense emotional discomfort. One major problem here is that these behaviors, or attempted solutions, usually lead to even more problems and emotional distress for both the individual and those around them. For instance, any of the above behaviors may lead to even more guilt, shame, fear, isolation and invalidation.  


Most of all, struggles with BPD and the emotional vulnerability and behavioral problems that typically accompany it, tend to interfere with people¹s ability to lead a life that feels meaningful and worthwhile. At our Center we offer a type of therapy called Dialectical Behavior Therapy or DBT (click on DBT for more info) that has been shown to be effective in treating BPD. Both the American Psychological Association (APA) and the American Psychiatric Association ( another APA) currently consider DBT to be a first-line treatment for BPD (click on either APA for a link to their respective website). We offer both standard DBT and DBT as an adjunct to ongoing psychotherapy outside our Center. Standard DBT involves both weekly individual psychotherapy, a weekly skills training group and telephone consultation with a Center therapist who participates in a weekly Consultation Group designed to help the therapist be as effective as possible. We also offer Skills Training Groups and DBT-based group therapy for those who choose to continue in individual psychotherapy with a clinician who is not on the Center staff.