Borderline Personality Disorder (BPD) is one of the most difficult mental health diagnoses to treat, making it very hard for the 1.4% of the United States population to experience it .
Because of the challenge in treating BPD, psychologist Marsha Linehan invented Dialectical Behavior Therapy (DBT) in the 1970’s. This treatment has shown positive effects on helping those with BPD improve their symptoms and live fulfilling lives despite their diagnosis.
What is BPD?
In the mental health realm, BPD is known for being an exceptionally challenging disorder for both the individual experiencing it as well as their treatment team and loved ones.
To begin with, BPD is a personality disorder, meaning it involves more ingrained beliefs and long-term behaviors. While diagnoses such as mood or anxiety disorders may change or vacillate in intensity over time, personality disorders are lifelong and often persistent.
BPD specifically is characterized by difficulties identifying and regulating emotions. Individuals that struggle with BPD “feel emotions intensely and for extended periods of time, and it is harder for them to return to a stable baseline after an emotionally triggering event .”
BPD often manifests as impulsivity, poor self-image, unstable relationships, and extreme behaviors to avoid real or imagined abandonment from others. Individuals with BPD have often learned to have their relational needs met or to cope with overwhelming emotions or situations in harmful or ineffective ways and repeat these patterns, despite their being ineffective or even harmful.
75% of those diagnosed with BPD are women, although many researchers believe just as many men are affected but that they are misdiagnosed with PTSD or Major Depressive Disorder .
What is DBT?
Dialectical Behavior Therapy is an evidence-based treatment method that teaches individuals skills in four areas known to present challenges for those with BPD:
- Distress Tolerance
- Emotion Regulation
- Interpersonal Effectiveness
Mindfulness encourages individuals to engage in the present moment without attempting to change it. Mindfulness skills focus on observing, describing, and participating in the world non-judgmentally, one-mindfully, and effectively .
Distress Tolerance teaches individuals that pain and distress will happen and helps them to “bear pain skillfully .” Distress tolerance skills help individuals to cope within circumstances that they cannot change using skills such as looking at the Pros and Cons, the STOP skill, TIP skill, self-soothing, and radical acceptance .
In the Emotion Regulation section of DBT, individuals are taught skills that help them “control or influence which emotions you have, when you have them, and how you experience and express them .”
Finally, Interpersonal Effectiveness helps individuals set boundaries, communicate thoughts and feelings, develop and maintain relationships, and learn to balance acceptance and change in relationships .
The Success of DBT
The four areas described above only scratch the surface of DBT assumptions, beliefs, skills, and treatment interventions involved in the DBT curriculum.
Individuals often engage in DBT for at least one year, during which time they attend one, two-hour skills group each week, a one-hour individual therapy session each week, and have access to “coaching calls” with their therapist should they ever need support.
DBT has grown to be the most widely-used and accepted treatment for individuals struggling with BPD and has been adapted to help those with other mood disorders, eating disorders, and substance use.
Research supports this increase in usage of DBT, showing that “BPD patients treated with DBT showed less likelihood to commit such acts by the end of a year’s therapy, as compared with patients offered “treatment as usual .”
DBT offers a varied approach to the many areas that cause dysfunction in the life of an individual struggling with BPD and can provide hope for a more fulfilling life, self-view, and relationships.
Resources: Unknown (2017). Borderline personality disorder. National Alliance on Mental Illness, retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder  Linehan, M. (2015). “The DBT Skills Training Manual – Second Edition.” The Guilford Press.  Stone, M. H. (2006). Management of borderline personality disorder: a review of psychotherapeutic approaches. World Psychiatry, 5:1.
About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published October 9, 2020, on EatingDisorderHope.com
Reviewed & Approved on October 9, 2020, by Jacquelyn Ekern MS, LPC