In the past several decades, we’ve watched the treatment of Borderline Personality Disorder (BPD) evolve from a virtually hopeless status with no clear answers as to what may work, to a far more sophisticated and hopeful array of possibilities (see our earlier blog on Increasing Hope for the Treatment of Borderline Personality Disorder). Have you ever wondered or worried that you might have BPD? The actual, current approach to diagnosing BPD is quite complex, but the four components that most folks with BPD demonstrate include:

  • Mood instability: A person with BPD may flip from feelings of joy to despair, sadness to profound anxiety, or affection to rage within minutes or hours. Sometimes these shifts occur many times throughout a given day. People with Bipolar Disorder, on the other hand, tend to have somewhat longer lasting moods though they also may demonstrate frequent shifts in mood.
  • Impulsivity: People with BPD tend to do things without thinking about the consequences first. Perhaps not surprisingly, this tendency often lands them in trouble. People with BPD also speak without thinking. They may lie to get out of trouble, exaggerate reality, or to lash out at others.
  • Disturbances in Thinking: We’re not talking about psychosis here although people with BPD do sometimes experience fleeting departures from reality. Rather, the more common disturbances in thinking that they have involve tendencies to see things in all or not, black and white terms with no shades of gray. Sometimes they are also inclined to having somewhat paranoid thoughts and see other people as maliciously motivated (though this “paranoia” does not reach psychotic levels very often).
  • Unstable Relationships: People with BPD are notorious for having struggles with interpersonal relationships. They get drawn into conflicts with other people and feel exquisitely hyper-sensitive to criticism or rejection.

If this description seems to fit you, please see a licensed mental health professional for a diagnosis. Although we see the mental health diagnostic system as highly flawed, there’s enough value in understanding the nature of your problems that we do recommend you get yourself checked out.

But if you discover that you have something like BPD, what should you do next? First, try not to blame yourself. BPD has a wide variety of causes including genetic, learning history, family issues, and traumas among others. No one asks to get BPD and frankly, BPD causes serious hurt and anguish to those who are afflicted with it. So what you do next is seek treatment, preferably from someone skilled in treating BPD with an approach that’s supported in the empirical literature. As we blogged previously, the primary approaches that have shown real promise in that literature include:

Dialectical Behavior Therapy (DBT)
Mentalization-Based Therapy (MBT)
Transference-Focused Psychotherapy (TFP)
Schema Therapy (ST)
Cognitive Behavioral Therapy (CBT) tailored specifically to BPD

Although DBT has the most support at this time, the others have been receiving increasing scrutiny and have exciting potential. Interestingly, they also do not seem especially incompatible with one another. One approach we’ve found particularly exciting is Schema Therapy, developed by Jeffrey Young, Ph.D. We’ll discuss that therapy in a later blog.