Borderline Personality Disorder Treatment (BPD) in New Jersey

Someone with borderline personality disorder (BPD) may suffer from unstable moods and erratic behavior. As a severe mental health condition, BPD affects the way people view themselves, others, and the world at large. In many cases, it impairs their ability to function and create a normal life.

Table of Contents

    Borderline Personality Disorder: Symptoms And Treatments

    Borderline personality disorder should not be taken lightly. It is a serious medical condition that demands expert care. The mental health specialists at Wellness Center NJ are experienced in treating people who suffer from BPD. Our licensed psychiatrists and certified therapists know how to deal with the unique challenges presented by the disorder.

     

    What is Borderline Personality Disorder?

    Borderline personality disorder, also known as BPD, is the clinical term used to describe long-standing instability in mood, behavior, sense of self, and interpersonal relationships.

    In BPD, a shifting sense of self leads to intense internal discord, causing discomfort and negative feelings.  These negative feelings can be so severe they often lead to a desperate attempt to find relief.  Often these attempts are impulsive and unhealthy, like binge eating, unsafe sex, or substance abuse.  BPD sufferers can experience intense emotional episodes ranging from anger to anxiety that last from a few hours to several days.

    When the self-image is as chaotic and everchanging as it is with BPD, it’s difficult for one to progress thru the normal developmental stages into maturity.  Making it harder still is the increased sensitivity that many people with BPD feel.

    BPD patients often experience a high degree of emotional stimulation in response to a situation that calls for a more subdued reaction. They can become consumed with emotion over minor conflicts or perceived slights.

    Another core feature of BPD is an intense fear of abandonment or rejection.  People with BPD strongly desire loving and lasting relationships.  However, in a desperate bid to alleviate their irrational fear of abandonment, they engage in behaviors that push other people away with behaviors like lying, clingy behavior, and starting a conflict in the hopes it will reduce the likelihood of abandonment.  Of course, the opposite tends to happen.

    BPD affects how one feels about themselves, other people, the world, and their place within it.  Ultimately, life-long instability caused by BPD leads to confusion about one’s identity and their place in the world.  The frequently fluctuating sense of self causes goals, values, and interests to change rapidly.

     

    Prevalence Of Borderline Personality Disorder

    BPD affects between 0.7% and 2% of the general population. Yet, borderline personality disorder makes up nearly 20% of the mental health inpatient population, indicating untreated BPD sufferers have disproportionately high healthcare services utilization.  This increased utilization of mental health care services places a significant economic burden on the system.

    BPD is much more common in females, with women making up about 75% of the diagnoses. Borderline Personality Disorder is extremely serious, with about 70% of BPD patients attempting suicide at some point in their life, and about 10% successful at completing their suicide attempt (Oldham, 2006).

     

    Diagnostic criteria of borderline personality disorder

    In general, the diagnostic criteria for BPD can be summarized with the following:

    • Unstable relationships
    • Fear of abandonment
    • Impulsive, self-destructive behaviors
    • Self-harm
    • Explosive anger
    • Chronic feelings of emptiness
    • Feeling suspicious of others or out of touch with reality
    • Extreme emotional swings

    The diagnostic criteria for a borderline personality disorder are based on the patient having experienced at least five of the nine symptoms below for a substantial period, along with a pervasive instability in self-image, moods, and relationships.

    1. Frantic efforts to avoid real or imagined abandonment; actions being guided by a pervasive fear of abandonment.   Individuals with BPD are usually terrified of rejection and being abandoned.  This fear is so upsetting that it is often behind frantic efforts to reduce that probability.  Interpersonal relationship skills are almost always lacking, and actions attempting to ensure a bond or prevent abandonment often are the same that ensure it.
    2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.  While lacking in long-term supportive relationships, people with borderline personality disorder have intense relationships that fluctuate from infatuation to anger and hatred.
    3. Identity disturbance: markedly and persistently unstable self-image or sense of self.  Just like their external relationships, people with BPD often have an unstable relationship with themselves, ranging from hate to guilt and shame.
    4. Impulsivity in at least two potentially self-damaging areas (e.g., spending, sex, substance abuse, reckless driving, binge eating).  Substance abuse is diagnosed with BPD 64% of the time, and its diagnosed with an eating disorder 53% of the time.
    5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.  Close to 70% of BPD patients will attempt suicide at least once in their life.
    6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
    7. Chronic feelings of emptiness. This can present as emotional numbness or dissociation with reality.
    8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) Angry outbursts and an inability to direct that anger are among the reasons why borderline personality disorder clients are often plagued with legal troubles.
    9. Transient, stress-related paranoid ideation or severe dissociative symptoms. These can range from mild paranoia regarding the intentions of others to full-blown psychotic symptoms with a dissociative detachment from reality.

    American Psychiatric Association, DSM-IV-TR: 7102

    In essence, BPD can be thought of as being associated with:

    • Frantic goal-directed activity to avoid real or imagined abandonment and rejection
    • Intense feelings of depression, anger, or anxiety that last from a few hours to several days. These feelings are often associated with impulsive behaviors, self-injury, and substance abuse in attempts to lessen the discomfort caused by these feelings
    • Distortions in the sense of self that leads to frequent changes in goals, friends, jobs, values, and identity
    • Reoccurring suicidal behavior
    • Temporary paranoid thinking or losing touch with reality as a result of stress

    Other Symptoms of BPD

    • Paranoid thoughts or beliefs regarding other people’s motives
    • Heightened sensitivity to rejection or criticism, regardless of how minor
    • Self-harm behaviors like cutting, substance use, and binge eating
    • Moods that are highly intense and highly changeable
    • Difficulties controlling anger
    • Temporary paranoia brought on by stress
    • A pervasive pattern of unstable or prematurely intense relationship0s
    • An unstable and distorted self-image that frequently changes
    • Impulsive behaviors that are often dangerous
    • Rapid changes in how one self-identifies and appraises their place in the world

    “Overall, the most distinguishing symptoms of BPD are marked sensitivity to minor rejection or criticism;[13] alternating between extremes of idealization and devaluation, along with varying moods and difficulty regulating strong emotional reactions. Dangerous and impulsive behavior are also correlated with the disorder.”

    BPD is rarely diagnosed by itself; BPD patients are at a much higher risk of binge eating disorder, depression, anxiety, and substance abuse.  The rates of comorbid disorders for BPD range from 10% (Somatoform) all the way up to 80%-96% (mood disorders).  BPD has a comorbid rate (co-occurring disorders) of 88% with anxiety, 64% with substance abuse, and 53% with an eating disorder.

    BPD comorbid rates with other disorders

    • Mood Disorders: 80%-96%
    • Anxiety disorders: 88%
    • Substance Abuse Disorders: 64%
    • Eating Disorders: 53%

    These peripheral disorders so frequently co-diagnosed with BPD usually improve with treatment for borderline personality disorder.  However, treating the peripheral conditions does not usually improve borderline personality disorder on its own.

     

    Causes of Borderline Personality Disorder

    The cause of borderline personality disorder involves complex interactions between internal genetically inherited traits and their interaction with external environmental factors, like childhood abuse, neglect, or trauma.

    BPD has a strong genetic link, with about 50% of disease’s cause explained by genetics.  Having family members who have BPD can predispose an individual to the disorder.  There are also significant environmental factors that predispose people to BPD, which can be mitigated with the proper treatment.

    BPD is associated with functional and structural changes in the brain. These differences explain why BPD sufferers so often feel like their brain is on high alert, and things feel scary and stressful. That’s how they feel at a baseline so that when something comes up that causes additional anxiety, the effects can be intense.  Once the body’s stress systems are activated and stress hormones like cortisol are released, it takes people with BPD much longer to calm down and break out of the tunnel vision often associated with stress episodes in people with BPD.

    These fundamental differences in BPD sufferers’ brains do not mean they are at the mercy of their disorder.  Every time a behavior or coping skill is remembered and practiced, neural pathways get created and strengthened in the brain.

     

    Treatments for BPD

    Treatments for Borderline Personality range in severity from outpatient BPD treatment services to a higher level of care like inpatient BPD treatment. If 24/7 medical monitoring is required because you might hurt yourself or someone else you may need a residential treatment center.

    With no FDA-approved medications for treating borderline personality disorder, treatment relies almost exclusively on counseling and therapy as the primary means of treating BPD.  Individual counseling and group counseling are both effective in treating Borderline Personality Disorder.  Medications are often used to treat conditions presenting with BPD like depression and anxiety.

    The treatment philosophy of treating BPD can be summed up as a balance between acceptance and change.  Indeed, the tension between change and acceptance is at the core of one of BPD’s most popular treatments, called DBT.

    Ultimately, healing comes down to breaking dysfunctional patterns related to thoughts, feelings, and behaviors that cause distress. Some of these habits that you will need to change have had a lifetime of reinforcement.  It can feel unnatural to react in new and different ways.  That feeling will end as new ways of thinking and acting replace embedded habitual behaviors and tendencies.  Remember, neurons that wire together fire together.  Each time you engage in a behavior, the links in the brain supporting that behavior becomes stronger.

     

    Mentality & Lifestyle Changes

    Lifestyle changes are essential to the long-term success of treatment.  For example, practicing a healthy lifestyle with proper nutrition and adequate amounts of sleep lowers emotional vulnerability, in turn, delaying or preventing triggers that would typically erupt into a volatile emotional storm.  Preventing triggers prevents a desperate attempt for relief by engaging in unhealthy and harmful behaviors like sex, overeating, or creating interpersonal chaos within relationships.  The urge to engage in unhealthy behaviors stems from a misguided effort for relief from internal discord.

    Lifestyle changes in 3 key areas are essential for a successful recovery from BPD.  The first involves acceptance of the disorder and the resulting volatile shifts in emotion.  Acceptance is often the opposite of what BPD patients have done their entire lives, resisting negative emotional states. However, this is one of the critical first steps on a journey of healing.

    After acceptance of the disorder is established, clients progress to learning impulse control and increased distress tolerance.  Improvements in impulse control and distress tolerance are often facilitated by mindfulness, meditation, and various grounding exercises.

    The third area needing improvement is the affected person’s relationships.  Cognitive Behavior Therapy is often helpful at this stage. It helps clients check their assumptions about others and stop projecting their negative feelings onto others due to the increased sensitivity found within the average BPD patient.

     

    Therapy & Counseling For Borderline Personality Disorder

    Because the bulk of treatment for BPD involves psychotherapy, the type of therapy chosen is essential.  In general, researchers recommend these therapies to treat BPD:

    • Schema-Focused Therapy – The focus of this therapy is on replacing maladaptive beliefs and coping mechanisms created by unmet childhood needs. Schema therapy also seeks to analyze and understand long-standing behavioral patterns by connecting past experiences with current behaviors.
    • Dialectical Behavior Therapy (DBT) – One of the first therapies to be shown effective for BPD, DBT merges components of Zen Buddhism and Cognitive Behavior Therapy to help patients accept negative emotions while increasing distress tolerance.  DBT skills can help you minimize the distress that often drives unhealthy coping mechanisms and behaviors.
    • Mentalization-Based Therapy – Helping clients realize what triggers certain mental states is a big part of Mentalization-Based Therapy, an approach currently being studied as a BPD treatment.
    • Transference Based Psychotherapy – This is a therapy that uses the relationship between client and counselor to understand how the client interacts with other people. Through transference, the client projecting elements of past relationships onto relationships in the present- both counselor and client are given insight into interpersonal behaviors, patterns, and any hidden payoffs to negative behaviors.
    • Psychodynamic Psychotherapy – When most people think about “talk therapy,” psychodynamic psychotherapy comes to mind.
    • Cognitive behavior therapy – Formulated in the 1990s by Dr. David Burns, this is one of the most studied behavior therapies.
    • Interpersonal Therapy – Usually damaged severely are the relationships held by borderline personality disorder patients.
    • Supportive Therapy – Focused more on helping clients get thru a rough patch in the treatment episode, supportive therapy may be appropriate as a stand-alone therapy or supplemental therapy.

    Different therapies can be beneficial at different points in a client’s treatment episode.  At any given time a mental health professional has several treatment options to choose from.

    For example, if a patient is able to think clearly and objectively, then an approach like psychodynamic psychotherapy might be chosen.   For very analytical patients, something like CBT might be more appropriate.  Table 6 has patient selection criteria for four therapies used to treat borderline personality disorder.

    Table 6 – Patient selection for four therapies: psychodynamic, cognitive, interpersonal, and supportive

    TYPE OF THERAPY SELECTIVE PATIENT VARIABLES
    Psychodynamic
    • Chronic sense of emptiness and underestimation of self-worth
    • Loss or long separation in childhood
    • Conflicts in past relationships
    • Capacity for insight
    • Ability to modulate regression
    • Access to dreams and fantasy
    • Little need for direction and guidance
    • Stable environment
    Cognitive
    • Obvious distorted thoughts about self, world, and future
    • Pragmatic (logical) thinking
    • Real inadequacies (including inadequate responses to other psychotherapies)
    • Moderate to a high need for direction and guidance
    • Responsiveness to behavioral training and self-help (high degree of self-control)
    Interpersonal
    • Recent, focused dispute with a spouse or significant other
    • Social or communication problems
    • Recent role transition or life change
    • Abnormal grief reaction
    • Modest to a moderate need for direction and guidance
    • Responsiveness to environmental manipulation
    Supportive
    • Failure to progress in other types of therapy
    • Suicidal
    • Cognitively impaired and illogical
    • Acute or chronic medical illness
    • Presence of somatization or denial of illness
    • Requiring high levels of guidance or responsive to behavioral methods

    In closing:

    Borderline Personality Disorder is hugely disruptive to an individual’s life and relationships.  Reduced functioning is observed in social, employment, or academic-related pursuits.  Despite this, the long term prognoses for BPD is quite favorable, with several effective BPD treatments validated by research.

    The mental health treatment program at Wellness Center NJ is designed specifically to care for people who suffer from conditions like BPD. Our mental health experts are dedicated to providing the best, most individualized BPD treatment.

    Before recommending a course of action, we take a comprehensive history of each patient. We then discuss the options with the patient. By tailoring our care programs to each individual, and by inviting feedback, we help to ensure long-term symptom management and long-term recovery.

    If you believe you or someone you know may suffer from a personality disorder, contact Wellness Center NJ today. Call us at (201) 503-7118 to learn more about our treatment philosophy or to enroll in a program.

    Sources

    Table 6 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877618/

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