How to Cross the Border(line): Borderline Personality Disorder Treatments

I was first diagnosed with Borderline Personality Disorder at the age of nineteen, and I remember running from my therapist’s office to my dorm room and looking it up online. The results were not promising.

“Severe mental illness…”

“Considered by many to be untreatable…”

“Completed suicide rate approximately ten percent…”

“Doctors recommend regular inpatient treatment to monitor…”

“Dear God”, I thought to myself, “can you not just give me leprosy?” (I would later find out that leprosy is about as attractive to future boyfriends as Borderline Personality Disorder, so really it’s a toss-up.)

I rejected the diagnosis for years, preferring instead to call myself bipolar. After all, bipolar disorder is considered more treatable (possibly, honestly, because far more people have heard of it). There are support groups and community breakfasts and little pamphlets full of hope. My doctor even put me on a mood stabilizer, the same one given to bipolar patients. It worked. See? I was bipolar, not borderline. One small tablet a day and all my problems were erased! Except kind of actually not at all.

“Untreatable”, my brain kept repeating. “Untreatable, untreatable, untreatable.”

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My new therapist, Mike, was coaxing me out of the stairwell and back into his office, where I’d just hurled a full bottle of Pepsi at the wall. (This would become such a common occurrence, in fact, that he eventually forbade me from bringing beverages past the waiting room.)

When I was finally settled in a chair again, Mike folded his hands together and paused before saying, “Erin, I’d like to refer you to a place that can better meet your needs-“

“What are you saying?” I interrupted. “That you don’t WANT me anymore?”

“No”, he replied patiently. “I’m saying that I would love to continue seeing you, but I think you need more than just talk therapy. I’m referring you to the Center for Intensive Treatment of Personality Disorders in Manhattan. There’s a waiting list, but-”

“They’ll never let me in”, I said back in a singsong. “I don’t have a personality disorder.” And then, as an afterthought, I added, “Just out of curiosity, what do you mean ‘more than talk therapy’? What else is there?”

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I was enrolled in the Intensive Outpatient program five days a week for a year. And let me tell you, I may still be a walking ball of anxiety who sometimes hides behind a book during parties or, lacking a book, will hide behind my tallest friend, but if someone were to ask, “THINK FAST! What are the available Borderline Personality Disorder Treatments READY SET GO”, I could rattle them off without even looking up. I could even set them to the tune of the Big Mac jingle, although I won’t do that to you.

If you’ve been diagnosed with Borderline Personality Disorder, here is a list of things that will probably happen to you after your diagnosis, in descending order of likelihood. (Assuming you want to seek treatment.)

1. Self-medicating. I don’t care how you do it. Vodka, reality television, Oscar Meyer bologna slices, unfiltered cigarettes, attractive bartenders, self-help books. Hurling self-help books out the window and into a dumpster, which will in turn scatter a litter of feral cats and wake up half the neighbors. (Not that I would know.)

2. Professional medicating by a psychiatrist, most likely with mood stabilizers and/or an antidepressant, although occasionally antipsychotic or anti-anxiety medications may be mixed in as well.

3. Individual therapy with someone who perhaps doesn’t quite understand what BPD is but is sweet and kind and keeps asking, “So how do you plan to take good care of yourself today?” And you will be like, “Maybe I will actually toast my Pop-Tart instead of eating it cold from the package.” And she may refer you to a treatment center, where you’ll probably experience…

4. Dialectical Behavioral Therapy (DBT)

This is considered the most effective and certainly the most widespread treatment for BPD. It was developed by a psychologist who herself had the disorder and merges cognitive behavioral therapy with eastern spiritual traditions (specifically Buddhism) to develop crisis management and healthier social skills. The four modules include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Due to the complexity of DBT and the many “sub-skills” of each module, individuals may be in treatment for a year or longer. However, there are also DBT self-help books and websites for those who do not have access to a program in their area.

5. Schema-Focused Therapy

A “schema” is a pattern of thought or behavior, which in BPD is often self-defeating or even life-threatening. Schema Therapy was developed by one Dr. Jeffrey E. Young for patients who stopped responding to more traditional methods of psychotherapy. It draws theory and techniques from object relations, attachment theory, cognitive behavioral therapy, and Gestalt therapy. I suppose you’ll want to know what that is.

6. Gestalt Therapy

Gestalt therapy was developed in the 1940s and focuses on insights into patients’ gestalts (an organized whole that is perceived as more than a sum of its parts). “It teaches therapists and patients the phenomenological method of awareness, in which perceiving, feeling, and acting are distinguished from interpreting and reshuffling preexisting attitudes.” (source: gestalt.org) It is unlikely that it will be used on its own as treatment for BPD, but it is an important component of the BPD-specific schema-focused therapy.

7. Mentalization-Based Therapy

MBT is a form of psychodynamic therapy developed specifically for people with BPD. “Mentalization is the capacity to understand both behavior and feelings and how they’re associated with specific mental states, not just in ourselves, but in others as well. It is theorized that people with Borderline Personality Disorder have a decreased capacity for mentalization.” (source: psychcentral.com) In short, its focus is on helping people to differentiate and separate their own thoughts and feelings (“I hate myself!”) from those around them (“everyone hates me!”).

8. Transference-Focused Psychotherapy

“TFP builds on a psychodynamic object relations model of psychological functioning. The treatment focuses on internalized images of self and other that organize the patient’s interpersonal experience. The exaggerated, distorted, and unrealistic internal images of self and other characteristics of severe personality disorders are associated with problems in mood regulation, self-esteem, and interpersonal relationships. The aim of the treatment is to modify these internalized relationship patterns by exploring them as they are activated in the therapeutic relationship and in the patient’s interpersonal life. The ultimate aim is to create more stable, realistic and better-integrated experiences of self and other, leading to improved interpersonal functioning and adaptation to life.” (source: psychoanalysis.columbia.edu)

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After a year in the intensive outpatient program and exposure to several of these treatments, I improved significantly. After two years I was able to maintain a fairly healthy romantic relationship without flipping out randomly and throwing pork chops on the floor. And now, after occasionally seeking “maintenance” therapy and buying a DBT workbook I keep by my bed, I no longer meet the five out of nine criteria for Borderline Personality Disorder.

I’d say that’s pretty good news.