BPD Treatments
Is BPD treatable?
Yes!
Most people with BPD recover after diagnosis and effective treatment. In fact, almost half of the people who are diagnosed with BPD will not meet the criteria for a diagnosis just two years later. After ten years, 88% of people who were once diagnosed with BPD resolve acute symptoms of impulsivity and active attempts to manage interpersonal difficulties. Unlike most other psychiatric disorders, those who remit from BPD don’t usually relapse.
People with BPD can learn to manage their symptoms successfully due to the plasticity of the brain. Neuroplasticity is the structural and functional changes that occur in the brain due to modifications in a person’s behaviour, environment, thoughts, emotions as well as illness and injuries. Neural connections have the capacity to regenerate and improve damaged neural pathways. With committed and active engagement from the individual, mental health professional and support group of family, friends or carers, the adult brain can be rewired to become more flexible and adaptive to control emotions. Strong and trusting relationship is key for people with BPD to develop stronger and more flexible and automatic patterns and eventually lead fulfilling lives. There is no medication that specifically treats BPD.
What BPD treatments are available?
BPD is a complex disorder with many layers and facets to it. Therefore, no person living with BPD is the same. Finding the right therapist and creating an individualised treatment plan is crucial to a positive BPD patient journey.
Many modes and methods of treatments are available for BPD. The three main forms are: psychotherapy, medication and hospitalisation.
Psychotherapy
Psychotherapy is most effective BPD treatment and it is essential that the patient trusts their therapist and that the relationship is a good ‘fit’. Clinicians who have received training and are providing treatment for people with a BPD diagnosis may utilise a range of these different approaches. All these re-learning therapies require multi-year commitment and engagement.
- Dialectical behavioural therapy (DBT) is a skills-based approach alongside both physical and meditative exercises specifically addressing four areas that tend to be problematic for people with BPD: self-image, impulsive behaviours, mood instability and poor relationships. To address these areas, DBT tries to build four major behavioural skill areas: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. DBT was initially developed to treat suicidality in adults with BPD, however, it is now being used effectively for adolescents with self-harm behaviours. These modules focus on finding a balance between change and acceptance of behaviours and beliefs. DBT treatment structure includes individual therapy and group therapy.
- Cognitive behavioural therapy (CBT) is a talk therapy that develops the patient’s awareness of negative or maladaptive thinking, allowing them to view challenging situations more clearly. This method helps patients with the search for and practice of alternative problem-solving strategies.
- Mentalization-based therapy (MBT) is a form of talk therapy specifically developed for BPD treatment. MBT aims to improve patients’ mentalisation capacity in identifying their own thoughts and feelings and separating them from those around them and help examine the validity of thoughts about themselves and others. The goal of this method is to improving interpersonal relationships and affect regulation.
- Cognitive Analytic Therapy (CAT) combines CBT’s practical methods with a focus on the relationship between patient and therapist. CAT aids to reflect on how the individual relates to people, including themselves and why chains of events, thoughts, emotions and motivations lead to problems such as in interpersonal relationships, self harm, angry outbursts, etc. Often these patterns are developed early in childhood and are repeated in adult life.
- Schema-focused therapy (SFT) is based on the idea that BPD comes from a long-standing patterns or themes of thinking, feeling and behaving. SFT focuses on reframing self-image and self-defeating schemas that have been obstacles for accomplishing one’s goals. This method combines aspects of cognitive behavioural methods with other forms of psychotherapy to develop positive and healthy patterns in the individual’s life while breaking negative ones.
- Transference-focused psychotherapy (TFP) is also known as psychodynamic psychotherapy and was developed specifically for BPD treatment. TFP uses the developing patient-therapist relationships to help the individual to observe shifts in the dominant self experience by clarification of internal states, confrontation of contradictions that are observed and interpretation that help explain the divisions and links between different states.
- Acceptance and commitment therapy (ACT) is a mindfulness based therapy that focuses on three skills areas: defusion, acceptance and contact with the present moment. ACT helps patients to observe the physical and thinking self for awareness of everything in the moment.
- Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a manual-based group therapy led by a social worker that is intended to supplement other treatment types. STEPPS focuses on improving BPD symptoms of mood, impulsivity, and functioning through a combination of cognitive-behavioural methods, psychoeducation and skills training. Training sessions can include family members and significant others.
- Good Psychiatric Management (GPM) is a weekly therapy that includes prescribing medications, education, family interventions and focus on life and goals outside of therapy. GPM was developed as a “containing environment” in which people with BPD can learn to trust and feel. Although this therapy requires clinical experience, it is the least theory-bound and easiest to learn out of the above psychotherapies for community mental health professionals without extensive training.
Source: Psychological therapies for people with borderline personality disorder
MARSHA LINEHAN – The need for a relationships of equality between therapist and client
Studies show that therapy given by a person trained in treating BPD and guided by the Clinical Practice Guidelines can be just as effective as one of the therapies mentioned providing it includes the following factors:
A clear plan for therapy guided by an understanding of what works for BPD.
Clear limits of what the therapist can and can’t provide and when to refer to other supports as needed.
Providing the person and their support network e.g. family/friends/carers with information about the diagnosis, treatment and prognosis in a hopeful and realistic way.
Empathy and validation of the person’s distress.
A focus on the relationship. The therapist treats the person as an individual and seeks to understand what is going on for the person.
The therapy focuses more on the reasons for the person’s behaviours and actions rather than on the actions themselves and helps them to develop an understanding of their thoughts and feelings and the link between beliefs and behaviours.
An exploration together of what situations lead to distress.
Assisting in the learning of less harmful skills for managing stress. Being prepared and having a consistent response to distress.
The repair of misunderstandings between the therapist and the patient when they occur.
Developing together a collaborative management plan of what works and when/what doesn’t work and why.
Promotes autonomy and reduce dependence.
Recognising that the person’s experience is “real” to them. They are “doing the best they can” given their circumstances at that time.
Building and maintaining motivation. Some people with BPD feel uncertain and unhopeful about change. Many find it hard to imagine how things can improve so the therapist must maintain hope for change even when the person with BPD is unable to.
The therapy also focuses on helping the person regain or maintain their interests and job/study and relationships.
Source: A Guide to Accessing Services for Borderline Personality Disorder in Victoria
VALERIE PORR – Her ideal treatment: A combination of therapies
Click BorderlinerNotes to see more interview footage relating to treatments.
Medication
Currently there are no medications to treat BPD. However, medications can be in addition to psychotherapy to relieve associated problems or active comorbid disorders such as depression, anxiety, psychosis, bipolar disorder or PTSD. Drugs may be prescribed in an acute crisis but should be withdrawn once the crisis is resolved. These may include: antidepressants, mood stabilisers and antipsychotics.
Hospitalisation
A person with BPD in an acute crisis where there is significant risk to themselves or others may require inpatient care in a specialist environment such as hospitals and psychiatric clinics. Often, inpatient treatment will be a combination of medication and psychotherapy sessions.
It is unlikely for people to be hospitalised with BPD for a long-term. Short-term inpatient care allows people with BPD to gain support and structure in a safe environment before returning to their home where they may feel more at ease.
For more information
Health Direct – Treatment for BPD
Australian BPD Foundation Ltd – Psychological therapies
Australian BPD Foundation Ltd – Factors for effective treatment of BPD
Australian BPD Foundation Ltd – Role of medication
MPR – BPD: How effective are psychotherapies?
Sources
The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study.
Efficacy of psychotherapies for borderline personality disorder
