Borderline personality disorder (BPD) is a serious mental illness characterized by unstable moods, behavior, and relationships. People with BPD often experience intense emotions, impulsivity, and severe instability in relationships, self-image, and behavior.
Many people wonder if someone with BPD can truly get better and change their deeply ingrained patterns of thinking and behaving. The short answer is yes – with proper treatment and support, many people with BPD can and do get better over time. Recovery is absolutely possible.
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a serious mental health condition marked by a pattern of ongoing instability in moods, behavior, self-image, and functioning. These experiences often disrupt a person’s daily life.
According to the National Institute of Mental Health (NIMH), the signs and symptoms of BPD include:
– Intense emotional responses disproportionate to the situation
– Highly impulsive behaviors
– Unstable relationships
– Distorted sense of self
– Feelings of emptiness and boredom
– Intense fear of abandonment, even over minor separation
– Recurring suicidal behaviors or threats
– Self-harming behaviors like cutting
– Intense anger and difficulty controlling anger
– Temporary stress-related paranoia or loss of contact with reality
People with BPD tend to see things in extremes – all good or all bad. Their emotions can shift very quickly, and small things can trigger intense reactions. The disorder usually begins during adolescence or early adulthood. With treatment, many people with BPD can improve over time.
What Causes BPD?
Researchers don’t know exactly what causes borderline personality disorder, but it likely involves a combination of genetic, neurological, environmental, and social factors.
Some potential causes and risk factors for developing BPD include:
– Genetics – BPD seems to run in families, so certain genetic or biological factors may play a role.
– Brain changes – Issues with certain areas of the brain involved in emotions and impulses may contribute to BPD.
– Childhood trauma – Many people with BPD experienced trauma, abuse, neglect, separation, or invalidation during childhood. These experiences may wire the brain to be vulnerable to unstable emotions or relationships.
– Different life experiences – People can develop different versions of personality disorders based on their unique experiences. Environmental factors shape the type of symptoms someone develops.
Overall, a complex interaction between biological vulnerabilities and life experiences seems to lead someone to develop BPD. Treatment needs to address both biological and personal aspects of the disorder.
Can Someone with BPD Really Change?
So can someone with BPD truly change their ingrained patterns of thinking, feeling, and behaving over time?
The answer is yes – with comprehensive treatment tailored to BPD, many people can achieve remission from symptoms and develop skills for better managing their emotions and relationships.
Full recovery from BPD is absolutely possible, especially with early and consistent treatment. According to Perry D. Hoffman, PhD, President of the National Education Alliance for Borderline Personality Disorder (NEABPD), recovery rates for BPD are around 85% with proper treatment.
However, treating BPD takes a lot of time and effort. Change does not happen overnight. BPD is considered a pervasive and persistent mental illness, which means the symptoms are widespread and tend to be chronic if not treated.
But in one longitudinal study, more than 90% of people with BPD showed good or excellent outcomes over 10 years if they completed an evidence-based treatment program. Around half of the participants achieved full remission.
So while BPD is a serious and complex mental illness, the vast majority of people with it can achieve stability, happiness, and healthy relationships with comprehensive treatment. Recovery is absolutely attainable.
Why Treatment is Essential
Treatment is absolutely essential for someone with BPD to improve – change will not happen on its own without intervention.
According to the National Alliance on Mental Illness (NAMI), the main components of effective BPD treatment include:
– Psychotherapy: Usually long-term talk therapy focused on emotions, behavior, and relationships. The most effective modalities for BPD include dialectical behavior therapy (DBT) and mentalization-based therapy.
– Medications: No medications for BPD specifically, but doctors may prescribe antidepressants, mood stabilizers, or antipsychotics to treat specific symptoms. Medication can enhance the benefits of therapy.
– Skills training: Learning skills for emotional regulation, mindfulness, distress tolerance, healthy relationships, and more. Can occur in therapy or skills training groups.
– Support systems: Having a strong support system is crucial – whether through family, peer support groups, community services, or therapists. Support aids recovery.
– Plenty of time: Treating BPD requires intensive therapy for several years. With consistent therapy, new thinking and behavioral patterns can become ingrained over time.
Trying to treat BPD without professional help usually leads to limited improvement or worsening of symptoms. A combination of therapies and social support offers the best chance for change.
Signs Someone with BPD is Improving
How can you tell if someone with BPD is making real progress in treatment and improving their symptoms?
Signs someone with BPD may be responding well to treatment and improving include:
– Decreased impulsivity and self-harming behaviors
– Less intense, extreme emotions
– More control over anger and fewer outbursts
– Improved ability to see situations in shades of grey vs. black-and-white
– Healthier relationships and increased trust of others
– Reduced fear of abandonment
– A stable sense of identity and self-image
– Feeling empowered and in control
– Developing new coping strategies for stress
– Ability to self-reflect with empathy
– A consistently positive outlook
Improving BPD symptoms takes time and effort. But you can track progress through a combination of:
– Self-reporting from the individual
– Feedback from family members
– Observations of mental health professionals
– Questionnaires tracking BPD symptoms
– A reduction in BPD-related behaviors like self-harm
With comprehensive treatment and time, permanent change is absolutely possible.
Treatment Modalities for BPD
Certain treatment modalities are considered particularly effective for helping improve borderline personality disorder:
Dialectical Behavior Therapy (DBT)
DBT was developed specifically for treating BPD. It uses cognitive-behavioral techniques focused on:
– Mindfulness and acceptance skills
– Emotional regulation skills
– Distress tolerance skills
– Interpersonal effectiveness skills
DBT helps people with BPD reduce self-destructive behaviors, manage emotions, and improve relationships through a combination of group therapy, individual therapy, phone coaching, and homework assignments.
Numerous studies support DBT’s effectiveness in treating BPD symptoms. It helps reduce suicide attempts, self-harm, substance abuse, depression, and rage.
Mentalization-Based Therapy (MBT)
MBT aims to improve people’s ability to “mentalize” – understand yourself and others in terms of inner thoughts, feelings, beliefs, and motivations. MBT for BPD focuses on:
– Increasing empathy
– Improving understanding of other people’s behaviors
– Identifying triggers
– Reducing impulsivity
– Developing self-soothing techniques
Like DBT, studies show MBT can lead to significant improvements in empathy, impulsivity, and relationships. It helps people relate better to others.
Schema Therapy
Schema therapy combines CBT, attachment theory, and psychodynamic approaches. The therapist helps identify unhelpful “schemas” – patterns of thinking about self and others learned in childhood.
For BPD, schema therapy focuses on:
– Modifying early maladaptive schemas like mistrust or emotional deprivation
– Meeting unmet childhood needs
– Changing coping modes like detachment or overcompensation
Research indicates schema therapy meaningfully reduces BPD symptoms like anger, impulsivity, and chronic loneliness.
Transference-Focused Psychotherapy (TFP)
TFP uses techniques from psychodynamic therapies to help address the interpersonal difficulties common in BPD. Goals include:
– Improving reflective functioning
– Reducing maladaptive defenses like splitting
– Resolving deep-rooted conflicts
– Transferring insights about past relationships to present relationships
Studies show TFP lowers depression, anger, impulsivity, aggression, and attachment issues in people with BPD.
Good Psychiatric Management (GPM)
GPM provides a flexible, common-sense approach to treating BPD through:
– Medication management
– Education on BPD symptoms
– Motivating towards positive change
– Teaching coping strategies
– Fostering a strong therapeutic alliance
Research indicates GPM reduces mood instability, impulsivity, anger, and improves interpersonal functioning.
Many experts recommend integrating multiple modalities like CBT, DBT, and medication rather than relying on one approach. An integrative strategy drawing from different therapies based on each person’s symptoms tends to work best for improving BPD.
How Family Members Can Support Change
Family members can play a huge role in helping their loved one recover from BPD. Some tips include:
– Educating yourself on BPD through resources like NAMI and NEABPD. Understanding BPD facilitates empathy.
– Encouraging your loved one to seek professional treatment and offering to help find providers or provide transportation to appointments.
– Providing emotional support by listening and validating your loved one’s struggles.
– Avoiding criticism or judgment and focusing on positivity.
– Helping your loved one implement skills learned in therapy like mindfulness or emotional regulation in their daily lives.
– Participating in family therapy or joining a support group for families impacted by BPD.
– Setting healthy boundaries and not enabling harmful behaviors.
– Taking care of your own mental health – BPD impacts the whole family.
– Being patient and focusing on progress. Change takes time.
– Recognizing small improvements and not getting discouraged by occasional setbacks.
With comprehensive treatment, social support, and time, permanent change is absolutely possible. Remain hopeful and encouraging.
Tips for Living with Someone with BPD
If you have a loved one with BPD, here are some tips for living together and maintaining a stable, healthy relationship:
– Educate yourself about BPD so you can better understand their emotions and behaviors. Recognize their reactions often reflect unmet needs.
– Set clear boundaries and expectations for acceptable behavior – yet be prepared to compassionately reinforce them. Consistency is crucial.
– Make time for open communication and be an empathetic listener when they’re struggling. Don’t lose patience.
– Encourage positive behaviors through acknowledgement, not criticism. Reinforce progress.
– Let them take responsibility for their actions and treatments. Don’t enable harmful behaviors.
– Allow them space when emotions run high. Take breaks to cool down when needed.
– Don’t take feelings or outbursts personally. The disorder drives them, not you.
– Participate in family therapy together to improve communication and relatability.
– Take care of yourself. Seek your own mental health support if needed.
– Focus on positives, stay patient, and celebrate small victories. Progress can take time.
With mutual understanding and empathy, healthy relationships are absolutely possible.
When is Hospitalization Necessary?
Most people with BPD can be treated through outpatient psychotherapy, skills training, and medication management. However, in some circumstances hospitalization may become necessary.
Reasons someone with BPD may need psychiatric hospitalization include:
– Acting on suicidal thoughts or plans like overdosing on medication or acquiring means for suicide. Hospitalization ensures safety.
– Severe self-harming behaviors that are escalating in frequency or severity. Inpatient care allows healing while preventing access to means of self-harm.
– Psychotic symptoms like losing touch with reality, hallucinations, or delusions. Hospitalization helps stabilize acute symptoms.
– Extreme emotional instability where outbursts or impulsive behaviors put oneself or others at risk of harm. A structured environment minimizes harm.
– Substance abuse issues or addiction that require medical detox, supervision, and intensive treatment unavailable outside hospitalization.
– Severe malnutrition or dramatic weight loss due to an eating disorder. Medical stabilization of health is needed.
– Medication non-compliance despite outpatient efforts. Hospitalization allows close monitoring of medication effects.
The decision to hospitalize someone requires balancing safety risks against personal autonomy. Hospitalization tends to be short-term and focused on stabilization. Longer term treatment generally shifts to outpatient settings.
Can Medication Help Treat BPD?
While no medications are FDA-approved specifically for BPD, certain medications may be used off-label to help manage specific BPD symptoms:
Medication Class | Potential BPD Uses |
---|---|
Antidepressants | May help depression, anxiety, anger, and impulsivity |
Mood stabilizers | Help emotional instability and rage outbursts |
Antipsychotics | Reduce paranoid thoughts, dissociation, hallucinations |
Anti-anxiety medication | Lessen anxiety, sleep issues, and emotional reactivity |
However, medication should never be used as a stand-alone treatment for BPD. It should complement psychotherapy, skills training, and other interventions.
Medication can provide relief from specific symptoms, but does not teach new skills. Long-term success requires learning new coping strategies and thought patterns.
Coping Strategies and Self-Help for BPD
In addition to professional treatment, developing personalized coping strategies and self-help techniques can empower someone with BPD to better manage symptoms. Some options include:
– **Mindfulness meditation** – Reduces emotional reactivity and impulsivity. Apps like Calm provide guided practices.
– **Diet and exercise** – Helps improve mood, thinking, and physical health. Provides a healthy outlet for emotions.
– **Journaling** – Allows reflection on emotions and triggers. Can identify thought distortions.
– **Creative pursuits** – Arts, music, and hobbies help channel feelings in a positive way.
– **Relaxation techniques** – Breathing exercises, yoga, spending time in nature. Helps calm the nervous system.
– **Service to others** – Volunteering and helping people in need can improve self-worth and life meaning.
– **Peer support groups** – Connecting with others facing similar struggles reduces isolation and validates experiences.
– **Setting small goals** – Boosts gratification from accomplishing something tangible each day. Progress builds self-efficacy.
– **Reading about BPD** – Develop deeper understanding of the disorder and treatment strategies. Marsha Linehan’s books are excellent.
With time and practice, personalized coping strategies can make day-to-day life more stable and enjoyable. They supplement professional treatment.
Creating a Treatment Plan for BPD
A comprehensive treatment plan for BPD should include several components coordinated by a mental health professional:
– **Individual therapy** tailored to BPD at least once a week, such as DBT or CBT. Works on thought patterns, behaviors, and symptom management.
– **Medication management** to treat any co-occurring disorders or targeted BPD symptoms that are acute.
– **Group skills training** classes to develop emotional regulation and interpersonal skills. Provides support from peers also living with BPD.
– **Case management** services to help utilize community resources, navigate the healthcare system, and monitor progress.
– **Crisis intervention services** like emergency phone counseling to call in distressing situations. Prevents harmful impulsive actions.
– **Family therapy** to improve communication, relatability, and home support systems.
– **Residential or day treatment programs** may be needed temporarily for those with severe BPD needing more intensive, structured care.
– **Peer support groups** provide connections with others experiencing BPD for mutual understanding and sharing coping strategies.
– **Substance abuse or eating disorder treatment** for any co-occurring disorders contributing to BPD instability.
With an integrated treatment plan tailored to individual needs, most people with BPD can achieve remission of symptoms or recovering a fulfilling, stable life.
Hope for Recovery from BPD
For people recently diagnosed with borderline personality disorder, the prospects of change and recovery can seem daunting. The symptoms can feel consuming.
However, it’s important to have hope. With comprehensive dialectical behavior therapy, medication, skills training, and an empathetic support system, most people with BPD improve significantly over time. Recovery is absolutely attainable.
Many inspiring people with borderline personality disorder have shared their stories of hope and recovery, including Marsha Linehan, creator of DBT, who overcame suicidal thoughts and achieving stability. Their stories demonstrate that permanent change is possible.
While BPD is a serious condition, it does not define someone forever. It involves biological vulnerabilities combined with learned thought and behavior patterns – all of which can change through treatment and insight. With time, new and healthy ways of thinking and acting can become habit.
For families supporting someone with BPD, know that your patience, compassion, and encouragement can make a huge difference in their healing process. You are not powerless. There are many resources and treatment modalities available. Have hope in their ability to get better, even if progress feels slow.
With BPD, setbacks will happen along the road to recovery. Periods of progress may alternate with times of struggle. What’s important is maintaining a big-picture perspective on the improvements made over months and years, not just day-to-day. Even small steps forward ultimately lead to remission. Believe in their ability to reach a healthy, stable life.
Setting Goals in BPD Treatment
Setting specific measurable goals is an important aspect of borderline personality disorder treatment and recovery. Goals provide concrete markers of progress to strive towards.
Some examples of good goals to set in BPD treatment include:
– Participating in DBT or talk therapy a certain number of times per week or month
– Reducing frequency of self-harming behaviors like cutting by a specific percentage over a set timeframe
– Increasing use of newly learned coping skills like mindfulness meditation or distress tolerance techniques
– Improving relationships with family by initiating one positive interaction per day
– Journaling emotions a certain number of times per week to improve self-awareness
– Making healthy lifestyle changes like consistent exercise, improved sleep habits, better nutrition
– Practicing new interpersonal skills during social interactions to reduce conflicts
– Achieving a certain period of abstinence from drugs or alcohol
– Reaching out for support when feeling angry or abandoned rather than lashing out
– Reducing suicidal thoughts or urges to self-harm by utilizing crisis resources
It can be helpful to develop goals collaboratively with a therapist. They should be realistic, yet challenging. Reviewing progress helps motivate ongoing improvement.
BPD in Men vs. Women
While BPD is more commonly diagnosed in women, it certainly occurs in men as well. Some key gender differences include:
– **Prevalence** – About 75% of people diagnosed with BPD are female. The reasons for higher prevalence in women are not fully understood.
– **Symptoms** – Men with BPD are more likely to show antisocial behaviors like aggression, substance abuse, and risk-taking. Women tend to turn anger and aggression inward through self-harm.
– **Causes** – Sexual trauma may play a larger role in developing BPD in women, whereas abandonment or neglect by parents may be more prevalent for men.
– **Diagnosis** – BPD can be overlooked in men, as stereotypes suggest it only affects women. Male symptoms like anger outbursts may be misattributed to other conditions.
– **Treatment** – Men may resist therapy due to social norms about showing emotion. Adjusting therapeutic approaches to men’s coping styles can improve engagement.
– **Support Groups** – Men may feel more isolated or misunderstood due to lower prevalence. Groups specifically for men with BPD can provide improved peer support.
While some gender differences exist, core BPD symptoms involved emotional instability, impulsivity, and relationship conflicts affect both men and women. Effective treatments like DBT can help people of all genders develop skills to better manage BPD.
Dealing with BPD Triggers
People with borderline personality disorder often have strong emotional reactions and impulses when triggered by situations related to instability and rejection. Learning to effectively cope with triggers is crucial to managing life with BPD. Strategies include:
– **Identifying triggers** – Increase self-awareness of situations, interactions, or memories that tend to rapidly escalate emotions and reactions. Common triggers involve perceived rejection, criticism, abandonment, betrayal, and loneliness.
– **Preemptive coping** – Prepare mentally for known triggers like a difficult conversation or appointment. Practice breathing and self-soothing skills beforehand to stay calm when triggered.
– **Mindfulness** – When triggered, pause and observe feelings and urges without reacting. Say to yourself “this is just my BPD being triggered; these intense emotions will pass.” Wait it out.
– **Distracting yourself** – Engage in something enjoyable and absorbing to take your mind temporarily off the trigger. Listen to music, watch a funny video, exercise, etc.
– **Talking to someone** – Speaking with a trusted friend or therapist can help defuse reactions to triggering situations. Feel listened to and understood.
– **Writing in a journal** – Express your turbulent feelings on paper. Helps discharge emotions without acting rashly.
– **Using coping skills** – Utilize newly learned DBT, CBT, and mindfulness skills when triggered. They will eventually replace temperamental reactions.
Learning to calmly ride out triggers without acting destructively or impulsively takes practice but improves BPD stability. Triggers lose their power over time.
BPD Symptoms in Teenagers
The peak time for borderline personality disorder to emerge is during the teen years as a result of brain development and social pressures. Some signs of possible BPD in a teenager may include:
– Intense mood swings and emotional reactivity
– Risky, impulsive behaviors like substance abuse, unsafe sex, or daredevil acts
– Self-harming behaviors like cutting or burning skin
– Extreme insecurity, poor self-image, identity disturbance
– Difficulty maintaining stable relationships
– Sudden uncontrolled anger or rage
– Chronic feelings of emptiness or boredom
– Frantic efforts to avoid abandonment, even from minor separations
– Black and white thinking, intense idealization or demonization of others
– Suspiciousness, dissociation, or paranoid thoughts under stress
The teenage brain naturally involves intensified emotions and impulses. But if these symptoms are pervasive in multiple settings and impairing daily life, seeking evaluation for possible BPD from a psychologist is recommended, as early treatment is ideal.
With compassion, patience, and professional help, the teenage years can be a pivotal time for intervening early and changing the trajectory towards BPD in adulthood. There is always hope.
Dating Someone with BPD
Dating someone with borderline personality disorder can be challenging but absolutely worthwhile if both partners educate themselves, communicate openly, and commit to supporting treatment. Some tips include:
– Learning about BPD so you know what to reasonably expect and how to be supportive. Recognize their reactions reflect unmet needs.
– Providing constant reassurance you care about them. People with BPD crave security the relationship is stable.
– Not taking mood swings and anger outbursts personally. Be patient and validating.
– Encouraging and reinforcing their therapy and treatment goals. Help hold them accountable.
– Setting honest boundaries and sticking to them. Don’t enable harmful behaviors.
– Making quality time to regularly express affection and appreciation for each other.
– Giving space when emotions run high. Take a break to cool down if needed.
– Speaking up clearly when you feel hurt or needs aren’t being met. Avoid passive aggression.
– Celebrating small positive steps forward. Don’t underestimate progress.
– Keeping your own support network. You can’t be their only support.
With empathy, reassurance of your commitment, good communication, and encouragement for treatment, a loving relationship is absolutely possible.
BestJobs for People with BPD
When considering jobs or careers that may be suited for someone with borderline personality disorder, look for roles with:
– **Flexibility** – BPD symptoms may fluctuate day-to-day. Flexible schedules or work-from-home options allow adapting as needed.
– **Independence** – Roles with minimal interpersonal conflict reduce triggers. Independent work utilizes strengths.
– **Creativity** – Careers involving art, writing, design, or innovation provide positive outlets for emotions.
– **Helping others** – Counseling, teaching, healthcare, and social work let them draw on compassion and empathy.
– **Clear structure** – Well-defined duties, expectations, and protocols are stabilizing. Ambiguity and unpredictability can be stressful.
– **Supportive environment** – Seek companies with understanding leadership that offers EAP services. Makes asking for accommodations easier.
– **Movement** – Physical activity within the role helps relieve stress. Fieldwork, active jobs, or Ablility to listen to music etc.
Some examples of potentially good jobs for someone with BPD include gardener, park ranger, massage therapist, counselor, researcher, author, administrative roles, IT technician, craftsperson, and animal care roles. Focus on their strengths and passions.
Conclusion
Borderline personality disorder involves significant challenges – yet recovery is absolutely within reach. With comprehensive professional treatment using modalities like DBT and MBT, a strong support system, and commitment to learning new coping skills, most people with BPD can achieve stability, lasting relationships, and a life worth living. It takes patience, compassion from loved ones, and trust in the ability to change ingrained patterns over time. Progress builds on itself incrementally. There will be setbacks, but the overall trajectory points upwards towards health and fulfillment with proper treatment. Believe in yourself, utilize available resources, and don’t lose hope during the difficult times. Consistent work towards recovery leads to an enriching, purposeful life. You have the power to get better.