Treating Borderline Personality Disorder

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Borderline personality disorder (BPD) is characterised by unstable moods, relationship difficulties, and impulsive behaviour. Living with a young person who has been diagnosed with BPD can be challenging, but there is treatment available that can help.

About BPD

Borderline personality disorder is a brain disorder. There are several symptoms of BPD, which often begin in adolescence. Young people with BPD are often described as being highly sensitive, struggling with emotional dysregulation, volatility, and difficulties in interpersonal relationships.

These symptoms can be accompanied by:

  • Impulsivity
  • Extreme changes in mood
  • Anger
  • Sadness
  • Emptiness
  • Loneliness
  • Self-harm
  • Suicidal thoughts

Young people diagnosed with BPD may have a high-risk profile with repeated emergency department admissions, and over 70٪ of young people will attempt to end their lives. There are usually many unsuccessful attempts at individual therapy and residential treatment episodes. They may also have co-occurring conditions, such as substance use disorder, eating disorders, depression, anxiety, bipolar disorder and other mental health concerns.

Parents need to remember that BPD can be a severely impairing illness – it’s not a choice. A diagnosis can be made if these symptoms and behaviours have been observable and evident for more than twelve months in a young person under 18. Research suggests that the younger diagnosis is made, the better the outcome. Children as young as 11 can accurately describe both the presentations and the process that predicts the early onset of BPD.

Research indicates that early intervention for BPD is effective and significantly improves long term outcomes.[1] Left untreated, BPD can continue until the 4th decade, when symptoms will gradually decline with age. It is essential to receive treatment as early as possible in specialist BPD programmes.

Teenagers and young adults who have experienced complex trauma or have been diagnosed with BPD can often find it challenging to understand the needs of others. This can lead to conflict in friendship groups, at home, and in the wider community. Sometimes these behaviours can look like young people don’t care about others or are only concerned for themselves.

The reality is that it is often very difficult for young people with BPD to be able to see outside of their viewpoint on the world. Rigid thinking, hyper-aroused states, and sometimes difficulty in mentalising can leave young people feeling isolated and unlovable and their friends and family feeling increasingly frustrated and angry.

Treatment for BPD

Historically, mental health clinicians would shy away from making a diagnosis of BPD as it was considered untreatable. This is no longer the case – young people diagnosed with BPD do get well. In fact, with the right treatment, young people report a 70% reduction in symptoms with a 60%-70% long term remission rate, and over 90% of young people report significant and life-changing improvements in coping skills. Remain hopeful, however small the sparkle.

Treatment for BPD includes:

  • One-to-one therapy – therapy provides each young adult with a safe space to share their thoughts, worries and concerns. During these sessions, young adults can learn new coping mechanisms to help them become more self-aware.
  • Art therapy – when paired with traditional therapy, art therapy helps young adults relieve mental stress and explore their emotions and feelings without words. It also provides a new outlet to manage negative thoughts and feelings.
  • Psychodynamic psychotherapy – this form of therapy can help young adults understand how they feel and why they feel that way. This talking therapy can also help people to develop new coping strategies.

There is hope for young adults struggling with borderline personality disorder. Research has shown that BPD is treatable, and symptoms can dissipate over several years.[2]

Excellent treatment programmes are fluid and designed around the needs of young people. There are many great therapeutic modalities, although each has its limitations. Parents should look for pluralism in therapy – great teams trained in several different approaches, including dialectical behavioural therapy (DBT), schema therapy, and eye movement desensitisation and reprocessing therapy (EMDR).

The best programmes for BPD focus on developing self-regulation skills and have plenty of opportunities to explore interpersonal relationships, create connections and develop healthy friendships. Programmes that are fixed duration or have fixed weekly or monthly achievement schedules can never be truly trauma-focused or young person driven and tend to be cognitive in nature.

Cognitive based therapies have a very low success rate with BPD. Flexibility, trauma-focused, creative, experiential and purpose-driven programmes have a higher rate of engagement and more effective outcomes for young people and their families.

At The Wave, our treatment heals both the body and the mind. We offer clinical and medical interventions and provide educational and volunteering opportunities to provide a well-rounded treatment approach that serves each young adult who comes to us. We view mental health and addiction from a trauma-informed perspective, fully personalising each treatment programme to adapt to each unique individual.

Emergency Treatment for BPD

Therapists in outpatient settings may refer clients for emergency treatment if there is a rapid escalation of events and behaviours. This can lead to crisis admissions or involve emergency services and can be very difficult to manage for therapists working alone in outpatient settings.

Knowing when children and young people present a significant risk of hurting themselves, overdosing, or refusing to comply with treatment may warrant emergency treatment. Therapists may refer a young person to residential or inpatient treatment if the risk appears too great for outpatient settings, if the motivation to change is low, or when there is a need for involuntary admission for the young person’s safety.

Therapists will often clarify what is and what is not an emergency. This will help parents and young people know when to call their therapist and when to wait until the next session. In some cases, going straight to the emergency room is the most appropriate action.

In cases of self-harm, young people may need medical assessment for anything more than superficial wounds. In the case of an overdose of any amount or type of ingestion, medical advice should be sought immediately. Call your G.P. or emergency department and ask for the on-call psychiatrist if in doubt. Your therapist will also have guidelines on when and how to reach them out of hours.

Conclusion

If you are concerned about a young adult in your life, contact The Wave today. Therapy at The Wave is designed to meet the needs of young people diagnosed with BPD. Our programmes are based around strong therapeutic relationships with therapy and support teams who are all specialists in the care and management of young people diagnosed with BPD.

The Wave is an International Centre of Excellence in BPD treatment for teenagers and young adults. Young people and families travel to us to experience one of the very few trauma-focused BPD specialist programmes for adolescents. With facilities situated in beautiful Malaysia, our team of expert clinicians are fully equipped to treat co-occurring disorders of BPD and addiction.


Fiona Yassin is the International Clinical Director of The Wave Clinic. Fiona is a UK Registered Adolescent and Family Psychotherapist and Clinical Supervisor (Licence number #361609 NCP/ICP), further trained in the specialty of Eating Disorders and Borderline Personality Disorder Treatment. Fiona is trained in FBT (Family Based Therapy), CBTE for eating disorders, FREED (King’s College, London), EMDR for eating disorders (EMDRIA) and has a Post-Graduate Diploma in Neuroscience and Trauma from the University of Tennessee, Knoxville.

Fiona works with international families and family offices from the UK, Dubai, Kuwait, Singapore and Malaysia. Fiona can be contacted by email on [email protected].

Sources:

[1] Chanen, Andrew et al. “Borderline Personality Disorder In Young People And The Prospects For Prevention And Early Intervention”. Current Psychiatry Reviews, vol 4, no. 1, 2008, pp. 48-57. Bentham Science Publishers Ltd., https://doi.org/10.2174/157340008783743820. Accessed 11 May 2022.

[2] Biskin, Robert S. “The Lifetime Course of Borderline Personality Disorder.” Canadian journal of psychiatry. Revue canadienne de psychiatrie vol. 60,7 (2015): 303-8. doi:10.1177/070674371506000702

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