As everyone is different, there is no one-size-fits-all approach to treating borderline personality disorder (BPD). However, on the whole, treatment usually includes some type of talking therapy and may also include medication depending on the severity of symptoms.
There are many different types of psychotherapy, but all involve helping you to explore how you think and feel, and why. As well as listening and discussing important issues with you, the psychotherapist can suggest ways to resolve problems and, if necessary, help you to change your attitudes and reactions to situations you find triggering.
Psychotherapy for BPD should only be delivered by a trained professional. The type of psychotherapy you choose may be based on a combination of personal preference and the availability of specific treatments in your local area. Treatment for BPD may last a year or longer, depending on your needs and your history. You can speak to your GP about finding the right kind of psychotherapy for your circumstances.
Dialectical behaviour therapy (DBT)
This therapy is specifically designed to treat people with BPD. This type of therapy is based on the idea that two important factors contribute towards BPD:
- High levels of emotionally vulnerability. For example, even the slightest of stressors can make them feel extremely anxious and out of control.
- Growing up in a dismissive environment whereby their thoughts and feelings were dismissed as unimportant and not worth discussing.
The goal of DBT is to break the cycle of having intense emotions but not having them accepted by introducing two important concepts:
- Validation: helping you to see your emotions as valid, real, important, and acceptable.
- Dialectics: helping you to understand that the majority of situations we find ourselves in are not ‘black or white’, and that life is made up of many shades of grey. Dialectics help you to become more open to ideas and opinions that contradict your own.
DBT usually involves weekly individual and group sessions. You’ll be given an out-of-hours contact number to call if your symptoms get worse or you are in crisis.
Mentalisation-based therapy (MBT)
MBT is based on the concept that people with BPD have a poor capacity to mentalise. Or put another way, they can struggle to examine their own thoughts and beliefs, assessing whether they’re useful, realistic and based on reality.
Another important part of mentalisation is to recognise that other people have their own thoughts, emotions, beliefs, wishes and needs, and our interpretation of other people’s mental states may not necessarily be correct. In addition, it’s important to be aware of the potential impact that our actions will have on other people’s mental states.
Initially, MBT may be delivered in a hospital, where you would stay as an inpatient. The treatment usually consists of daily individual sessions with a therapist and group sessions with other people living with BPD.
A course of MBT usually lasts around 18 months. Some hospitals and specialist centres encourage you to remain as an inpatient during this time. Other hospitals and centres may recommend that you leave the hospital after a certain period of time but remain being treated as an outpatient, where you visit the hospital regularly.
Therapeutic communities (TCs)
In these structured environments, people with a range of complex psychological conditions and needs come together to interact and take part in therapy. TCs are designed to help people with long-standing emotional problems and a history of self-harming or suicide attempts by teaching them the skills needed to interact socially with others and manage their emotional distress in positive and productive ways.
Most TCs are residential, such as in large houses. People stay for around one to four days a week, over the course of a year or more depending on their situation.
While medicine isn’t recommended by the National Institute for Health and Care Excellence (NICE) guidelines, there’s evidence that it may be helpful for certain problems in some people. Medicines are often used if you have another associated mental health condition, such as a depressive illness or an anxiety disorder.
Mood stabilisers or antipsychotics are also sometimes prescribed to help mood swings, alleviate psychotic symptoms or reduce impulsive behaviour.
Any type of treatment for BPD should be accompanied by self-help measures which might include:
- Stress management techniques
- Eating a balanced diet
- Avoiding too much sugar or caffeine
- Avoiding or reducing use of alcohol and recreational drugs
- Getting enough sleep
- Staying physically active
- Yoga, pilates or meditation for mindfulness
- Keeping a journal about your thoughts and feelings
- Creative writing
- Hobbies such as painting, drawing or another type of art
- Listening to music to help you cope during stressful times
- Talking to friends and family when you’re struggling.
Additional resources which you may find helpful: