Therapy for borderline personality disorder
Have you been told that you are complicated, unstable? That you “fly off the handle” for no reason? That it’s hard to be around you? I know it hurts and that you feel disgusted. That you have lost trust in others because you have been let down too many times.
When you have borderline personality disorder, this is something people will often say to you. Whether it comes from your bosses, your coworkers, your family, your friends, or your spouse, it doesn’t matter—it just hurts. It’s not your fault. You didn’t choose to have borderline personality disorder; it may be due to traumatic events you’ve experienced, or it may be due to an imbalance in the brain, because that’s where emotions are managed.
What is BPD (borderline personality disorder)?
In people with borderline personality disorder (BPD), these two brain structures are out of balance, causing you to react strongly and quickly, often without even realizing it, but others may notice. You have low self-esteem, you feel like hurting yourself, engaging in destructive behavior, and you have suicidal thoughts because life is painful. You feel like BPD is taking over your life and you don’t understand why you feel empty, like you don’t belong anywhere. People with BPD often have difficulty in their interpersonal relationships.
They are afraid of being abandoned or rejected and fear breakups like the plague. When they think they are being rejected, it can cause conflicts with others because of their fear of losing their loved ones. When I say loved ones, I mean family members, spouses, coworkers, friends, and even neighbors. To be diagnosed, the patient must meet at least five of the following nine criteria (adapted from the DSM-5; Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013):
Diagnostic criteria for borderline personality disorder according to the DSM
- Marked and persistent instability in self-image or sense of self;
- Maintaining unstable and intense relationships and often being in conflict with loved ones because of extreme idealization and devaluation of the other person (I love you, I hate you);
- Efforts to avoid real or imagined abandonment;
Having an unstable mood; - Suicidal or self-harming behaviors, gestures, or threats;
- Chronic feeling of emptiness;
- Engaging in impulsive, deviant, or self-destructive behaviors to regulate emotions in at least two areas that may be harmful to oneself, such as alcohol, medication, or drug use, dangerous driving, risky sexual practices, or self-mutilation;
- Chronic feelings of emptiness;
- Transient ideas of persecution or severe dissociative symptoms in stressful situations.
Criteria versus symptoms
I would like to point out that it is not always necessary to have a diagnosis of borderline personality disorder to observe traits of the disorder in others. For example, the following traits may be noted:
- boredom;
- high sensitivity to criticism from others;
- mood swings in a very short period of time (smiling and happy one minute and angry the next).
When we talk about symptoms and diagnosis, it can be easy to get lost in all of this. In fact, it is not uncommon for people with borderline personality disorder to have a co-occurring disorder, such as anxiety, depression or mood disorders, bipolar disorder, addictions, or eating disorders. This is one of the reasons why it may be helpful to consult a healthcare professional, who can help you better understand what you are experiencing and find the best treatment for you (medication or therapy).
Risk factors
Borderline personality disorder is often a combination of several factors that lead to the development of the disorder, such as:
- trauma experienced during childhood;
- separations or bereavements at a young age;
- serious attachment issues;
- heredity, for example if there are mental health disorders in the family;
- high sensitivity to one’s own emotions and those of others;
etc.
Four modes of functioning of the TPL person
(Desrosiers, J., Briand, C., Dubé, M-C., Maltez, R., Groulx, J. Mieux vivre avec la personnalité limite, 152 pages, 2019).
We all find ways to evolve in our lives; we adapt, despite the obstacles that stand in our way. We function through good times and bad with our education, our past, our values, and what we have been taught. Borderline personality disorder is no exception, despite the traits that may color its reality from time to time.
1
Self-destruct mode
The person will be in relationships that do not suit them and do not allow them to grow as an individual, and they will feel a great emptiness inside, because they will do everything for others and forget about themselves; they will lose themselves in making others happy and end up not knowing who they are, because their needs will not be respected. They will be surrounded by abusive relationships.
2
Lethargic mode
The person will have had relationships in the past that hurt them, and they will do everything they can to avoid feeling hurt again. To do this, they will avoid forming bonds with others, which will lead to them becoming isolated and no longer experiencing negative emotions… but they will also fail to learn how to manage them. Their relationships with others are superficial and lack emotional commitment.
3
Ambivalent mode
The person may have been in both of the previous modes and acquired tools that help them maintain relationships with others: if it works, great; if not, too bad (remember the borderline personality trait of idealization and devaluation mentioned above). The person learns to know themselves better and to want to respect themselves more.
4
Coherent mode
This is the most functional mode. It is a state in which the person lives with their BPD on a daily basis, maintains positive relationships with others, and feels good about themselves.
When should you consult?
Try to listen to your body, your mind, and your heart. You may be tired, exhausted, or worn out without knowing why… Don’t wait until you are no longer able to do your usual activities to seek help. If you are feeling emotionally, physically, or psychologically exhausted, don’t wait—call. Your work may be affected by your symptoms, as well as your relationships with colleagues, family, spouse, and even your children.
A healthcare professional can assess whether you have borderline personality disorder, refer you to specialists, and give you tools to get better and regain your balance. If you think you have symptoms of borderline personality disorder, seek help. As they say, “prevention is better than cure.” This is true for you, but also for those around you, because they may be tired, exhausted, and feeling helpless.
How can therapy help?
Clinical studies show that people who have undergone active therapy (hence the importance of prevention and early consultation) can be “cured” after 15 to 20 years of instability. In general, the symptoms of borderline personality disorder begin early in adolescence and intensify in early adulthood. However, despite the stability achieved, some symptoms may temporarily return if the person experiences significant events such as a breakup, bereavement, major failure, moving, etc. This is not a failure, but rather a reminder to reuse the tools that have been learned over the years to regain balance and functionality.
There are different types of therapies, many of which have shown good results. In some cases, medication may be added to therapy to help stabilize mood or manage anxiety. This can optimize the effects of therapy. Hospitalization may be considered during a period of intense suicidal crisis, but a long hospitalization can sometimes reinforce the BPD person’s sense of failure, so it is not necessarily desirable, although sometimes it is necessary. Psychotherapy is, in my opinion, the cornerstone of treatment for patients with borderline personality disorder. The bond between the counselor and the person is essential for the consultations to have lasting beneficial effects.
Who can benefit from therapy?
The person suffering from BPD
Personality disorders affect approximately 5% of the population (CIUSSS-Capitale-Nationale). People with BPD often struggle with frequent and persistent suicidal thoughts. Unfortunately, up to 10% of these individuals will commit suicide because they do not see a pleasant future, do not believe they are entitled to happiness, and fear that the disorder will take over their lives. However, personality disorder is not only a burden; it can also become an ally, and it is with this vision that I work with the people who consult me.
The sessions are designed to help you regain balance in your everyday life: work, family, love, children, colleagues, etc. The sessions help to dissect cognitive distortions, put black-and-white opinions into perspective, and learn to accept the gray areas in your life. Not everything is bad, and not everything is good. In addition, the consultations will enable you to better manage your emotions, which will help you maintain interpersonal relationships, as it will be easier to adequately express your discomforts and needs to others.
During the sessions, you will notice that the storms decrease in intensity and perhaps even in frequency, because impulsivity is also addressed in the sessions with the aim of optimizing the quality of your relationships with others and making you feel less misunderstood.
Close relatives
When working with loved ones, I work with you on how you can approach your loved one when you have something to say to them. I know that you sometimes fear their reactions and may even be afraid of them, and my job is to give you the strength to set boundaries with your loved one, even though they have borderline personality disorder. Behaviors may be explainable, but that doesn’t mean they are excusable, and having a mental health disorder does not justify everything, including the mood swings you may fear.
I help you reclaim your place in your loved one’s life. I help you develop and reinforce your right to have expectations and boundaries with your loved one. We work together to empower the person without making them feel abandoned or making you feel guilty. My role is to help you identify your personal boundaries, name them, and have them recognized, because you are human too, and you need to be heard as well.
Why a social worker instead of a psychologist?
I have been working in mental health since 2008 and specialize in borderline personality disorder. I led groups when I worked at a CLSC, I offer my services to several people with borderline personality disorder or their loved ones, and I created a virtual support group so that people with BPD and their families can ask questions, vent, and seek or offer help to a community that understands borderline personality disorder.
Many people ask me what the main difference is between a social worker and a psychologist. How can I help? First, it is important to know that social workers have a bad reputation in society: they are often talked about in the media in terms of youth protection services and rarely as consultants. In addition, people tend to search for “psychologists” on Google, without realizing that there are other professionals who can help them, such as social workers.
The role of social workers is to analyze the person’s entire environment: their work, their relationship, their friendships, their school environment, the neighborhood in which they live, the values that shape them, the education they have received, etc. We analyze to find out where the difficulties come from so that we can offer solutions and tools that will help them better tolerate difficult situations and regain their ability to act.
Social workers are committed to addressing obstacles and injustices in society and focus on improving people’s health and well-being. Social workers work with individuals to overcome life’s challenges and cope with traumatic events. Social workers help guide, initiate, and clarify changes for the people who come to them for help. The ultimate goal of their work is to help people recover and thrive.
As a social worker, I see the people who come to me for help as whole individuals, with their own strengths, qualities, resources, and resilience. I believe in the potential of the human beings I help; I accompany you in your efforts, I listen, I support and encourage you, and I am there with you. I learn as much from my consultations as those who come to see me. I feel a deep gratitude for the people who place their trust in me.
