Dialect Behavioral Therapy for Borderline Personality Disorder

borderline personality disorder:

• mental disorder characterized by
• impulsiveness, emotional instability,
• high anxiety, periods of anger,
• difficulties in building long-term
• relationships with other people, alternation
• idealization and devaluation.

The term “borderline personality disorder“ comes from the American Classification System for Mental Disorders. In our country, this diagnosis sounded differently – “borderline type of emotionally unstable personality disorder or psychopathy of an excitable circle.”

Nevertheless, in recent years. BPD has been associated with such a direction in psychotherapy as dialectical behavioral therapy. Which has been the world standard for helping these patients in many countries. For the past 30–40 years and has only recently appeared in the UK.

BPD is not just another trendy diagnosis, it is a serious condition that is very difficult to live with, and often almost impossible.

It occurs more often in adolescence.

The causes of its occurrence are always combined and not reliably studied, but they note a genetic predisposition (that is, the presence of similar personality traits among relatives), as well as episodes of psychological or physical abuse suffered in early childhood and individual biological causes characteristic of a given person (in particular metabolic disorders of biologically active substances in the brain, mainly serotonin).

When and how do symptoms of borderline personality disorder appear?

BPD is primarily an instability that affects all aspects of life:

1. A disturbed perception of one’s identity – such a person is constantly inclined to change the place of study, work, explaining this by searching for himself, he tries on all possible religions, tries to join various social groups, often unsuccessfully, because nothing brings him satisfaction and inner confidence that he is on the right track. Charm is replaced by disappointment, euphoria by despondency and self-hatred, and later by real depression itself.
2. Emotions inadequate to the stimulus provoking them – such a person is called “taking everything to heart”, it is often noticed that for a trifling occasion or without it, he explodes, for days, weeks, and sometimes for months he remembers some event and retains an emotional reaction about it, a good mood turns into a bad one in a split second and is often manifested by aggression out of the blue.

3. A feeling of inner emptiness

   It is a typical complaint of a patient with BPD. Sometimes it is described as a black hole in the soul, where there is nothing, no emotion, no feeling, no thought. It is extremely painful and, as a rule, knocks out of normal life.

4. Self-harm – self-inflicted cuts, burns, self-blows (including the head against the wall in the literal sense of the word) allow at least for a while to translate emotional pain into physical pain and thereby reduce its severity.
5. Fear of abandonment and unstable relationships– the fear of losing a loved one (beloved, friend, girlfriend) is so strong and uncontrollable that a person literally “sticks” to another, begins to follow him, be jealous, “strangle with his love”, control and, as a result, the other cannot stand and really goes away. And often it is a seeming feeling of abandonment, which always occurs when the Other does something that is not what the patient with BPD expects from him. Emotions are extremely contradictory to significant people and vary from crazy love with the desire to “carry on hands” to complete depreciation and the verdict “scoundrel” as the mildest in this context. At the same time, the phrases “I hate you” and “I can’t live without you” coexist side by side and emotional reactions coexist in the same way. It’s not good for building long-term relationships.
6. Impulsive behavior – and not just impulsive (that is, not controlled), but also leading to self-destruction. For example, such a person may have experience of unprotected sexual relations (and repeated) with strangers, experience of drug use, alcohol abuse in large quantities, various kinds of eating disorders, reckless driving, sometimes without a license, participation in gambling, etc. …
7. Suicidal tendencies – all of the above is extremely difficult to endure, and often a person thinks about ending his suffering in one way or another, and often makes attempts, which, alas, can ultimately be crowned with success.

Dialectical Behavioral Therapy (DBT)

Dialectical Behavioral Therapy (DBT) was developed by American clinical psychologist, PhD Marsha Linnehan, and is a structured program consisting of the following main components:

1. Weekly visits to skills training in a group format, where, through learning and regular homework, it becomes possible to gain emotional regulation, which our patients are so bad at.
2. Weekly one-to-one meetings with a psychotherapist to reinforce acquired skills and prevent unproductive and self-injurious behavior.
3. 24-Hour Phone Coaching – Provides patients with 24/7 support from a psychotherapist in those moments when they are particularly difficult to cope with.
4. Consultative weekly DPT is a group for therapists that prevents their personal burnout and strengthens their motivation to continue helping patients with emotional and behavioral disorders, as well as to find the most effective strategy in treating such patients.

DBT belongs to the “third wave” of cognitive behavioral therapy and combines behavioral therapy strategies with mindfulness practices. And at City Psychological Services, we provide both mindfulness therapy and Dbt therapy in London. 

DBT is a balanced dialectical position that emphasizes the synthesis of opposites: acceptance and change, passivity and activity, the patient’s vulnerability and the need to contact the environment, etc.

Conceptually, DBT suggests that people with BPD lack important interpersonal skills. Also emotional self-regulation, and stress tolerance, which in particular lead to dysfunctional behavior.

Dialectical balance in DBT is achieved through a balance between accepting the patient. For who they are and helping them achieve the changes they need. Acceptance techniques include mindfulness (i.e. attention to the present moment, nonjudgmental attitude, and application of effective strategies) and patient support.

Techniques for change include behavioral analysis of maladaptive behavior, finding a solution, strengthening emotional self-regulation skills, effective interpersonal communication, cognitive modification, and a range of strategies based on exposure.

This achieves five main goals:

• formation of motivation for change
• assistance in the formation of new patterns of behavior
• generalization of new patterns of behavior outside the therapeutic space
• structuring the therapeutic environment necessary to support the patient’s resources
• increasing the ability of the therapist to help the patient

Counseling Dialectical Behavior Therapy is the world standard for helping people with borderline personality disorder, suicidal behavior and self-harm.

Currently, the indications for it are expanded and also include: Bipolar affective disorder,

• major depressive disorder,
• eating disorder,
• post-traumatic stress disorder,
• Substance abuse
• Adolescents with BPD traits.