- Unstable self image and sense of self
- Impulsivity in at least two areas that are potentially self-destructive such as: substance abuse and addiction
- Sexual compulsivity and promiscuity
- Eating disorders (anorexia, bulimia, binge-eating)
- Impulsive spending/gambling
- Frantic efforts to avoid real or imagined abandonment
Borderline Personality Disorder
Borderline Personality Disorder is a pervasive characterological disturbance that occurs in approximately 2 percent of the population, making Borderline Personality Disorder, commonly referred to as BPD, once of the common personality disorders. BPD is diagnosed 3 times more often in females and onset is typically in early adulthood.
- A pattern of unstable and intense interpersonal relationships and the tendency to polarize people and experiences alternating between ‘all good’ idealization and ‘all bad’ devaluation
- Affective instability due to a marked reactivity of mood with periods of intense depression
- Irritability and/or anxiety lasting a few hours to a few days
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Recurrent suicidal gestures, threats or self-injuring behavior (cutting)
- Chronic feelings of emptines
- Possible dissociative and paranoid symptoms when individual is under stress
In considering the multitude of symptoms presented here, it is important to note that many people possess these traits to some extent. It is when they are intense, pervasive and severely impact an area of life functioning that they are diagnosed. Furthermore a DSM diagnosis of BPD requires five out of nine listed criteria to be present for a significant period of time in order for a diagnosis to be made.
The individual suffering with Borderline Personality Disorder typically has a history of pathological family experiences involving possible physical, sexual or/and emotional abuse, certain patterns of over-involvement between parent and child, abandonment by a parent, inconsistent and unstable attachment patterns, poor emotional support, neglect, hostility and lack of communication within family environment. An ‘invalidating environment’ in childhood has also been significantly linked to Borderline Personality Disorder whereupon the child’s emotional experiences, feelings and expressions are consistently dismissed, belittled, minimized, criticized or ignored. When this occurs consistently throughout a child’s emotional development, there can be a thwarting of the development of the child’s emotional self and ability to know, understand and regulate what they are feeling. This disruption to their affective regulation system and identity occurs because the invalidating environment tells them that their most private and innate experience is wrong and over time there is a conflict set up where the individual begins to not trust what they are feeling and their self experience becomes increasingly distorted.
The expression of feeling is one of the most personal and intrinsic parts of one’s core self, who one is, how one defines themselves and how they communicate their sense of self and the world to others, and when a child does not have their feelings mirrored back to them in order for them to learn what they are feeling, but rather they are invalidated, criticized or rejected, it follows that there is a base denial of one’s self and identity. The child learns that their internal experience is wrong and inappropriate and the true self becomes increasingly corroded and disorganized as the psyche constructs defenses to deal with and tolerate their environment, often internalizing the invalidation and patterns of abuse, leading them to often feel like they are crazy, even if they are functioning normally. This leads these individuals to often develop difficulties with impulse control due to lacking the ability to regulate their emotions and due to a fragmented sense of self. Often times a drug addiction becomes part of that.
There is also research that suggests there be may be biological factors involved in the development of Borderline Personality Disorder, such as biochemical irregularities that produce a vulnerability in temperament and sensitivity. A Biosocial theory was developed around this and states that difficulties associated with BPD are produced and often exacerbated when a person with this temperamental vulnerability is raised in an invalidating environment.
The instability and impulsivity experienced by those suffering with Borderline Personality Disorder appears understandable given the disorganization of their internal world and the difficulty they have regulating emotions. Furthermore, the combination of affective dysregulation, low impulse control, history of trauma and unstable, low sense of self create fertile ground for drug and alcohol abuse and addiction as these individuals turn to substances in an effort to self-medicate and regulate themselves, not to mention the array of other symptoms that those dealing with BPD may experience that often mirror the chaos, inconsistency and pain they have internalized from their life experience.
Besides the common co-occurrence of substance abuse and addiction, BPD often co-occurs with eating disorders, posttraumatic stress disorder (PTSD), mood disorders, depression and anxiety disorders. Cliffside Malibu can help with a complete addiction recovery plan to treat everything that you need.
The treatment for those suffering from Borderline Personality Disorder is often comprised of intensive long term individual therapy. Anti-depressant medication has also been found useful in treating some cases of BPD when combined with therapeutic treatment. Dialectical Behavior Therapy (DBT) techniques are often utilized and are generally very effective in treating this population. DBT typically includes a group and an individual component of therapy. The individual component often involves the therapist and client developing specific and measurable treatment goals and conducting here and now sessions that process in depth what occurred for the client during the week.
Self-injurious and suicidal behaviors take first priority, followed by behaviors that impede the therapy process, often a re-creation of what occurs in the client’s outside relationships, and a good vehicle to be used in therapy to provide corrective and adaptive experiences. Quality of life issues are also addressed, with a meta-goal of working towards improving one’s life generally. Developing coping resources and skills with regard to client’s emotional, interpersonal and overall life functioning are also a strong focus of individual therapy, and roadblocks the individual experiences in these areas are addressed and explored. Individual therapy may need to occur more than once per week to assist in crisis stabilization, and phone contact outside therapy sessions is common.
The group therapy component for BPD is broken down into four modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills and distress tolerance skills and is typically held once per week. Due to the frequency of dual diagnosis for those suffering with Borderline Personality Disorder, meaning that the individual is suffering from a psychiatric disorder in co-occurrence with a substance abuse problem, a dual diagnosis or drug and alcohol treatment center is often the necessary and most effective treatment avenue. This provides the individual with a safe and structured environment to stabilize and participate in the intensive individual and group therapy that is required to address the numerous addictive and self-destructive behaviors of Borderline Personality Disorder.
For additional information on the exclusive Dual Diagnosis program at Cliffside Malibu, please visit our main rehab center page.