Treating Borderline Personality Disorder with Dialectical Behavior Therapy

Posted by Andy Alt / http://mentaldimensions.wordpress.com

January 11, 2009

A few minutes ago I stopped doing nothing long enough to pick up my most recent copy of TIME magazine. The following are some excerpts from an article about Borderline Personality Disorder (Click the link below to read the full article). BPD is one of the things I have been told I have.

According to this article, it’s common for antidepressants to be ineffective with patients who have Borderline Personality Disorder.

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Borderline patients are often overmedicated–partly because therapists see them as difficult–but for Lily, as for most borderlines, the meds did little. “Drug treatment for BPD is much less impressive than most people think,” Paris writes in Treatment of Borderline Personality Disorder.
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The Mystery of Borderline Personality Disorder
By John Cloud / Seattle Thursday, Jan. 08, 2009 -

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And possibly the most difficult of all to fathom–and thus one of the most creatively named–is the mysterious-sounding borderline personality disorder (BPD). University of Washington psychologist Marsha Linehan, one of the world’s leading experts on BPD, describes it this way: “Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”
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What defines borderline personality disorder–and makes it so explosive–is the sufferers’ inability to calibrate their feelings and behavior. When faced with an event that makes them depressed or angry, they often become inconsolable or enraged. Such problems may be exacerbated by impulsive behaviors: overeating or substance abuse; suicide attempts; intentional self-injury.
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BPD treatment has improved dramatically in the past few years. Until recently, a diagnosis of borderline personality disorder was seen as a “death sentence,” as Dr. Kenneth Silk of the University of Michigan wrote in the April 2008 issue of the American Journal of Psychiatry. Clinicians often avoided naming the illness and instead told patients they had a less stigmatizing disorder.
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At one point in the late ’90s, Lily was taking five drugs that doctors had prescribed: three antidepressants, an antianxiety medication and a sleeping pill. Borderline patients are often overmedicated–partly because therapists see them as difficult–but for Lily, as for most borderlines, the meds did little. “Drug treatment for BPD is much less impressive than most people think,” Paris writes in Treatment of Borderline Personality Disorder.
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It was Linehan who changed all that. In the early 1990s, she became the first researcher to conduct a randomized study on the treatment of borderline personality disorder. The trial–which showed that a treatment she created called “dialectical behavior therapy” significantly reduced borderlines’ tendency to hurt themselves as well as the number of days they spent as inpatients–astonished a field that had come to see borderlines as hopeless.
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Linehan also taught Lily various skills to regulate her emotions. Among the most important is one Linehan calls the “wise mind”–a kind of calm, Zen state that Linehan insists even the most debilitated patients can achieve. “Generally,” she writes, “I have patients follow their breath … and try to let their focus settle into their physical center, at the bottom of their inhalation. That very centered point is wise mind.” Lily remembers this sensation clearly; she came to feel that her dark moods had a physical location in her body–her solar plexus–and when she focused on it, she could deactivate a destructive emotion.
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If some of this sounds like advice you heard in kindergarten, it should. Remember that borderlines have never learned to regulate their emotions. It’s important to note that Linehan doesn’t just practice tough love with her patients; she also tells them she knows they are hurting and doing the best they can. She emphasizes that she believes in them even though many therapists have tossed them aside. “Clients cannot fail,” she says. “But both treatment and a therapist can fail.” Both compassion and irreverence, both validation and tough love–these are the dialectics at the heart of Linehan’s approach.
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Recent discussions about BPD and the recent article in TIME magazine can be found at:

Time Magazine Digs Into The “Mystery” Of Borderline Personality Disorder (Jan 13, 2009 – Furious Seasons)

Lazy woman’s post—On Borderline Personality Disorder (Jan 11, 2009 – Beyond Meds)

Are we becoming borderlines? (Jan 11, 2009 – JustAna)