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Borderline Personality Disorder: Dialectical Behavior Therapy and Comprehensive Care

Evidence-based treatment of borderline personality disorder including dialectical behavior therapy, mentalization-based therapy and integrated psychiatric care

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is Borderline Personality Disorder: Dialectical Behavior Therapy and Comprehensive Care?

Borderline personality disorder is pervasive pattern of instability in interpersonal relationships, self-image and affects with marked impulsivity.

DSM-5 criteria require 5 of 9 criteria including frantic efforts to avoid abandonment, unstable intense relationships, identity disturbance, impulsivity, suicidal behavior, affective instability, emptiness, anger and stress-related paranoid ideation.

Lifetime prevalence approximates 1.6% with female predominance in clinical settings though community samples suggest equal prevalence.

High comorbidity includes major depression, anxiety disorders, PTSD, substance use disorders, eating disorders and other personality disorders.

Recent research demonstrates significant improvement and remission rates with appropriate treatment changing previously pessimistic prognosis.

Symptoms

Pervasive instability of interpersonal relationships alternating between idealization and devaluation.
Frantic efforts to avoid real or imagined abandonment with intense fear of being alone.
Identity disturbance with markedly persistent unstable self-image and sense of self.
Impulsivity in potentially self-damaging areas including spending, sex, substance abuse, reckless driving, binge eating.
Recurrent suicidal behavior, gestures, threats or self-mutilating behavior with affective instability and chronic emptiness.

Risk Factors

Childhood trauma including physical, sexual or emotional abuse and neglect strongly associated with disorder development.
Genetic vulnerability with heritability estimates of 40-65% for trait dimensions of impulsivity and emotional dysregulation.
Adverse childhood experiences including parental loss, mental illness, substance abuse contribute to risk.
Invalidating childhood environment described in biosocial theory contributes to development of emotion dysregulation.
Comorbid psychiatric conditions and substance use complicate course and treatment requiring integrated approach.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Suicidal ideation, suicide attempt, severe self-harm or behavioral dyscontrol require urgent psychiatric evaluation.
  • Pervasive interpersonal difficulties, identity instability and emotional dysregulation impairing functioning warrant comprehensive evaluation.
  • Comorbid major depression, substance use disorder, PTSD or eating disorder requires integrated specialty care.
  • Crisis presentations to emergency department for self-harm or suicidality benefit from specialized borderline personality programs.
  • Multidisciplinary care including psychiatrist, dialectical behavior therapy trained therapist, primary care, family involvement optimizes outcomes.

Treatment Methods

01
Dialectical behavior therapy combining individual therapy, skills training group, phone coaching and consultation team is most evidence-based.
02
Mentalization-based therapy focusing on capacity to understand mental states of self and others provides alternative.
03
Transference-focused psychotherapy and schema therapy are additional evidence-based psychotherapeutic options.
04
Pharmacotherapy addresses specific symptom domains including mood instability, impulsivity, transient psychotic symptoms with no medication FDA approved specifically for BPD.
05
Comprehensive treatment plan integrating evidence-based psychotherapy, judicious pharmacotherapy targeting symptom domains, treatment of psychiatric comorbidity, family psychoeducation, crisis planning, and long-term continuity of care provides foundation for recovery from this severe but treatable disorder with substantial improvement and remission demonstrated in longitudinal studies.

Which Department to Visit?

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.