Borderline Personality Disorder (now called Emotionally Unstable Personality Disorder in the UK) can be regarded by some professionals with trepidation. BPD has many traits and can affect individuals in many different ways; this is in part due to the DSM IV TR requiring an individual to meet 5 out of a possible 9 criteria to receive a diagnosis. The different combinations that are made possible as a result of this create an extremely heterogeneous population in the way that BPD presents. Each of these traits requires intervention, however a complicating factor in the recovery of a person with BPD is the likelihood that they will also present with suicidality. 75% of people who suffer from BPD have a history of suicide attempts. When suicidality occurs, it quite rightly demands the focus of the professionals involved in the individual’s care, which can postpone the treatment of other symptoms.
The B in BPD is a relic of a now outdated theory which proposed that the disorder is on the border between mild and severe mental illness. In fact, BPD is far from mild; it is understood to have 9 criteria which fit into 4 core traits: affective, impulsive, interpersonal and cognitive. Individuals with BPD are undoubtedly complex, however a common factor to everyone with BPD is thought to be emotional dysregulation. Acute difficulty in regulating emotions towards both oneself and one’s world can result in instability in mood, impulse control and difficulty with interpersonal relationships.
Treatments for BPD are constantly evolving and as may be expected the combination of both psychopharmacological and psychological interventions are important in recovery. One psychological intervention that shows promise is Dialectical
Behavioural Therapy (DBT). DBT developed from Cognitive Behavioural Therapy and involves a combination of three theoretical positions: behavioural science, dialectical philosophy and zen practice. An empirical evidence base for DBT is ever growing and it has been shown to be effective in treating emotional dysregulation in a large number of randomised controlled trials (e.g. Panos et al, 2014).
All this can paint a picture of an individual with BPD who is at the mercy of the condition. People with BPD, however, can display prodigious determination in their journeys to recovery. People with BPD stand fast in the face of wave after wave of hardship. They stand against their illness in the search for continuity and calmness. A huge part of recovery comes from this strength and often people with BPD are creative, determined, understanding, worldly and insightful. We are all individuals and we all suffer from trials and tribulations. It is important to remember that people with BPD are not only BPD. The disorder can be challenged, it can be controlled, it can be overcome.