Displaying items by tag: borderline personality disorder

Quick Facts

Dialectical behaviour therapy (DBT) is a modified version of cognitive-behavioural therapy (CBT) designed to treat borderline personality disorder (BPD). It can also be used to treat other conditions, like suicidal behaviour, self-harm, substance use, post-traumatic stress disorder (PTSD), depression and eating disorders.

• How DBT works

  The term ‘dialectical’ means ‘working with opposites’. DBT uses seemingly opposing strategies of ‘acceptance’ and ‘change’. The therapist accepts you just as you are, but acknowledges the need for change in order for you to recover, move forward and reach your personal goals.

  During a course of DBT, the therapist works with you to help you move away from harmful coping behaviours and towards a life that you find personally meaningful and fulfilling.

  DBT involves developing two sets of acceptance-oriented skills and two sets of change-oriented skills.

• Acceptance-oriented skills

  Mindfulness

  Learning how to focus your awareness on the present moment, and to acknowledge and accept your thoughts, feelings, behaviours and bodily sensations as they occur, without the need to control or manipulate them.

  Related: Mindfulness

  Distress tolerance

  Learning how to manage and cope during a crisis, and to tolerate distress when it is difficult or impossible to change a situation. Learning to accept any given situation just as it is, rather than how you think it should be, or want it to be. Learning new skills like distraction and self-soothing, for both coping with and improving distressing moments.

• Change-oriented skills

  Emotional regulation

  Learning how to effectively manage your emotional experience, and not allow your emotions to manage you.

  Interpersonal effectiveness

  Learning assertiveness strategies to appropriately ask for what you want or need. Learning how to say no, and how to manage interpersonal conflict in a way that maintains respect for yourself and others.

  A typical course of DBT

  DBT is typically run as a 24-week program, often taken twice to create a one-year program. In its standard form, there are three ways you receive DBT during the program. There are also shorter versions of DBT such as 12 week courses depending on the setting, and some versions do not include telephone coaching. DBT has been adapted for different needs.

  DBT skills training group

  A group facilitator teaches specific skills in a classroom setting, and sets tasks for the group members to practise between sessions. The skills training group typically meets once weekly, usually for around 2½ hours, across the 24-week program.

  Individual therapy

  Running at the same time as the group, individual therapy typically occurs weekly to enhance your motivation and commitment to the program. It’s also an opportunity to discuss and apply specific DBT skills to your current everyday life.

  Between-sessions telephone coaching

  On-the-spot telephone coaching from your therapist can be available at times during the week when you’re struggling. Your therapist guides you and encourages you to apply your new DBT skills to address and manage your issues.

• How to get DBT treatment

  In most Australian states, DBT programs can be accessed through both the public and private mental health system.

  Public services

  Some hospitals may run public DBT programs. Talk to your case manager, mental health professional or GP about referral options.

  Private services

  Private DBT programs require payment. Prices will vary depending on the specific service you choose. If you have private health insurance, check that it covers psychiatric admissions.

  If you don’t have private health insurance but you’re eligible for the National Disability Insurance Scheme (NDIS), you may be able to allocate funds to access a DBT program within the private system.

  To join a private DBT program, a psychiatrist from the specific hospital or clinic can provide a referral for you.

  Finding a service near you

  To find services providing BPD treatment in Australia or New Zealand, visit Project Air Strategy’s Service Directory.

  For state-based mental health assistance:

  • Victorian Mental Health Service Directory and Spectrum
  • NSW Mental Health Line on 1800 011 511 (available 24 hours)
  • ACT Mental Health Triage Service 1800 629 354
  • QLD Health 13 43 25 84
  • SA Health Mental Health Triage Service on 13 14 65 (available 24 hours)
  • WA Mental Health Emergency Response Line 1300 555 788 (metro) or 08 9224 8888 (State Wide)
  • Tasmanian Mental Health Service Helpline 1800 332 388
  • NT Crisis Assessment Telephone Triage and Liaison Service 1800 682 288.

• References

  1. Gottman, J. M., & Levenson, R. W. (1992). Marital processes predictive of later dissolution: Behavior, physiology, and health. Journal of Personality and Social Psychology, 63, 221–233.
  2. Wegner, D. M., & Erber, R. (1992). The hyperaccessibility of suppressed thoughts. Journal of Personality and Social Psychology, 63, 903–912.
  3. Goldfried, M. R., & Davison, G. C. (1976). Clinical behavior therapy. New York: Holt, Rinehart & Winston.
  4. Roemer, L., & Borkovec, T. D. (1994). Effects of suppressing thoughts about emotional material. Journal of Abnormal Psychology, 103, 467–474.
  5. Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of Personality and Social Psychology, 53, 5–13.
  6. De Mello, A. (1984). The song of the bird. New York: Image Books.
  7. Nagasako, E. M., Oaklander, A. L., & Dworkin, R.H. (2003). Congenital insensitivity to pain: An update. Pain, 101(3), 213–219.
  8. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delacorte Press.
  9. Gross, J. J., & Levenson, R. W. (1997). Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, 106, 95–103.
  10. Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362.

This SANE factsheet was reviewed by industry professionals.

This SANE resource was created with support from The Vizard Foundation.

Quick facts

• Borderline personality disorder (BPD) affects a person’s emotions, impulses and relationships. 
• Most people living with BPD have been through something traumatic.
• Self-care strategies, psychological therapies, and support in the community can all help people living with BPD.
• It is possible to live a full and meaningful life even if a person lives with BPD.

• What is borderline personality disorder (BPD)?

  People with borderline personality disorder have challenges managing their emotions and impulses. They can also have unstable feelings about who they are, and their relationships.  

  Signs of BPD usually appear in late adolescence or early adulthood. While the symptoms can be confusing and easily misunderstood, it is possible to live a meaningful life with BPD. With support and treatment, people can manage, reduce or even eliminate symptoms.  

• Symptoms of BPD

  To receive a diagnosis of BPD, five of these nine symptoms need to be present¹: 

  • Feeling empty, or having low self-esteem. 
  • Paranoia or emotional detachment. 
  • Anxiety about relationships, making efforts to avoid being abandoned. 
  • Impulsive, risky behaviour. 
  • Self-harm, threatening or attempting suicide. 

  • Anger, moodiness, irritability or difficulty controlling anger. 
  • A pattern of intense and challenging interpersonal relationships. 
  • Difficulties with self-image, identity or sense of self. 
  • Moods that feel unstable and reactive. 

  BPD is a very diverse condition. For example, not all people with BPD experience self-harm, though many do. 

  Some people with BPD may engage in behaviour that seems manipulative or attention-seeking to others. This behaviour results from the symptoms of BPD, not from being a bad person. 

• Causes of BPD

  BPD’s causes are not fully understood, but are likely to be a combination of genetics and life experiences³. It is common for people living with BPD to have a history of traumatic experiences, such as childhood neglect or abuse. In fact, there is an overlap between BPD and complex Post-Traumatic Stress Disorder (Complex PTSD). Some advocates and clinicians argue that BPD should be renamed to complex PTSD. There is no doubt that many people experience both.  

  Experts argue that the symptoms of BPD develop as a way of coping with the impacts of trauma. After a trauma, some people have strong negative emotions and difficulty trusting others. It may be that for people with BPD, impulsive behaviours or self-harm develops in order to cope with these difficult experiences and intense emotions.

• How common is BPD?

  Research estimates around 1% of the general adult community live with BPD².  

  Women are more likely to be diagnosed with BPD, but men experience BPD at a similar rate. 

• Managing life with BPD

  Things can sometimes feel unpredictable and out-of-control for people with BPD. The first thing to do is learn as much as possible about BPD. This can help people understand the condition, and find the right treatment and support. 

  People with BPD find these things can be helpful: 

  • establishing good routines  
  • tracking moods and emotions to understand their patterns 
  • looking after physical health through healthy eating, exercise and sleeping well 
  • learning about emotion regulation and distress-tolerance skills  
  • accessing peer support 

  • developing a personalised safety plan.

• Treatment and support for BPD

  The most effective treatments for BPD are psychological therapies. They can help people learn to better understand and manage their feelings, and how they respond to people and situations³. Treatment for PTSD can also be part of support for BPD, if relevant. 

  As with any health problem, seeing an understanding GP is a good start. A GP can provide referrals to mental health services.  

  Ideally, assessment and treatment should be provided by a mental health professional who has training and knowledge around BPD.  

  There are many types of therapy known to be helpful for people with BPD. These are often long-term therapies that focus on coping with emotions, tolerating distress, and healthy relationships. Sometimes these therapies are offered in settings dedicated to a specific treatment area or style. However, many mental health professionals also use parts of these different therapies in more traditional one-on-one therapy sessions. 

  Evidence-based therapies for BPD include⁴: 

  • Dialectical behavioural therapy (DBT) 

  • Schema therapy 

  • Mentalisation based therapy (MBT) 

  • Psychodynamic therapy 

  • Cognitive analytic therapy (CAT) 

  Often people with BPD need support managing thoughts of self-harm or suicide. In these situations, it is important to get help, whether that's staying safe yourself, or supporting someone else who is suicidal. Talking to a GP or mental health professional is also important as they can help you learn ways of dealing with painful emotions, and making a plan for how to cope when suicidal thoughts come up. 

  If you or someone you know is at immediate risk, call 000 or visit your nearest hospital. For support with suicidal thoughts, please contact Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.

• Help for family & friends

  The family and friends of someone with BPD need care and support too — it’s okay for family and friends to set boundaries and to prioritise their own physical and mental health.  

  Families and friends cope better when they learn about the condition, and how to communicate and relate to the person affected. It's also good to know what to do in case of an emotional crisis. 

  There are many other people out there who share similar experience, and services designed to help carers of people with mental health issues. Check out our Guide for Families and Friends for more info.

  Effective support is available, and a person who is experiencing BPD can live a fulfilling life.  

  To connect with others who get it, visit our online Forums. They’re safe, anonymous and available 24/7.

  VISIT FORUMS

• Resources

  • Meet Stephanie – real story of living with BPD 
  • Clinical Practice Guidelines for the Management of BPD (NHMRC)  
  • Support for families, friends and carers of people with BPD (Family Connections) 

  • Personality Disorder information and resources (Project Air)  
  • For support with managing suicidal thoughts, contact Suicide Call Back Service – 1300 659 467 or Lifeline – 13 11 14 

• References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5). In: 5th ed. American Psychiatric Association; 2013.  

  2. Ellison WD, Rosenstein LK, Morgan TA, Zimmerman M. Community and clinical epidemiology of borderline personality disorder. Psychiatr Clin. 2018;41(4):561–73.  

  3. National Health and Medical Research Council. Clinical Practice Guidelines for the Management of Borderline Personality Disorder. Canberra; 2012.  

  4. Carrotte ER, Blanchard ME. Understanding how best to respond to the needs of Australians living with personality disorder. South Melbourne; 2018.