We have already seen from other articles published on this site that those of us who suffered severe childhood trauma are at a much-increased risk of developing borderline personality disorder (BPD) as adults than average.
We have also examined the symptoms of BPD in other posts so there is no need to repeat that here.
Instead, in this post, I will look at nine important goals that BPD sufferers may need to aim for on their road to recovery (different individuals with BPD have different sets of symptoms, so not all BPD sufferers will need to address every goal and different individual BPD sufferers will need to address their own particular combination of treatment aims accordingly).
But first, what does the research say about how likely a person with BPD is to get better?
BPD SUFFERERS GET BETTER WITH TIME?
Until relatively recently it was believed a person with BPD did not stand a good chance of getting significantly better. However, this is no longer the case. One reason that this error was made is believed (e.g. Cohen and Cohen, 1984) to be that the less recent research into the possibility of remission over-focused on individuals with the severest forms of BPD at the expense of ignoring less severe cases (in relation to this, you may wish to read my article about high and low functioning BPD sufferers or my article on Kernberg’s theory about upper and lower BPD.
Gunderston et al. (2011) carried out a longitudinal study of BPD sufferers (as well as sufferers of other personality disorders) and found that, after 24 months, nearly 50% had recovered to the degree that they no longer met the criteria to be diagnosed as having a personality disorder any longer.
Other studies have also supported the finding that those suffering from BPD improve over time and, better still, once recovered tend NOT to relapse. Furthermore, there is increasing evidence suggesting that, by middle age, the majority of those diagnosed with BPD earlier in their lives are able to function at close to normal levels.
However, the above should not detract from the fact that BPD is a very serious disorder and up to 10% of sufferers eventually die by suicide. Also, even after decades, a large minority of sufferers remain dysfunctional.
The Nine Steps To Achieving BPD Recovery :
1) Learn to deal with feelings of intense anger.
Many sufferers of BPD experience outbursts of severe rage which may, in part, be linked to the damage done to the development of the amygdala (a brain region involved in the processing of emotions) during childhood ( caused by growing up in a chronically stressful environment).
The BPD sufferers is particularly likely to experience intense anger when events occur that remind him/her of his/her childhood trauma, such as being rejected or abandoned.
2) Eliminate self-destructive and impulsive behaviours.
These may include self-harm (eg. cutting), binge eating, excessive use of drugs/alcohol, unsafe sex, reckless driving etc.
The BPD sufferers, consciously or unconsciously, may be carrying out such activities in a desperate attempt to numb the psychological pain. Psychologists refer to this short-term (and ultimately damaging) coping mechanism as dissociation.
3) Overcome the intense fear of rejection and abandonment.
Many BPD sufferers intensely fear rejection/abandonment and may make desperate attempts to avoid it, including threatening/attempting suicide. This is connected to the fact that many BPD sufferers experienced deeply insecure childhoods, and being rejected as adults can trigger memories, and the corresponding emotions, of having been rejected/abandoned as children.
4) Stabilize interpersonal relationships.
Often, BPD sufferers fluctuate between idealizing and demonizing those they are emotionally intimate with, seeing them as ‘all good’ one minute and ‘all bad’ the next. Indeed, many BPD sufferers think in terms of ‘black and white’ in general, ignoring the shades of grey in-between. Such thinking is unhelpful and over-simplistic. Life is much more complex than that.
5) Improve self-image.
Many BPD sufferers were excessively criticized and made to feel unlovable as children. They are then likely to have internalized these negative messages and, consequently, to have grown up to believe, erroneously, that they are ‘intrinsically a bad and unworthy person’.
6) Learn to cope with stress more effectively.
We have seen in other posts that a very stressful childhood can physically damage the brain’s development (e.g. by damaging an area of the brain known as the amygdala) which can lead to severe over-reactivity to stress as an adult (psychologists refer to this as emotional dysregulation or emotional lability.
7) Stop self-harming behaviour.
BPD sufferers often self-harm as a way of coping with mental anguish and distress; this is a form of dissociation. They may, too, threaten or attempt suicide in response to real or imagined rejection.
8) Find meaning in life.
Often, BPD sufferers experience life as being empty, meaningless, pointless, futile and absurd.
9) Eliminate paranoia.
Because many BPD sufferers felt constantly in danger and under threat during their childhoods, this was fertile ground in which to develop paranoid thinking which may worsen and become pathological in adulthood.
Dialectical Behaviour Therapy:
Currently, dialectical behaviour therapy (DBT) is believed to be one of the most effective treatments for BPD. For information about DBT from MIND, click here.