Self help for borderline personality disorder

Seven Self-Help Ideas for Borderline Personality Disorder — Amanda L. Smith, LCSW

Borderline personality disorder is a mental health diagnosis that can make it difficult for someone to cope with a variety of emotions and thoughts. Many people with borderline personality disorder live in a constant state of worry or fear over real or perceived abandonment. The diagnosis also leaves people significantly more likely to practice self-harm or die by suicide.

The good news is that, with treatment and support, a person with borderline personality disorder can find new ways of coping and feel better. The not-so-good news is that professional help may be exceedingly difficult to find in many areas of the world. Self-help strategies and tools can often assist a person in coping with their their most distressing symptoms.

Below you’ll find seven ways that people who have been diagnosed with borderline personality disorder can help themselves.

Identify Diagnostic Tools

Unless you are a mental health professional, you probably aren't going to be in a position to diagnose yourself or a loved one with borderline personality disorder. Only a medical professional can accurately give that diagnosis. However, the internet has made it easy for you to take online screenings that can help give you a better idea of whether or not you have a borderline personality disorder.

You can find other diagnostic tools by Googling queries such as: “depression screening online” or “anxiety test online.” I also like to recommend researcher Dr. Kristin Neff’s online questionnaire about being self-compassionate.

Although these tools may not be perfect, they may be a way for you to learn more about yourself and your symptoms. Just make sure the test you take is a reputable one and created based on best scientific and medical practices.

You may also want to check out this article on the pros and cons of self-diagnosing.

Mindfulness Techniques

Mindfulness is a process by which individuals are encouraged to be more "in the moment." It involves being present in things that are happening at any given second, rather than being absorbed in events of the past, future, or our own mind. It also means observing things that are occurring, and sensations that you are feeling, without being too judgmental, critical, or analytical.

Mindfulness, for most of us, is notoriously difficult and requires a great deal of practice and conscious observation. Other practices, like meditation, can help one achieve this state of mind. However, when it comes to mental illnesses in general, and borderline personality disorder specifically, there is good news, as mindfulness can help someone achieve piece and ease their symptoms.

Some people find that something as simple as coloring with pencils or markers can be a way to practice mindfulness.

Furthermore, mindfulness is a core component of dialectical behavior therapy, a specific type of component that has shown promise when it comes to treating borderline personality disorder. It can help individuals regulate their emotions, develop emotional discipline, and concentrate more on their feelings and emotions. It can also help to calm feelings of anxiety and depression.

Perhaps most importantly, mindfulness can help someone change their brain chemistry, thinking patterns, and emotional capacity. For people who are learning to cope with the symptoms of borderline personality disorder, this can be an important skill.

Meditation

Meditation, like mindfulness, can be incredibly helpful to someone with borderline personality disorder. Indeed, meditation and mindfulness often go hand in hand.

Meditation comes with many specific benefits. Meditation is a practice that involves slowing down, concentrating on thoughts, breathing, or a chant in order to ease one's mind. There are many different types of meditations, and all of these can have different impacts.

Many studies show the benefits of meditation on mental health in general. It can ease anxiety and symptoms of depression and make people feel more at ease and at peace. This, in turn, can regulate emotional intensity, calm emotional outbursts, and help people have healthier relationships - this, of course, can have a major impact on people with borderline personality disorder.

Indeed, as noted by a scientific review, individuals who have borderline personality disorder and meditate often show improvements over a number of symptoms.

Podcasts

I’ve loved podcasts for years and know that I learn a lot when I listen to each episode. You can find podcasts about topics that range from mindfulness, healthy relationships, self-care, and coping with anxiety or depression. If you have an interest, there a podcast waiting for you.

Here are some of the podcasts I like to recommend to my clients and their families.

(And if you have a favorite podcast to recommend to me, please let me know. You can write to me at [email protected].)

Distract Yourself

Sometimes, the best thing you can do when you are in a moment of crisis is to distract yourself from whatever pain you are in. This can be exceptionally difficult, but there's good news: With practice, it gets easier.

How can you distract yourself? Thankfully, there are a variety of different ways.

• What's a hobby that you love? Are you a knitter? Puzzles? Drawing? Writing? Find a project and throw yourself into it.

• Is there work that you can do, either around your house or for your job?

This distraction can be tough. It can be painful, difficult to do. It can take time in order to learn how to distract yourself and determine what hobby or method works best. However, the important thing is that you try. You may find that engaging in a hobby is the best way to get yourself through a moment of crisis or an intense period of emotional pain. When that moment passes - and they do pass - you can reevaluate. But sometimes, the key is to push yourself through a problematic experience and bring yourself into a better place.

DBT Skills Training

Dialectical behavior therapy (DBT) is an evidence-based treatment that has been a life-saving therapy for people all over the world. Unfortunately, there are still many parts of the world where DBT is not available or may not be affordable.

If you cannot get access to a therapist or are on a waiting list for DBT, online skills training may provide you with an ideal way of helping to learn the skills you need.

Online skills training can you help you learn:

• ways to soothe yourself when you’re upset.

• how to control your thoughts and emotions.

• what to do when you feel empty, bored, or even self-destructive.

• how you to be a better, healthier version of you.

Seek Online Support

One of the many positives of the advent of the digital world that we live in is that there is no shortage of resources for people who are looking for help. Indeed, there are many Facebook pages and groups for people who are looking for support and information.

I also love to recommend #BPDChat on Twitter. It’s an encouraging and hopeful resource for many people who are seeking connection and encouragement.

These resources can be very helpful in a variety of ways, including helping you share your experiences, discuss coping techniques, and finding people who will be compassionate and validating. Please remember that you aren't alone, and you should find other people to share stories of healing and hope.

Online support, however, should never be confused with treatment with a licensed health care professional. Some online communities are positive and hopeful places to seek support and information but other web sites may contain information that is inaccurate and even harmful.

Note: If you are currently in a mental health crisis, please call your local emergency services or consider reaching out to to someone who is in a position to help. That next phone call or email may be the one that connects you to the resources you need the most.

If you want to learn more about borderline personality disorder, I can strongly recommend these books:

• The Borderline Personality Disorder Wellness Planner for Families

• Coping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder

• Beyond Borderline: True Stories of Recovery

management - Borderline in the ACT

If you experience symptoms of BPD, you may feel like every day is a struggle against your emotional ups and downs. Here are some tips to cope with difficult emotions day by day and improving your long-term health and wellbeing.

Wanting to self-harm

What you can do to get through it:

• Confide in someone you trust and ask for help
• Identify your self-harm triggers and become aware the urge emerges
• Identify effective distractions:
  • Rub ice over where you want to hurt yourself
  • Sticky tape or plaster your skin and peel it off
  • Take a cold bath
  • Deep breathing
• Find new and healthy coping strategies
• Keep a diary for your emotions and coping strategies
• Eat, sleep and exercise well
• Notify those around you know what to do in a crisis
• Reach out to a mental health professional

To view more self-management quick tips visit Sunrise.

For more information

Project Air Strategy: What is self-harm?

Mind UK – Understanding self harm for a more thorough guideline of causes of self harm, accessing treatment and support, tips for helping yourself now and long-term and guidance for friends and family.

Feeling sad, loneliness and depression

Sadness can be a difficult emotion to deal with and it is possible that it deepens into depression.

What you can do to get through it:

• Confide in someone you trust
• Look after your physical health and hygiene
• Find activities that you enjoy and find relaxing
• Create a resilience list. For example:
  • Wrap up in a blanket and watch your favourite TV show
  • Massage your hands with a nice-smelling moisturiser
  • Write all your negative feelings on a piece of paper and tear it up
  • Listen to a song you find uplifting

• Keep a mood diary
• Reach out to a mental health professional

For more information

Project Air Strategy – Managing emotions.

Coping with Depression is a information package designed by the Centre for Clinical Interventions. Download the modules to learn to manage your mood.

Mind UK – Understanding depression for a more thorough guideline of possible causes of depression, accessing treatment and support, tips for helping yourself and guidance for friends and family.

Feeling anxious, tense and panicky

Anxiety occurs in times of fear which includes stress, embarrassment, criticism and rejection. In a period of intense fear, panic attacks can appear unexpectedly and suddenly.

SUNRISE – Finding the right distress tolerance skill for your situation

What you can do to get through it:

• Confide in someone you trust and ask for help
• Look after your physical health
• Try relaxation techniques
  • Make yourself a hot drink and drink it slowly, notice the taste and smell, the shape of the mug and its weight in your hand
  • Practice breathing exercises
  • Do a reality checklist – write down everything you can think about where you are right now, such as time, date, colour of the room, etc.
  • Take a warm bath or shower – this can help change your mood by creating a soothing atmosphere and a distracting physical sensation
• Give yourself time to acknowledge the symptoms
• Keep a diary
• Reach out to a mental health professional

BREATHEAWARE – Deep breathing exercise

For more information

Overcoming health anxiety is a set of modules designed by Centre for Clinical Interventions. You can complete these modules to understand anxiety and help you decrease your health worries and concerns.

Project Air Strategy – Managing emotions.

People Sense – Combating stress.

Mind UK – Understanding anxiety and panic attacks for a more thorough guideline of possible causes of anxiety and panic attacks, accessing treatment, tips for helping yourself and guidance for friends and family.

Dissociation and spaced out

Everyone spaces out as a form of escape, however, dissociation becomes a problem when it interferes with your daily life or leads you to risky behaviours. In the beginning, you probably would not realise that it happens until someone else notifies you.

What you can do to get through it:

• Look after your physical health
• Keep a journal
• Visualise safe places
• Practice grounding techniques. For example:
  • Chew a piece of ginger or chilli and notice the strong smell and taste
  • Clap your hands and notice the stinging sensation
  • Drink a glass of ice cold water
  • Walk barefoot
  • Do a reality checklist – write down or say the time and date

• Notify those around you know what to do in a crisis
• Reach out to a mental health professional

For more information

Project Air Strategy – Managing distress.

Overcoming distress intolerance is a set of modules designed by Centre for Clinical Interventions. You can complete these modules to understand about distress and help you distressing or uncomfortable feelings more effectively.

Angry outbursts and prolonged frustrations

Anger is a normal human emotion, however, if uncontrolled or persists over a long time period it can be destructive and this can be frightening for you and those around you. Therefore, time is critical to calming down to dissipate the anger.

What you can do to get through it:

• Identify triggers
• Look out for the warning signs in your body
• Give yourself time out to think
• Try “cool down” techniques. For example:
  • Breathe slowly
  • Rip up newspaper
  • Hit a pillow
  • Throw ice cubes into the bath so they smash
  • Visualise a relaxing memory or use your imagination
• Control your thinking by cognitive restructuring, problem solving, better communication and humour.
• Practice anger management skills
• Eat, sleep and exercise well

For more information

Australian Psychological Society – Managing your anger.

Interpersonal Effectiveness is a set of modules designed by Centre for Clinical Interventions. You can complete these modules to understand about anger and stress and learn to cope with anger and stress more effectively.

Project Air Strategy – Managing anger

Mind UK – How to deal with anger for a more thorough guideline of possible causes of anger, accessing treatment and support, tips for helping yourself now and long-term and guidance for friends and family.

Alcohol and drug use

People consume alcohol and drugs for various reasons – relaxation, focus, fit in, feeling bored, curious, escape problems or relief from emotional distress. Recreational substances affect the way you see things, your mood and your behaviour. There are health, vocational, criminal, relationship and financial dangers with over consumption of substances and taking illegal drugs. It is difficult to accept you may have a problem and ask for help. Be honest with yourself and others and get the help and support you need.

What you can do to get through it:

• Recognise when your substance use has become a problem
• Confide in someone you trust and ask for help
• Investigate suitable treatment and support options near you
• Find alternative healthy coping strategies
• Eat, sleep and exercise well
• Deal with setbacks and keep going

For more information

Project Air Strategy – Problems with alcohol & drug use to identify signs and effects of substance misuse and ways to cope with cravings.

Mind UK – Understanding mental health effects of recreational drugs and alcohol for guideline of effects of alcohol and drugs, what might happen if you have dual diagnosis with a mental health problem, accessing support, and guidance for friends and family.

Emotional distress

People with BPD spend a lot of energy fighting emotional dysregulation, so acceptance of your condition may be difficult. Accepting your emotional responses does not mean approving them or resigning yourself to suffering. It means to stop fighting, avoiding, suppressing or denying your feelings and therefore reducing their power of overwhelming your rational thinking.

Practicing mindfulness techniques can be very effective in letting go of the past and future and exclusively be in the present moment without judgement or criticism of your emotional impulses.

• Observe your emotions from the outside.
• Watch your emotions come and go.
• Tune into your bodily sensations that come with the emotions.
• Tell yourself that you accept the emotions you can feel.
• Remind yourself that just because you’re feeling something doesn’t mean it’s reality.

For more information

Very Well – How to effectively handle stress with BPD.

Project Air Strategy fact sheets What is Mindfulness?

Please see this link for an introduction to practicing Mindfulness.

For mindfulness exercises download the following Project Air Strategy sheets:

• Mindfulness exercise: balloons
• Mindfulness exercise: sushi train
• Mindfulness exercise: leaves
  
• Mindfulness exercise: sounds
• How did I get here?

Effective communication

Expressing yourself to others can sometimes be challenging. Reading verbal and non-verbal language can be particularly more difficult with BPD. Remember to respect other’s voices and that you’re not always going to get it right. Effective communication is a skill that requires practice beginning with being clear and open about your own thoughts and feelings to maintain good relationships with others. Download Project Air Strategy – Effective communication and Project Air Strategy – Relationships difficulties, arguments & conflicts.

Daily self-care

It is important to look after your physical and mental health. This will give you the best chance to managing difficult emotions and situations and to live a fulfilling life. Download the Project Air Strategy – The importance of self-care.

For more information

SA Health: Coping with Borderline Personality Disorder

Australian BPD Foundation – WeCanOnline

Are you interested in being part of an informal online ‘community of peers’ group for people with the diagnosis of BPD? The purpose of the group is to raise awareness of the diagnosis of BPD and the effects this has on people. WeCanOnline also want to have a collective voice to lobby for better access, treatment options, and more receptive or specialised BPD services. Press the link to complete a survey before joining.

Borderline Personality Disorder Support Group

This online support group welcomes all individuals. The forums are community-lead and not staffed by mental health professionals.

BPD Recovery

This is a safe arena for those with mental illnesses and disorders (specifically BPD) to share concerns, voice opinions, seek like-minded individuals working toward recovery, discuss medications and therapy approaches, and explore the impact of their illness(es) have had on their life and the lives of their loved ones. The tools promoted here are mostly CBT-based. As mentioned, you need not have a formal diagnosis to participate or benefit from the resources offered here. All are welcome.

SANE Forums

The Lived Experience Forum is a safe, anonymous community for people living with mental illness, moderated 24/7 by mental health professionals.

Beyondblue online community

This community is all about supporting and learning from each other for all those affected by a mental health-related concern. To reply to posts or start a new thread, you’ll need to be a member. Forum memberships is open to anyone residing in Australia. These forums are community-led and not staffed by mental health professionals.

Elefriends

This free UK-based online community is a place to offer as well as receive support. It is a safe place to yourself, where you can listen, share and be heard. Anyone over 18 can join. The community is moderated by handlers at Mind UK. It is available for users on desktop, iPhone and Android.

The resources below are not meant to replace professional mental health services.

Sunrise – DBT Distress Tolerance Skills: Your 6-Skill Guide to Navigate Emotional Crises includes quick tips and videos to help you get to a more manageable emotional place for crisis survival.

Supplementary Materials for DBT® Skills Training Handouts and Worksheets: Second Edition A complete set of DBT skills training handouts and worksheets for use as suggested by your therapist. You may download and print any or all of these handouts and worksheets for your personal use. If you have questions about how to utilise the handouts and worksheets, please ask your therapist.

Coping with BPD for management strategies.

DBT Peer Connections Skills Training Academy is a free online course created by peers for peers dedicated to improving their emotional health through daily DBT skills practice. The e-course is interactive with videos, reflection journal, diary cards and quizzes.

DBT Peer Connections has links to DBT handouts, worksheets and to a private peer support facebook community.

Centre for Clinical Interventions have information packages that you can download to work through for your concerned mental health condition.

BreakAway MHE – the 9-steps includes a portrayal of real life BPD experience (author’s experience) with the goal to assist with understanding how BPD develops, as well as to teach principles and skills to promote self-awareness and self-mastery.

Help for people with borderline personality disorder //Psychological newspaper

Psychologists and psychotherapists are often approached by people who, in the process of psychodiagnostics and initial interviews, have borderline personality disorder or "emotionally unstable personality disorder" according to ICD-10. What are its signs? How is life for people with page personality disorder? What do experts think about healing? What self-help techniques can people with BPD use in difficult situations? I will talk about this in the article.

Borderline personality disorder (BPD) is a group of personality disorders characterized by self-injurious behavior and difficulties in interpersonal relationships. Some people characterize BPD as "the apocalypse."

I highlight such signs of BPD as: constant anxiety, people with BPD may be anxious because of the crises that accompany their lives, changing events. Often there is an alarming suspiciousness in connection with the state of health. Anxiety leads to psychosomatic illnesses, which reinforces the "vicious circle" - going to the doctors. Anxiety is associated with fear in the lives of people with BPD. A lot of things can scare them, these are new relationships, and intimacy, and parting, and other situations. Numerous spheres of life of people with BPD are “saturated” with fear, as in children aged 3-5 years, who are prone to various fears and anxieties. Especially fear and suspicion can increase in situations of stress. People with BPD have low self-esteem. It is as if a constant critic, distinguished by self-criticism, “sits” inside, and self-doubt and doubts are born from this.

It is worth noting that it is difficult for people with BPD to answer the question: “who am I?”, “What do I want?”, The so-called diffuse identity manifests itself, where there are no strong goals, values ​​and beliefs. When there is a series of events associated with parting with a loved one, with failures in work or in the sphere of relationships with others, which is typical for people with BPD due to emotional instability, emotional or mental pain arises - it resembles an uncomfortable feeling inside, close to despair. People with BPD may have problems controlling their emotions, which manifests itself in uncontrollable anger and anger, chronic conflicts with others. It is very difficult for them to be in a relationship with one partner for a long time, therefore, changes often occur in relationships, even some chaos, the search for more and more new partners.

People with BPD tend to change jobs frequently. The work book is literally teeming with notes about various organizations in which I had to work. As a result, they may face certain difficulties in finding employment in the future. The litmus test for BPD in people's behavior is self-harm and suicide. At the same time, self-harm can manifest itself in different ways, from suicidal attempts to masochistic tendencies in behavior, when people with BPD want the other person to scold, offend, hurt. For some people with BPD, various kinds of addictions are characteristic, for example, alcoholism, drug addiction, gambling, Internet addiction. People with BPD are characterized by unreasonable spending of money, risky driving, and promiscuity. Often, after traumatic events, there may be problems with sleep, nightmares, obsessive thoughts about unpleasant situations, memories that disturb and do not allow you to live in peace. In general, the signs of BPD are characterized by polymorphism, and behavioral patterns - by a variety of manifestations.

You can describe borderline personality disorder with the word: INSTABILITY, where:

N - hate. People with BPD are characterized by a feeling of hatred as a long, intense, negative feeling, reflecting disgust, hostility, rejection of someone.
E - Yeralash. Characterized by disorder, confusion, confusion. Chaotic interpersonal, incl. intimate relationships, lack of structure.
C - Self harm. Among people with BPD, there are suicide attempts, cutting, poisoning, self-harm with the help of other people in interpersonal relationships, self-infliction of pain.
T - Spending. Unreasonable spending of money on unnecessary purchases, unreasonable expenditure of effort.
A - Ambivalence. Opposite feelings in a short amount of time. For example, love and hate.
B - Pain. Characterized by mental pain with repeated unsuccessful attempts, for example, in building interpersonal relationships, employment, etc.
I - Idealization. The tendency to idealize other people and depreciate them after a short period of time.
L - Lie. People with BPD are prone to deceit, lies, embellishment of reality.
N - Troubles. People with BPD often find themselves in conflict situations, quarrels, unfriendly relationships.
Oh - emptiness. People with BPD often feel empty inside, lack of interest.
S - Boredom. A feeling of boredom, a decrease in activity, a lack of prolonged interest in any activity, the world around and other people are characteristic.
T - Branding, branding. They often brand themselves. After hospitalization in a hospital, they feel the stigma of the mentally ill, acutely experience such a state, and isolate themselves.
INSTABILITY characterizes the lives of people with BPD, these are interpersonal relationships, and situations related to employment, and mood, and behavior in general.

Expert opinions on borderline personality disorder

Anton Yezhov, PhD in Psychiatry. Institute of Neurology, Psychiatry and Narcology of the Academy of Sciences of Ukraine, Kharkiv, full member of the Russian Psychotherapeutic Association, certified and accredited by the Moscow Gestalt Institute (according to the standards of the European Association of Gestalt Therapists).

- Anton Vladimirovich, what is borderline personality disorder?

- In ICD-10: F60.3 it is “Emotionally labile personality disorder. Impulsive and borderline type. With borderline character disorder ( BPD), patients generally test reality, however, during diagnosis, there may be a slight distortion in the description of events occurring with the patient, as a result of a poorly developed ability for reflection, mentalization, the impact of strong affects and primitive defenses on cognitive processes. In some cases, there may be quasi-psychotic episodes in the form of short paranoid reactions, usually provoked by any dual and uncertain situation, as well as episodes of dissociation. But, as a rule, all these phenomena do not develop into stable delusional and hallucinatory symptoms. Patients with PPH also have a rather high suicidal risk, but the main motive is most often a demonstrative protest, jealousy, a desire to “punish” a partner and make him feel guilty. In PPH, rage, hatred, resentment dominate in suicidal behavior. Auto-aggressive actions are usually performed impulsively, at the peak of affect, often in a demonstrative style.

- How can BPD be corrected?

- In the therapy of CPH, the pathogenetic is long-term psychotherapy focused on the client-therapeutic relationship - this is the main type of treatment! Pharmacotherapy acts as a maintenance therapy. Drugs in the treatment of BPH include selective serotonin reuptake inhibitors, low dose antipsychotics, and mood stabilizers. The general approach in the pharmacotherapy of BPH is to reduce the unnecessary use of medications (!), medicating the target symptoms with an understanding of pharmacodynamics.

Irina Mlodik, Ph.D. in Psychology, psychologist, Gestalt therapist, existential psychotherapist, author of books and articles on child and adult practical psychology, author's training courses.

- Irina Yurievna, please tell me, is it possible to recover from borderline personality disorder?

- About the treatment: it's hard to say. I do not have a psychiatric, not a medical position on this matter. I believe that in each of us there can be a borderline arranged and borderline functioning part. In that sense, there's no cure for the way you're made. One can only reduce the consequences of border effects. Including and mainly with the help of high-quality and long-term, for example, humanistically oriented or analytical psychotherapy. Long-term and regular therapy creates a special type of relationship with the therapist, which allows, being in high-quality and constant contact: to live through many difficult and not processed by the psyche affects from childhood, to create and maintain with the help of therapeutic contact an important, permanent, uninterrupted connection with the therapist (which there was almost certainly no person with BPD), who becomes an important “adult” in the life of a “border guard” who can be relied upon. Subsequently, from relying on the connection and the figure of the therapist, inside and the person with BPD, other relationships grow both inside themselves (to their internal objects) and outside, they have the opportunity to maintain closeness not only with the therapist, but also with other people and build with them a long-term relationship. Affects become rarer, not so amplitude, endurable. There is an opportunity to know one’s own painful places better, take care of oneself more, be less exposed to destructive relationships and processes, better understand one’s reactions, features and manifestations, learn to treat oneself like this in the world of people, sometimes explaining to them one’s own characteristics and properties.

Advice for People with BPD to Use in a Crisis

Calming an emotional storm

Stop fighting, avoiding, repressing, or denying what you are feeling. Give yourself permission to feel, this will take away the power of feelings over you. Try to simply experience your feelings without judgment or criticism.

Awareness

Let go of the past and the future, focus solely on the present moment. Mindfulness techniques can be very effective in this regard.
• Start by observing your emotions, step back and just observe them.
• Watch them come and go (it can help to think of them as waves that come and go).
• Focus on physical sensations that are accompanied by emotions.
• Tell yourself that you accept your emotions, accept what you feel right now.
• Remind yourself that just because you feel something doesn't mean it's real.

Do something to change your bad feelings

You will need to experiment to find out what works best for you. What can help when you are angry or have very strong feelings, when you are depressed, etc.

Some ideas for working on yourself

Tactile sensations . Try running your hand in cold or hot (but not scalding) water; hold a piece of ice in your hand; grab the edge of the piece of furniture as hard as you can. If you're feeling anxious and need to calm down, try taking a hot bath or shower; cover yourself with a blanket or cuddle with a pet.

Taste . If you feel empty or bored inside, try putting strong flavored sweets or mints in your mouth, slowly eating something with an intense taste, such as something salty. If you want to calm down, try something calming like hot tea or soup.

Smell . Light a candle, smell the flowers, try aromatherapy, spritz on your favorite perfume, or smell something that smells good in the kitchen. You may find you respond best to strong odors such as citrus, spices, etc.

Landmark . Focus on an image that grabs your attention. It could be something in your immediate environment (a great view, a beautiful flower, the location of a building, a favorite painting or photo) or something you imagine.

Sound . Try listening to loud music or a bell or whistle when you need a boost. To calm down, play soothing music or listen to soothing sounds of nature such as the wind, birds, or the ocean. The sound of a car can help a lot if you can't hear something more real.

Need to reduce emotional vulnerability

You are more likely to experience negative emotions when you are stressed. That is why it is very important to take care of your physical and mental well-being.

Take care of yourself :

• Avoid drugs.
• Eat a balanced, nutritious diet.
• Sleep well and rest.
• Practice self-help skills regularly.
• Minimize stressful situations.
• Practice relaxation techniques.

Basic methods of psychotherapy for BPD

1. Dialectical Behavioral Therapy (DBT).
2. Schematic (schematic) therapy.
3. Psychotherapy based on mentalization (MBT).
4. Transference-Focused Psychotherapy (TFP) is a psychotherapy focused on the analysis of transference.

Borderline personality disorder is not a sentence. Change is possible if there is a desire to change and improve the quality of life. I hope this article has helped you better understand the structure and manifestations of BPD, as well as approaches to psychotherapeutic treatment and self-help methods in a difficult situation.

symptoms, how to treat, drugs, how to choose a specialist

Nastya Medvedeva

learned to live with a personality disorder

According to WHO statistics, every fourth European faces mental health problems during his life. If I lived in Europe, I would be this very fourth.

The first encounter with a mental illness is very difficult. Relatives do not understand, it is difficult to choose a doctor and pick up pills, it is scary to go to the hospital and it is absolutely incomprehensible whether a normal life will ever return.

In the article I will answer the questions that I had in the course of this story. I will tell you about the doctors, methods of treatment and calculate how much it all cost in my case.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

What are the symptoms of borderline personality disorder

Borderline personality disorder is not my only, but my main diagnosis. Here are its main symptoms.

Mood swings. People with BPD have such an unstable mood that in five minutes it can change from bad to good and back several times.

Intense affective states. This is anxiety, aggression, depression, euphoria. They feel as if for some time there are no other emotions but this one. Those states that require a lot of energy usually last no more than three hours. But depression can drag on for several days.

Most often there is some external event that triggers this kind of thing. It may just be the background in which I live. For example, the absence of days off causes depression and anxiety, while unexpressed feelings cause aggression. Such conditions are also strongly influenced by the weather and the menstrual cycle.

/burnout/

How much I spent fighting burnout

Excessive emotional reactions out of proportion to the event. For example, before, if a partner refused to spend an evening with me because of workload, I could decide that we were about to part, get drunk and cut myself on purpose.

Black and white thinking. In the head of a person with BPD there are only polar concepts: beautiful and terrible, love and hate, happiness and sorrow. If I did something well, then in my head I was the best. If she did something badly, she considered herself simply unworthy of life. I treated other people the same way.

Problems with self-identification. A person with BPD does not know who he is, what he is. He is what other people think he is. This gives rise to dependence on someone else's opinion: in order to feel talented, smart, beautiful and interesting, a person needs to constantly hear that he is talented, smart, beautiful and interesting.

One can guess that there can be no talk of any stable self-esteem. One day you were rude on the subway, and all you know about yourself is that you are clumsy, slow and disturbing everyone. On another day, you were praised at work, and you feel talented, responsible and useful. And so in a circle.

The absence of an inner core leads to dependent relationships. For a long time I did not have my own interests, my own character - I just adopted them first from my parents, then from friends, partners. If there was no such close person, I just felt emptiness inside instead of any feelings.

Fear of being alone. Since it is quite difficult for people with BPD to learn to separate themselves from other people and stop looking at themselves through their eyes, being alone is a very strong fear. And it often gives rise to inappropriate behavior: because of the fear of losing a loved one, a person with BPD may unconsciously begin to manipulate him, and sometimes even leave him first, so as not to feel rejected.

Inability to distinguish objective reality from one's own ideas about it. People with BPD have a difficult relationship with empathy: they attach great importance to the thoughts and feelings of others, but often misinterpret them. For example, if my partner is in a bad mood, I always think that it has something to do with me. That I did something wrong, said something wrong, or he just fell out of love with me. Although in fact, most often he just worries about work and is immersed in his thoughts.

Tendency to dangerous behavior, self-harm and suicide. People with BPD often drink too much, use drugs, smoke, and cut themselves. But there are also less obvious dangerous behaviors: workaholism, abusive relationships, fasting, overeating, unprotected sex, depriving yourself of healthy sleep. People do this for various reasons. I hurt myself to feel something other than emptiness and to punish myself when I thought I was bad.

How I started treatment

Like many other disorders, BPD cannot be completely cured - it is a chronic condition. But you can get rid of the symptoms and go into remission. I cannot say that I have achieved this: I still have many signs of disorder, but I corrected them and learned to live with them.

Unfortunately, the vast majority of people with BPD live with other comorbidities. For example, I have been diagnosed with mixed anxiety and depressive disorder - a disease in which anxiety and depressive symptoms are equally expressed. I went through two periods of exacerbation, which I call depressive episodes. One lasted six months, the second nine.

/obsessive-compulsive-disorder/

How I live with obsessive-compulsive disorder

Message to a friend at the beginning of one of my depressive episodes

I had mental problems since I was a teenager. I hardly remember this period, but I remember how at the age of 15 I stood on the windowsill and wanted to jump off the seventh floor because of a quarrel with my parents. My concept of the norm is still so vague that I don’t understand if this is normal behavior, typical for teenagers, or not.

Every 40 seconds a suicide occurs in the world - WHO

HSE Brochure on Self-Injurious BehaviorPDF, 1. 1 MB

In general, I was a fairly "successful" teenager in all areas. So most of the time I was "good" in the eyes of others and felt good. In the days of failures and quarrels, everything was different, but I don’t remember exactly how. During the first depressive episode, I had problems with memory, and since then, memories of childhood and adolescence have remained fragmentary.

I remember well my inner feelings only from the age of 17. At this age, I graduated from school, left my parental home and my hometown. After the move, I began to feel severe pain in my chest and emptiness, I tried to find new close people with the help of whom, as I now understand, I could identify myself. This led to unhealthy relationships simply as a way to “feel like yourself.” When I drank alcohol, the pain in my chest went away. I began to drink more and more often, and then to use drugs.

It seemed to me that I was just having fun and nothing terrible was happening, but in fact, alcohol and drugs aggravated the situation. At first, the pain and depression went away, and then they became even stronger than before alcohol. The drugs worked the same way, and they also caused anxiety. After one of these experiences, for the first time, I experienced derealization - a state when everything around seems unreal.

Bad habits of Russians: which regions smoke and drink the most

Then suicidal thoughts appeared. At first it was just a weak background unwillingness to live, but later it turned into suicidal impulses. I could just go down the subway, and suddenly I would have the urge to jump onto the tracks. At that moment, I had become so accustomed to identifying myself through pain, unhappiness, alcohol, drugs, and bad guys that thoughts of suicide did not frighten me. It seemed to me that I was just such a person.

At the age of 20, for the first time, I thought that something was wrong with me. I suddenly became worse due to the long and severe stress associated with the death of a dog, the illness of a loved one, and problems with my studies. During that period, depressive states appeared: almost every day I was "covered" for several hours, during which I could not get out of bed and did not feel anything, except for severe pain in my chest and a desire to stop it.

Once such an attack began when I drank and just walked around Moscow. The pain was so strong that I thought: I just need to throw myself under the car. I didn't do it because I got scared and really didn't want to die at all, I just wanted to stop the pain.

Five minutes later, the pain subsided, and the desire to kill myself, too. At that moment, I became very scared, and I realized that I could not cope.

How I was treated by a psychotherapist

With mental problems, I advise you to contact a psychotherapist or psychiatrist. I do not advise going to a psychologist or neurologist, but I will also tell you a little about them.

Psychologist. This is a person with a general psychological education who generally knows how the human psyche functions. He can help with specific requests like relationship problems, career dissatisfaction, or low self-esteem. But in working with mental disorders, it is likely to be useless. First, he has no right to prescribe medicines. Secondly, he does not have knowledge in the field of psychotherapy, with the help of which one can significantly correct thinking and behavior.

/psychotherapy-search/

How to choose a psychotherapist

The exception is a clinical psychologist. Psychotherapy is just one of the areas of clinical psychology, so usually clinical psychologists have the skills of psychotherapy.

Psychotherapist. This is a specialist who has received education in the field of psychotherapy. During training, he masters one or several areas of psychotherapy that he uses in his work. For example, dialectical behavioral therapy has been developed for the treatment of BPD, which helps to reduce the intensity of emotional reactions to stress.

In general, it is not so easy to understand who can call himself a psychotherapist. Officially, this should be a doctor with a psychiatric education who has undergone special retraining. But now psychotherapists often refer to themselves as specialists without a medical education who have learned some specific psychotherapeutic method, like the same dialectical behavioral therapy. This is normal, and you can also go to them. Unlike psychotherapists with medical education, they cannot prescribe medications, but they can refer the client to a psychiatrist at the right time.

I chose my first psychotherapist very carefully: 11 years of experience, Ph.D., works in a private psychotherapy center, a specialist in “the whole spectrum of anxiety and depressive disorders,” as the website said.

Such careful selection did not help me. I do not remember this meeting well, but I remember that the doctor looked at his watch every five minutes and shamed me for using substances. Despite the abundance of serious symptoms, such as thoughts of suicide, the doctor diagnosed me with "neurasthenia" - in fact, neurosis. He prescribed a mild tranquilizer for anxiety, which proved to be useless. The appointment cost 4,000 R, which is slightly higher than the average cost of a psychotherapy session in Moscow.

/psychotherapy/

How much does psychotherapy cost

Soon I went to a specialist who was recommended to me by a friend. She calls herself a psychotherapist, but she has no medical education. She worked from home and charged 3,000 R per session, later reduced the price for me to 2,500 R. I went to her once a week for two and a half years with a break of four months. In total, during this time, I gave her about 263,000 R. At the time of the start of treatment, I was a twenty-year-old non-working student, so my parents paid most of it.

263,000 Р

I paid for the sessions with a specialist

Despite the lack of a medical education, this specialist helped me a lot. That's what I achieved with her in these two and a half years.

I learned to distinguish my emotions. Previously, I could only describe my condition as "I feel very bad." Now I understand exactly what I am experiencing: anxiety, aggression, sadness or insecurity. Thanks to this, I understand where the emotion came from and how to interact with it further.

Learned to control affective states and distinguish them from healthy ones. When a depressive attack hits me, I quickly recognize it and just go to bed - the next morning I already feel much better. When I'm anxious, I walk the streets or exercise to expend more energy and calm down.

I stopped cutting myself and wanting to die. Earlier, during attacks of acute mental pain, I cut my legs with a piece of glass, which I kept especially for these cases. She also struggled with the desire to kill herself. Such impulses still sometimes appear if I did not have time to stop the affective state. But now I just endure, because I know that in a couple of hours the pain will subside on its own.

I learned to notice the symptoms of exacerbations in time and stop them. For example, I know that if it's hard for me to brush my teeth and take a shower for three days in a row, then I need to rest. If I don't take a break, I may have a depressive episode.

Stopped using drugs. I made this decision before the therapy, simply by flushing all the supplies down the toilet. But therapy made me realize that drugs are just not the right way to get rid of pain. Now I am calm about drugs as a phenomenon, but I know that I cannot take them.

Has limited alcohol consumption. I didn’t drink at all for about a year, and now I try to drink no more than a couple of times a month and only on pleasant occasions. If I exceed this limit or feel cravings for alcohol, then I again refuse it for several months. I never drink again when I am psychologically ill.

Has built healthy relationships. After a series of objectively bad guys, I fell in love with a person with whom we have been together for more than three years - an unprecedented figure for many people with BPD.

Learned to ask for help and express anger openly. For quite a long time, I didn’t know how to do this: I was afraid that no one would need me so “imperfect” and “bad”. As it turned out in psychotherapy, I simply directed all unexpressed aggression at myself. For example, after a fight with a partner, I used to cut myself because I wanted to punish both of us in this way. Now I just openly say that I feel bad, ask for help to calm down, and then explain what upset me.

She stopped putting her own thoughts into the heads of those around her. I still have problems with reading emotions: I often feel that everyone around me feels bad because of me when I have nothing to do with it at all. But now I have learned to speak openly about it. For example, if I think a person is angry with me, I simply ask if my assumption is correct. Thoughts that the matter is still in me do not go anywhere even after a negative answer. But I understand that they are not quite adequate, and I just try not to pay attention.

I became less dependent on other people. I got my own internal support, consisting of a more or less stable opinion about myself, my desires, feelings and interests. Before, all this was not, and I was guided only by the opinions of others.

Learned to take care of myself, love myself and put myself first. I always tried to be as convenient as possible for other people: it seemed that if I did something wrong, then everyone would condemn me and leave me. Now I know that this is not true.

/discuss/cash-therapy/

Is it worth spending money on a psychotherapist?

In severe conditions, I often needed emergency help, and at such times a psychotherapist consulted me free of charge over the phone. For example, I called her when I was afraid that I might try to kill myself. In addition, I could write to her on any calm day, ask for advice, ask a question, talk about my condition and count on feedback. Once she even helped me free of charge during one of my breakdowns after my departure from psychotherapy.

During the entire period of treatment, I had appointments with three more psychotherapists. The cheapest appointment cost 2000 R - with a doctor who worked in a neuropsychiatric dispensary. He well defined my requests, problems and their sources, but I did not like him simply by his character and manner of communication: he was ironic and joked too much.

But the most expensive specialist I saw turned out to be frankly bad: it was a doctor at a private clinic in Riga, whose appointment cost 70 € — at the end of 2018 it was about 5600 R. I came to him because of the painful symptoms the withdrawal of antidepressants and, in response to complaints, I heard that I simply "do not have enough light in my life. " According to my calculations, I spent about 10,000 rubles on such single meetings with psychotherapists.

70 €

cost an appointment with the most expensive specialist I had

Psychotherapy cost me 273,000 R

Expenses

Price
My regular psychotherapist	263 000 Р
Single meetings with other psychotherapists	10 000 R

My regular psychotherapist

263,000 R

Single meetings with other psychotherapists

10,000 R

How I was treated by a neurologist

During a break in psychotherapy, I developed unpleasant physical symptoms: insomnia, noise in the ears, weakness, appetite , nervous tics, tremor. All this tormented me so much that I could not work, go outside, wash dishes, take a shower and generally get out of bed. At the same time, there was no depression, anxiety, or other mood problems. Now I already know that this is how depressive episodes begin, but then everything was new, and instead of a psychiatrist, I went to a neurologist.

It was a private clinic in the center of Moscow with average prices. The neurologist diagnosed me with two diagnoses: astheno-depressive syndrome and vascular dystonia. Unfortunately, at that time I did not yet know that the second is not a real disease, but simply a collection of symptoms that the doctor cannot attribute to any normal disease.

What's wrong with the diagnosis of "vegetovascular dystonia" - medspecial.ru

This is what the doctor's second appointment looked like. Under the advice of a psychotherapist, the doctor meant the appointment of a specialist with a psychiatric education, that is, in fact, a psychiatrist

The entire treatment was supposed to cost 46,000 R. I had an MRI for 4,500 R, went for acupuncture, darsonvalization, and electrophoresis for three days. I spent another 9000 RUR on this.

17100 R

I paid for treatment by a neurologist

The procedures did not help me at all, and the daily trips to the clinic were given with great difficulty. The tranquilizer caused terrible side effects that the doctor did not warn about. I couldn't sleep and tried to remedy the situation with a handful of over-the-counter sleeping pills, which still didn't help. Only four days after the appearance of the first mood disorders, the neurologist referred me to a psychiatrist, at the same time prescribing an antidepressant.

The neurologist cost me 17,100 R

Cost item	Price
Two appointments with a neurologist	3600 P
Brain MRI	4500 R
Three days of physiotherapy and acupuncture	9000 R

Two appointments with a neurologist

3600 R

Brain MRI

4500 R

Three days of physiotherapy and acupuncture

9000 Р

How I was treated by a psychiatrist

This is a doctor who can prescribe medications and make diagnoses. He is usually poorly versed in psychology and does not possess the skills of psychotherapeutic treatment. In principle, he can ask some personal questions, but he will not dig deep. But he will be able to remove the symptoms or even cure the disorder with the help of drugs.

For example, for borderline personality disorder, pills may be given at the start of treatment to relieve depression, anxiety, aggression, or overexcitation. The very cause of such reactions will not be removed by drugs; psychotherapy is needed for this. But pills can give an instant effect and quickly improve the quality of life. In addition, they treat comorbid conditions like depression.

The contact of a trusted psychiatrist was given to me by my psychotherapist. The doctor turned out to be a young girl from a public hospital, but I was treated by her on a paid basis due to problems with my insurance policy. The cost of an appointment with a psychiatrist, as I understand it, depends on the availability of an academic degree. My doctor was the cheapest in this regard, a session with her cost 2500 R. An appointment with the most expensive psychiatrist in this clinic now costs 7000 R.

2500 R

I paid for the session to my doctor

The psychiatrist turned out to be excellent, and I went to her for another ten months, while visiting a psychotherapist in parallel. We usually met once a month to correct the drug regimen, and the rest of the time we were in touch via messenger. Sometimes it was necessary to slightly change the dose of the same medicine, and the doctor did it remotely. If the doctor prescribed a new drug, we would have to meet to write a prescription, but those meetings were often free. In general, I spent about 30,000 R on a psychiatrist, excluding the cost of the drugs themselves.

To stop taking medication, I already went to another psychiatrist and spent 5,000 rubles on this meeting. Price My permanent psychiatrist 30,000 R Other psychiatrist appointment 5000 R

My regular psychiatrist

R30,000

Seeing another psychiatrist

5000 Р

How to find specialists for the treatment of borderline disorder

Recommendations. Perhaps the best way to get to a good doctor of any profile is to ask your friends. Unfortunately, in the case of mental disorders, this is not always possible: people often do not advertise such diseases. And not everyone will dare to write on Facebook about the search for a psychiatrist.

In this case, you can use the white and black lists of specialists that activists make up. They not only indicate the name of the specialist, contact and price, but also share their impressions.

The projects “Psychoactive”, “Going to the doctor”, EBMd have such lists. There are even lists of an even narrower focus: for example, a list for women who have experienced postpartum mental disorders or emotional burnout in the process of motherhood.

6 useful services for finding a psychotherapist

Part of the white list published by the Psychoactive project And this is what the black list of specialists looks like

Communities of sick people. If you have already been diagnosed with any disorder, you can ask the contacts of good specialists from your comrades in misfortune. For example, in the Anonymous Anxiety-Depressives group or the Bipolar Association.

Specialist bases. You can try to find a doctor at special bases. For example, find a psychologist on b17.ru, and a psychiatrist on Sberzdorovye. On both services, you can learn about the profile of a doctor, his education, working methods, and the cost of an appointment. On b17.ru, experts also leave a description in the first person, which will help you understand whether it suits you purely humanly or not.

I would not go to a specialist who writes about financial gain in the very first paragraph. The promise of a “guaranteed” deliverance from the problem also worries me. I like that the specialist describes in great detail and specifically the problems that can be addressed to her. She also indicates that she works with LGBT people

What to look for when choosing a specialist

Personality of a specialist. Probably, when you are looking for a dentist, you do not ask your friends what gender and orientation he is, how old he is, whether he has children, how he treats Putin and what tone of voice he has. But for me, in choosing a psychotherapist or psychologist, all these factors matter. It is clear that a competent therapist will not judge you, even if your positions on some issues do not coincide. But it would be difficult for me myself to talk about sex with an elderly psychologist or about the fear of men with a male therapist.

Specialist profile. Find out exactly what problems it solves. If a doctor has cured your friend of depression, it is not a fact that he will be able to help you with the same BPD or schizophrenia. You can also find out from the specialist himself: ask directly what experience he has with disorders of your spectrum. This also applies to less serious problems: a psychologist working with parent-child relationships may be powerless in solving career problems.

Sometimes psychologists themselves talk about their hobbies and marital status in profiles This clinical psychologist specializes in working with addictions, fears, depression and loneliness. He may not be able to help a person who is troubled by bad relationships with children or hallucinations

My feelings. This is probably the most important thing. Even if everything is fine on the outside, but you feel uncomfortable with this person after a few meetings, try to go to another specialist. This does not mean that your doctor is bad. Maybe it just doesn't suit you, even if it suits all your friends.

It is important to distinguish between the unpleasant sensations caused by the specialist and the unpleasant sensations caused by working with your problem. Psychotherapy is often very painful. Sometimes after one of the sessions you may even feel worse. And pills prescribed by a psychiatrist can cause side effects. All this does not mean that you got a bad specialist. In such cases, you just need to share your feelings with the doctor: he will tell you if everything is in order, and, if necessary, correct the work process somewhere.

What you should not be afraid of when choosing a specialist

A specialist works in a state hospital or a neuropsychiatric dispensary - PND. Before the start of treatment, I could not even think about working with the psyche in a state institution. For example, like many, I was afraid of "accounting", which in fact has not existed for a long time. There is only dispensary observation, in which the patient is obliged to visit a psychiatrist periodically. But such observation is established only for those whose disease is difficult to correct. In addition, it does not give the right to hospitalize a person without his consent.

Law regulating the rights of people with mental disorders

I was also sure that doctors in a public hospital would not be able to help me and would be a lot of rude. This really can be. But this can also happen in a private clinic.

Perhaps the probability of stumbling upon a bad specialist is indeed higher in PND. But if you go to a particular doctor, whom you for some reason have chosen from many others, you should not be afraid of him only because of the place of work.

Low cost consultation. A cheap doctor is not always bad, and an expensive one is not always good. In my treatment, it was the budget specialists who turned out to be the best - or simply the most suitable for me. Most often, a low price is associated with work in a state institution or at home, the young age of a specialist, a small amount of experience and the lack of academic degrees. All this may or may not affect the quality of work and the personality of the doctor.

How borderline and comorbid personality disorders are treated

The basis of treatment for borderline personality disorder is always psychotherapy. Unlike pills, it does not just remove symptoms, but corrects behavior and thinking, that is, the very essence of a personality disorder.

But, according to research, 85% of patients with BPD have signs of other mental disorders. Therefore, psychotherapy alone is often not enough. My comorbidity is a mixed anxiety and depressive disorder, so I will also talk about its treatment methods.

Psychotherapy . It can be short-term and long-term: some problems can be solved in a few sessions, others need several years. I advise you to ask a specialist at one of the first meetings how much time is required in your case.

The method of psychotherapy should be chosen depending on the disorder. In working with BPD, dialectical behavioral therapy and cognitive behavioral therapy are considered standards. I haven't tried them myself, but I plan to try them in the future.

How to choose the right method of psychotherapy - "Theories and Practices"

These methods do not eliminate any underlying conflicts, but simply provide skills for solving the problem here and now. The specialist will not delve into the previous experience of his client, but will simply make sure that this experience does not interfere with life: he will teach awareness and regulation of emotions, find harmful patterns of behavior and replace them with safe ones.

Summary of methods on the American Psychological Association website

My therapist practiced an existential-humanistic approach. In it, the specialist dives deeper into the life of the client. For example, a psychotherapist and I discussed my childhood, my attitude towards death, my understanding of the meaning of life. At the same time, she also taught me the skills of regulating emotions, although, in fact, behavioral therapy specializes in this.

Such psychotherapy had its pluses and minuses. On the one hand, with behavioral therapy, I could quickly achieve results that are important simply for banal survival. For example, when I wanted to kill myself, we spent more time looking for the reason for such a desire than preventing a suicide attempt. Now I understand that it was risky. As a result, I spent more than two years on psychotherapy and still did not master such important skills to the end.

On the other hand, Existential-Humanistic Therapy taught me not to associate myself with the disorder and generally allowed me to get to know myself better. Now I see my problems as more complex and deeper than just the problems of a person with BPD. It seems that this does not give any tangible advantages in everyday life, but globally I began to feel happier and more whole.

Skills training. In the treatment of BPD, group skills training sessions are considered effective—meetings in which people with BPD learn skills in mindfulness, stress tolerance, emotion regulation, and effective communication. This training lasts six months. Classes are held weekly, each of them takes from one and a half to three hours, depending on the program. According to an American study, skills training significantly reduces depressive symptoms in people with BPD and improves quality of life.

Study proving the effectiveness of skills training

Trainings are held both in public hospitals and in private centers. For example, in Moscow, the Gannushkin Psychiatric Hospital conducts skills training free of charge for its patients. Paid trainings in the capital cost about 10,000-12,000 R per month; in parallel, you must definitely visit your psychotherapist. I haven’t gotten to training yet precisely because of their high cost: in total, I would have to spend at least 20,000 R per month on therapy and training.

Light therapy. This is a treatment with lamps that are brighter than ordinary household lamps and are closest in their parameters to sunlight. In fact, such lamps simply deceive the body so that it behaves as if the real sun is shining on it. This method has long been considered effective in the treatment and prevention of seasonal depressive disorder, a disease that worsens during the dark winter and autumn months. But there are studies that talk about the effectiveness of light therapy for non-seasonal depression and even bipolar disorder in combination with medications.

Light therapy studies:
for seasonal depression;
for non-seasonal depression;
for bipolar disorder

Light therapy can be carried out at home: there are special lamps and glasses for this. I use a Beurer lamp, which I bought for 8000 R. If you put it 10-15 cm from the face, it will give an illumination of 10 thousand lux. For comparison: on a sunny day, the illumination on the street is 10-20 thousand lux, and under direct rays - 100 thousand lux. On a cloudy day, the sun gives only a thousand lux of illumination. And the illumination from artificial light in residential premises, according to Russian standards, is from 20 to 500 lux.

Article on light measurement - All About Circuits

I now use the lamp every day and seem to actually "swing" faster in the morning

Electroconvulsive therapy. This is a procedure in which a person's brain is literally shocked using electrodes attached to the scalp. It sounds very scary, but in fact, electroconvulsive therapy is considered the most effective way to treat severe depression, which can not always be cured even with medication. The effectiveness of electroconvulsive therapy in such patients is about 80%.

Electroconvulsive Therapy Article - American Psychiatric Association

This procedure is completely painless as it is done under anesthesia. But sometimes it causes short-term memory loss: some patients forget what happened to them in the weeks before treatment. In most cases, such problems go away within a couple of months, but sometimes they remain and turn into regular memory lapses.

Nevertheless, American psychiatrists believe that even with these risks, electroconvulsive therapy is safer for severe patients than many other treatments. Including because the lack of a positive effect from drugs and psychotherapy increases the risk of suicide in such people.

One session of electroconvulsive therapy at the Moscow Research Institute of Psychiatry costs a little more than 4,000 R. In a private clinic in Nizhny Novgorod — 2,000 R, in a private clinic in St. Petersburg — 7,500 R per session. How many sessions are required, the doctor decides.

Price list for paid medical services MNIIPPDF, 100 KB

Acupuncture and massage . Some studies show that acupuncture, when combined with other treatments, significantly improves the sleep of people with depression. Studies of the effect of the procedure on other symptoms of depression also find such a relationship, but the quality of these studies leaves much to be desired. The same goes for massage.

Acupuncture for Depression - Healthline

Acupuncture for Depression - Cochrane Library Article

Massage Therapy - PubMed

I went to a few acupuncture sessions early in my treatment for a depressive episode. They did not help me at all, and after one of the sessions I even felt worse. One procedure cost 1750 R.

Physical activity. Studies show a positive effect of physical activity on the treatment of mild to moderate depression, as well as other psychiatric disorders such as schizophrenia. In addition, physical activity reduces the likelihood of self-harm.

Physical activity as a therapy for depression - Pubmed

Physical activity for people with mental disorders - psychiatrist. com

But it is important to understand that this is only an addition to the main treatment - psychotherapy and drugs.

I do not recommend starting any serious sports during an exacerbation, but regular 15-minute walks can really improve well-being during difficult periods.

What medications can be prescribed for BPD, depression and anxiety disorder

In the vast majority of cases, all non-drug methods are used in combination with drugs. Even if a person does not have another disorder, the symptoms of BPD itself can interfere with life so much that they have to be removed with pills at first, since the effect of psychotherapy does not appear immediately.

The drugs prescribed are usually divided into several categories.

Antidepressants. Most commonly, antidepressants are used to treat depression, but not exclusively. This class of drugs may also be prescribed for bipolar disorder, anxiety disorders, and some personality disorders.

Use of antidepressants in the treatment of:
bipolar disorder;
anxiety disorder;
personality disorders

Antidepressants come in many forms and cause different reactions. Some give more energy, others, on the contrary, improve sleep. All antidepressants are cumulative drugs, that is, the effect of them can be felt no earlier than after a couple of weeks.

But they cause side effects immediately. The first week of taking antidepressants was the worst for me: anxiety, suicidal moods and sleep problems increased, dry mouth appeared, nausea, tremors, convulsions, panic attacks returned. Later, the drug was changed, but many side effects still accompanied me throughout the treatment. I gained weight, suffered from severe memory problems, dry mouth, decreased libido, and severe sleepiness from the "evening" pills.

The second time I managed to find the drug, and I took it for 13 months until the end of the drug treatment. In fact, the WHO recommends continuing to take antidepressants for at least nine months after a full recovery, but the psychiatrist allowed me to stop taking it earlier. Nevertheless, often antidepressants have to be taken for much longer, and sometimes even for a lifetime.

I got off the pills for a month, slowly reducing the dose every few days. It is believed that this way you can avoid withdrawal symptoms, but it did not help me. After giving up the last quarter of the pill, I got brain zaps - conditions for which there is no word in Russian yet. It was like electrical discharges that passed through the brain in a fraction of a second. At the same time, I completely controlled my body, and in general, outwardly, this was not expressed in any way. Doctors still do not know what exactly causes such sensations, but they consider them absolutely safe, albeit unpleasant.

Brain zaps article in Russian - PsyAndNeuro

Brain zaps article in English - Medical News Today

In addition, I noticed nausea, incredible weakness and irritability for a month.

These are my lifelong prescriptions for antidepressants that I hope never to use again.

I was taking two different types of antidepressants at the same time. One cost 2000 R per month, the second cost 800 R per month. Thus, in 13 months I spent about 30,000 Rs on antidepressants.

30,000 R

I spent on antidepressants during 13 months of treatment

Tranquilizers. These medicines relieve anxiety, tension and fear, so they are used primarily for the treatment of anxiety disorders. The drugs act instantly: they can quickly relieve a panic attack or help you fall asleep with insomnia. Common side effects include drowsiness and lethargy, but these problems can be avoided by adjusting the dose. I also had paradoxical side effects like increased anxiety - in this case, I had to change the drug.

This is how life is with tranquilizers

There is a risk of addiction to tranquilizers during long-term use, so doctors try to use them only at the beginning of the treatment of the disease. I drank tranquilizers for a couple of weeks, and later used them only once in case of severe attacks of fear.

During the treatment I tried four tranquilizers and spent about 2000 rubles on them.

Normotimics. They regulate mood swings and transitions into different affective states. For example, with bipolar disorder, many alternately fall into the depressive phase, then into the manic phase. With BPD, such jumps also occur, but each phase lasts much less and is less intense. Normotimics help stop such emotional swings.

/shizofreniya/

How much does it cost to support a relative with a mental disorder

I tried only one mood stabilizer, but it made me depressed. The drug cost 700 R. After refusing it, mood swings returned, but their intensity could be regulated with the help of antipsychotics.

Antipsychotics. These drugs have an antipsychotic effect: they reduce psychomotor activity and relieve agitation. Most often, such drugs are used together with other drugs for affective, anxiety and personality disorders, but they can also be used independently, for example, in the treatment of schizophrenia.

There are typical antipsychotics - the first generation and atypical - the second generation. The latter are considered more effective, safer and cause fewer side effects, but the drug from the first group suited me.

Finding an antipsychotic was the hardest thing. I seem to have experienced a whole range of side effects: lethargy, anxiety, emptiness, melancholy, depression, convulsions, tremors, and even jaw pain.

During my treatment, I tried eight neuroleptics. The most expensive of them cost 2000 R, the cheapest - 50 R. It's funny, but it was he who eventually approached me. In general, I spent about 6,000 rubles on antipsychotics.

6000 R

I spent on neuroleptics during treatment

Correctors. While the psychiatrist was selecting antipsychotics for me, I drank correctors - this is the name of drugs from different groups that are suitable for eliminating the side effects of antipsychotics.

In my case, these were antiparkinsonian drugs, which, as the name suggests, are commonly used for Parkinson's disease. They cost only 400 R.

The drugs cost me 39100 R

Cost item	Price
Antidepressants	30,000 R
Antipsychotics	6000 R
Tranquilizers	2000 R
Normothymic	700 P
Correctors	400 P

Antidepressants

30,000 R

neuroleptics

6000 R

Transquilizers

2000 R

Normotimik

700 R

Correctors

400 R

How the first prescribed drug is selected for all people. The first prescribed drug is suitable. This does not mean that you have a bad doctor who prescribed bad medicine. It's just that everyone reacts differently to the same pills, and it's hard to predict.

The psychiatrist and I worked according to this scheme. She wrote me a prescription, I bought the drug and tried the prescribed dose. After that, I wrote to the doctor if the medicine helped me and if it caused any side effects. In response, the psychiatrist suggested reducing or, conversely, increasing the dose. This continued until the ideal dose was found.

My psychiatrist and I tried for a long time to achieve a balance between mood swings and no emotions at all

Often, even after a long dose adjustment, the drug did not fit. Then I came to the doctor again, she wrote out a prescription for another medicine, and everything happened again. For such meetings, I most often did not pay anything.

According to my calculations, at least 13 drugs did not suit me, for which I spent at least 10,000 R. Some of them are still at my place. You can’t sell such drugs - it’s illegal. If the active substance of the drug is not included in the list of psychotropic substances, a fine of 1,500 to 2,000 R is threatened for this. And if it is enabled, the sale of medicine is equated to the sale of drugs - for this you can go to prison for at least four years.

Art. 14.2 of the Code of Administrative Offenses on the sale of goods, the free sale of which is prohibited or restricted

Art. 228.1 of the Criminal Code on the sale of psychotropic substances

List of psychotropic substances

In what cases should you go to the hospital

At the beginning of one of the depressive episodes, I spent five months selecting the drug. It didn't work out to pick him up. This is tolerable if we are talking about mild or moderate depression, you just need to pick up further. But for severe depression with a high risk of suicidal outcome, inpatient treatment may be the best way out of the situation.

The psychiatrist advised me to go to the hospital at the first meeting, but then it seemed to me something terrible and shameful. The doctor said that I would come to this decision sooner or later, and I was right.

/bye-depression/

“Reminds me of a strict regime sanatorium”: how much I spent on treating depression

Spoiler: everything was reflected in work and other matters in the best possible way. I was finally able to deal with them normally

In order to be able to work, I chose a day hospital: for a month I came every day for droppers and injections, met with the doctor, after which I left without staying overnight. The IVs had a strong sedative effect, so I usually stayed an hour or two in the hospital to sleep. In general, I spent about three hours a day in the hospital and spent 40 minutes on the road one way.

At the same time, all the privileges of a regular hospital were also available to me. For example, I could eat in the canteen and stay in the hospital overnight. In addition, I could go to individual psychotherapy and various group meetings, but I refused, because I already went to another specialist.

My condition began to improve within a few days. They quickly picked up suitable drugs for me, and after a month I felt like a normal person.

One day in a day hospital cost about 3,000 R. This amount already included droppers, injections, psychiatric consultations, medicines, food, and stay in the ward. About once a week I missed droppers, so in general I spent about 78,000 rubles on such treatment in a month.

78,000 Р

I spent on treatment in a day hospital

Before inpatient treatment, it was necessary to do an examination. If a person takes pills for a long time, these tests should also be taken periodically.

Here are the tests I did:

1. Electrocardiogram - 500 R.
2. Complete blood count - 500 R.
3. Biochemical blood test: for glucose, total protein, total bilirubin, creatinine, AST and ALT - 230117

For hospitalization, you also need to take a blood test for HIV, hepatitis B, hepatitis C and syphilis. It costs about 2,000 R. Even during the treatment, the psychiatrist asked me to repeat an MRI of the brain - it cost about 5,000 R.

Thus, I spent a little more than 10,000 R for all examinations.

Examination and treatment in the hospital cost 88 300 R

Cost item	Price
Droppers, injections, psychiatric consultations, medicines, food and ward	78 000 Р
Brain MRI	5000 R
Blood chemistry	2300 P
Blood test for HIV, syphilis, hepatitis B and C	2000 R
Electrocardiogram	500 R
Complete blood count	500 R

droppers, injections, consultations of a psychiatrist, medicine, nutrition and ward

78 000 R

MRI of the brain

Biochemical blood test

2300 R

Blood A test for HIV, syphilis, syphilis, hepatitis B and C

2000 R

Electrocardiogram

500 R

General blood test

500 R

Is there life after treatment and how much it costs

when I was first delivered, I left the hospital and climbed into Google. After opening several links, I realized that this is a chronic disease that cannot be cured. That day I cried a lot and thought that I would always feel bad.

Long-term treatment for borderline personality disorder - American Journal of Psychiatry

BPD, like many other disorders, cannot really be completely cured. But you can live with it. According to American studies, with proper treatment, 70% of people with BPD have symptoms disappear within 6 years after the first hospitalization. At the same time, only 6% of patients, after entering remission, had symptoms of the disorder again.

Several times it seemed to me that I was in remission, but the disorder still returned. The last major breakdown was 14 months ago and lasted a week.

At such moments, to be honest, hands down

Even if the symptoms of the disorder do not go away completely, they can be corrected. I still experience mood swings, affective states, identity issues, and other attributes of the disorder. But all this no longer prevents me from living: I have learned to control my emotions, perceive myself as a separate person, and stop exacerbations. This is a difficult but interesting daily work. It can be said that I "psychotherapy" myself on a daily basis.

Self-help materials from the Higher School of Economics

Several things help me with this. First, I meditate. It turned out that such practices teach me the same thing that the psychotherapist taught me: to separate myself from my thoughts, to pay attention to objective reality instead of my illusions, to manage my emotions. For meditation, I use the HeadSpace application and pay 230 R per month for it.

How to meditate correctly and why do it at all - Meduza. Included by the Ministry of Justice in the register of publications performing the functions of a foreign agent. And we are obliged to inform you about it

Secondly, I play sports. I play football and train with my team, it takes 2500 R per month.

---

Learn more

• 
  Be more patient
• 
  Depression room clean
• 
  Can bipolar be treated without meds
• 
  How to not let people bother you
• 
  How to tell someone they hurt you examples
• 
  How to beat neuroticism
• 
  Nen type personality test
• 
  Wife with bipolar disorder
• 
  What does it mean to be indifferent
• 
  Help with anxiety naturally
• 
  Internal and external motivators