Treatment borderline personality

Borderline personality disorder - Diagnosis and treatment

Diagnosis

Personality disorders, including borderline personality disorder, are diagnosed based on a:

Detailed interview with your doctor or mental health provider
Psychological evaluation that may include completing questionnaires
Medical history and exam
Discussion of your signs and symptoms

A diagnosis of borderline personality disorder is usually made in adults, not in children or teenagers. That's because what appear to be signs and symptoms of borderline personality disorder may go away as children get older and become more mature.

Treatment

Borderline personality disorder is mainly treated using psychotherapy, but medication may be added. Your doctor also may recommend hospitalization if your safety is at risk.

Treatment can help you learn skills to manage and cope with your condition. It's also necessary to get treated for any other mental health disorders that often occur along with borderline personality disorder, such as depression or substance misuse. With treatment, you can feel better about yourself and live a more stable, rewarding life.

Psychotherapy

Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline personality disorder. Your therapist may adapt the type of therapy to best meet your needs. The goals of psychotherapy are to help you:

Focus on your current ability to function
Learn to manage emotions that feel uncomfortable
Reduce your impulsiveness by helping you observe feelings rather than acting on them
Work on improving relationships by being aware of your feelings and those of others
Learn about borderline personality disorder

Types of psychotherapy that have been found to be effective include:

Dialectical behavior therapy (DBT). DBT includes group and individual therapy designed specifically to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, tolerate distress and improve relationships.
Schema-focused therapy. Schema-focused therapy can be done individually or in a group. It can help you identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival, but as an adult are hurtful in many areas of your life. Therapy focuses on helping you get your needs met in a healthy manner to promote positive life patterns.
Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you identify your own thoughts and feelings at any given moment and create an alternate perspective on the situation. MBT emphasizes thinking before reacting.
Systems training for emotional predictability and problem-solving (STEPPS). STEPPS is a 20-week treatment that involves working in groups that incorporate your family members, caregivers, friends or significant others into treatment. STEPPS is used in addition to other types of psychotherapy.
Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations.
Good psychiatric management. This treatment approach relies on case management, anchoring treatment in an expectation of work or school participation. It focuses on making sense of emotionally difficult moments by considering the interpersonal context for feelings. It may integrate medications, groups, family education and individual therapy.

Medications

Although no drugs have been approved by the Food and Drug Administration specifically for the treatment of borderline personality disorder, certain medications may help with symptoms or co-occurring problems such as depression, impulsiveness, aggression or anxiety. Medications may include antidepressants, antipsychotics or mood-stabilizing drugs.

Talk to your doctor about the benefits and side effects of medications.

Hospitalization

At times, you may need more-intense treatment in a psychiatric hospital or clinic. Hospitalization may also keep you safe from self-injury or address suicidal thoughts or behaviors.

Recovery takes time

Learning to manage your emotions, thoughts and behaviors takes time. Most people improve considerably, but you may always struggle with some symptoms of borderline personality disorder. You may experience times when your symptoms are better or worse. But treatment can improve your ability to function and help you feel better about yourself.

You have the best chance for success when you consult a mental health provider who has experience treating borderline personality disorder.

More Information

Psychotherapy

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Coping and support

Symptoms associated with borderline personality disorder can be stressful and challenging for you and those around you. You may be aware that your emotions, thoughts and behaviors are self-destructive or damaging, yet you feel unable to manage them.

In addition to getting professional treatment, you can help manage and cope with your condition if you:

Learn about the disorder so that you understand its causes and treatments
Learn to recognize what may trigger angry outbursts or impulsive behavior
Seek professional help and stick to your treatment plan — attend all therapy sessions and take medications as directed
Work with your mental health provider to develop a plan for what to do the next time a crisis occurs
Get treatment for related problems, such as substance misuse
Consider involving people close to you in your treatment to help them understand and support you
Manage intense emotions by practicing coping skills, such as the use of breathing techniques and mindfulness meditation
Set limits and boundaries for yourself and others by learning how to appropriately express emotions in a manner that doesn't push others away or trigger abandonment or instability
Don't make assumptions about what people are feeling or thinking about you
Reach out to others with the disorder to share insights and experiences
Build a support system of people who can understand and respect you
Keep up a healthy lifestyle, such as eating a healthy diet, being physically active and engaging in social activities
Don't blame yourself for the disorder, but recognize your responsibility to get it treated

Preparing for your appointment

You may start by seeing your primary care doctor. After an initial appointment, your doctor may refer you to a mental health provider, such as a psychologist or psychiatrist. Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

Any symptoms you or people close to you have noticed, and for how long
Key personal information, including traumatic events in your past and any current major stressors
Your medical information, including other physical or mental health conditions
All medications you take, including prescription and over-the-counter medications, vitamins and other supplements, and the doses
Questions you want to ask your doctor so that you can make the most of your appointment

Take a family member or friend along, if possible. Someone who has known you for a long time may be able to share important information with the doctor or mental health provider, with your permission.

Basic questions to ask your doctor or a mental health provider include:

What's likely causing my symptoms or condition?
Are there any other possible causes?
What treatments are most likely to be effective for me?
How much can I expect my symptoms to improve with treatment?
How often will I need therapy sessions and for how long?
Are there medications that can help?
What are the possible side effects of the medication you may prescribe?
Do I need to take any precautions or follow any restrictions?
I have these other health conditions. How can I best manage them together?
How can my family or close friends help me in my treatment?
Do you have any printed material that I can take? What websites do you recommend?

Don't hesitate to ask questions during your appointment.

What to expect from your doctor

A doctor or mental health provider is likely to ask you a number of questions. Be ready to answer them to save time for topics you want to focus on. Possible questions include:

What are your symptoms? When did you first notice them?
How are these symptoms affecting your life, including your personal relationships and work?
How often during the course of a normal day do you experience a mood swing?
How often have you felt betrayed, victimized or abandoned? Why do you think that happened?
How well do you manage anger?
How well do you manage being alone?
How would you describe your sense of self-worth?
Have you ever felt you were bad, or even evil?
Have you had any problems with self-destructive or risky behavior?
Have you ever thought of or tried to harm yourself or attempted suicide?
Do you use alcohol or recreational drugs or misuse prescription drugs? If so, how often?
How would you describe your childhood, including your relationship with your parents or caregivers?
Were you physically or sexually abused or were you neglected as a child?
Have any of your close relatives or caregivers been diagnosed with a mental health problem, such as a personality disorder?
Have you been treated for any other mental health problems? If yes, what diagnoses were made, and what treatments were most effective?
Are you currently being treated for any other medical conditions?

By Mayo Clinic Staff

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TREATING BPD | National Education Alliance for Borderline Personality Disorder

Treatments for Borderline Personality Disorder

Current research shows that treatment can decrease the symptoms and suffering of people with BPD.

Talk therapy is usually the first choice of treatment (unlike some other illnesses where medication is often first.) Generally, treatment involves one to two sessions a week with a mental health counselor. For therapy to be effective, people must feel comfortable with and trust their therapist.

Some BPD symptoms are easier to treat than others. Fears that others might leave, intense, unstable relationships or feelings of emptiness are often hardest to change. Research shows that treatment is more effective in decreasing anger, suicide attempts and self- harm, as well as helping to improve over-all functioning and social adjustment

People whose symptoms improve may still have issues related to co-occurring disorders, such as depression, substance abuse, eating disorders, or post-traumatic stress disorder. However, research suggests that full-blown BPD symptoms rarely coming back after remission.

There are several treatments that are most often used to manage BPD

Dialectical behavior therapy (DBT) focuses on the concept of mindfulness, or paying attention to the present emotion. DBT teaches skills to control intense emotions, reduce self-destructive behavior, manage distress, and improve relationships. It seeks a balance between accepting and changing behaviors. This proactive, problem-solving approach was designed specifically to treat BPD. Treatment includes individual therapy sessions, skills training in a group setting, and phone coaching as needed. DBT is the most studied treatment for BPD and the one shown to be most effective.

Mentalization-based therapy (MBT) is a talk therapy that helps people identify and understand what others might be thinking and feeling.

Transference-focused therapy (TFP) is designed to help patients understand their emotions and interpersonal problems through the relationship between the patient and therapist. Patients then apply the insights they learn to other situations.

Good Psychiatric Management: GPM provides mental health professionals an easy-to-adopt “tool box” for patients with severe personality disorders.

Medications cannot cure BPD but can help treat other conditions that often accompany BPD such as depression, impulsivity, and anxiety. Often patients are treated with several medications, but there is little evidence that this approach is necessary or effective. People with BPD are encouraged to talk with their prescribing doctor about what to expect from each medication and its side effects. 1

Self-Care activities include: regular exercise, good sleep habits, a nutritious diet, taking medications as prescribed, and healthy stress management. Good self-care can help to reduce common symptoms of BPD such as mood changes, impulsive behavior, and irritability.

1. Zanarini MC, Frankenburg FR. omega-3 Fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry. 2003 Jan;160(1):167–9.

Borderline Personality Disorder, Symptoms, Causes, Diagnosis, Treatment

Borderline Personality Disorder (abbreviated as BPD ) is increasingly common among children today. The pathogenesis of this type of psychopathy is usually accompanied by a complex of unfavorable factors.

It is quite difficult to recognize this type of disease in everyday life. Often, it is confused with narcissism or simply the bad character of the individual, since the behavior of the "border guards" can be characterized by an extreme degree of unpredictability and hysteria, as well as a tendency to manipulation. For example, they confess their love to a partner, and after a couple of hours they leave “forever”, they can sincerely sympathize with someone, and then hit. It is also very common for patients of this type to constantly violate the boundaries of other people, shifting their problems onto them, and avoiding responsibility. Consider the symptoms of borderline in more detail.

Symptoms of borderline personality disorder (BPD)

The main symptomatic difference of this type of disorder is prolonged abnormal behavior of the patient .

While in many other psychopathy periods of instability alternate with remission, in the case of BPD the patient behaves destructively over a long period of time. In the field of psychological anomalies are such manifestations as:

aggressive behavior leading to problems in relationships,
unstable emotional background and inadequate self-image,
high anxiety,
total fear of loneliness and permanent feeling of boredom,
dichotomous thinking and changeable mood, dividing the world only into "black and white" (today I love, but tomorrow I hate).

Also among the main symptoms can be noted: sociopathy and fear of society associated with low self-esteem and, as a result, separation anxiety (it is experienced by a person when separated from home or loved ones). Patients often exhibit reckless irresponsible "risky" behavior, the extreme form of which may be self-harm or suicide attempt.

Types of spontaneous actions that accompany mental borderline personality disorders

Due to difficulties in self-identification, lack of one's own opinion and a tendency to polarity, spontaneous destructive actions are characteristic of BPD sufferers.

Panic fear of loneliness and lack of an inner core pushes them into contact with sociopathic personalities who are characterized by destructive behavior: gambling, theft, vandalism, promiscuous relationships, drug addiction. This also includes self-harm, which was mentioned above.

One of the reasons for this uncontrolled behavior is the problem with holding the inner impulse. The level of impulsivity is so high that a person is not able to control it.

Besherednichenko Andrey Nikolaevich

Chief physician of the Korsakov Medical Center network, psychiatrist-narcologist

Experience for more than 12 years

Consultation

Records for taking

Emotionally unstable personality disorder in the ICD of the 10th review of the 10th review of the 10th review of the 10th review personality disorder is defined as "Emotionally unstable personality disorder (F60.3)". In the clinical community on the territory of the Russian Federation, this name is used quite often and is used due to the fact that the main symptom, as described above, manifests itself in the form of an emotionally unstable mental state of a person.

BPD pathogenesis

In the pathogenesis of the disease lies an incorrectly or incompletely formed intrapersonal self-awareness, in other words, “self-identification”. Border guards hardly realize how they relate to the main areas of life. They have problems with the concept of their opinions, interests, hobbies, and their character as well. Hence the more common definition of the disorder - "borderline". In this aspect, it means maneuvering on the verge between psychopathy and a stable state. The word "borderline" in a particular case means a precarious state between the norm and deviation, as if a person lives on the verge between "mental illness" (psychosis) and "mental health". That is why, the slang name for patients of this type is “borderliners” (from the English expression “border line”, which literally translates as “border”).

In classical psychiatry, borderline personality disorder is also classified as a type of ego syntonic disorder. Ego syntonicity implies that the patient does not assess his condition as painful, is not critical of him and calmly accepts deviations in behavior, not believing that they harm him in any way. Moreover, the patient, as it were, “defends” his symptom, preventing his own cure due to the difficulty in identifying his own “I”.

Causes of BPD

The underlying causes of BPD are currently not clearly defined, however, like most other disorders, BPD is caused by a group of factors.

Hereditary (genetic determinism), physiological (disturbances in the brain) and social factors (low stress resistance and psychological traumatic factor).

Unfavorable social environment

According to statistics, groups of people exposed to an unfavorable social environment, for example, in the family, are more susceptible to the disease. These include:

difficult childhood,
abuse,
tyranny,
physical or emotional domestic violence,
early loss of parents.

It is worth noting that "borderliness" occurs 3 times more often among women than among men.

Post-traumatic stress disorder (PTSD) , as a variation of an unfavorable social factor, can act not only as a cause, but also as a concomitant individual disease that is in a pathogenetic relationship with the diagnosis in question.

Childhood chronic emotional trauma can contribute to the development of BPD, but in rare cases it is the only cause. Personal qualities that are responsible for the ability to cope with a stressful situation in this aspect also play a big role. Here it is worth noting that, according to statistics, an injury received in childhood (especially before the age of 10) can lead to a subsequent disorder much more likely than an injury received at an older age. Also, scientists note that situations not associated with direct violence, such as natural disasters or catastrophes, are less likely to lead to the development of post-traumatic syndrome.

Physiology

Another group of factors considers a possible cause of the development of the disease - a disruption in the functioning of neural brain connections, namely the destruction of the functioning of the frontal limbic neurons

Heredity

diagnosis. It is quite difficult to achieve clear indicators in this vein, however, according to European studies, BPD is located in 3rd place out of 10 in terms of the genetic determinant among personality disorders. It is logical to note that deviations in the work of certain parts of the brain can be inherited and lead to a number of psychological problems, the development of which is aggravated by the social factor. Most studies show that most often borderlineness is transmitted from the mother.

Borderline state of the psyche in psychiatry and the severity of personality disorders

In clinical psychiatry, three levels of mental disorder are traditionally distinguished:

Neurotic . These include neuroses of a different nature, implying reversible temporary conditions that can be treated.
Psychopathic level . In its plane lie personality disorders, which include anomalies in the nature of various pathogenesis or painful changes in its features, with which nothing can be done, since they relate to the personality structure of the individual.
Finally, the deepest lesion of the psyche manifests itself at the psychotic level . This includes such manifestations as delirium, hallucinations, twilight consciousness.

Modern psychoanalysis distinguishes 4 levels of deviations. Between the state of psychosis and neurosis, it is conditionally located just “ borderline level”, also called borderline state . A borderline state can mean both the disorder itself and the designation of the level of mental damage.

How to reliably identify borderline personality disorder (BPD)

Borderline personality disorder is extremely difficult to diagnose and differentiate, as it has a high level of comorbidity, in other words, it is combined with a large number of concomitant disorders. For example, panic anxiety, eating disorders, bipolar affective disorder, attention deficit disorder, sociopathy, and so on. In connection with the above, the patient has to undergo a long diagnostic process and special tests.

Borderline personality disorder BPD test

One of the fairly popular tools for detecting the presence of psychopathy are tests, which are, in fact, a personality questionnaire. Used in modern clinical psychology, a test for screening for the bright signs of BPD was developed in 2012 by a group of scientists. In their work, the authors relied on the basic criteria for differentiating borderline disorder.

The questionnaire edited by them is a fairly effective tool for diagnostic verification and confirmation of symptoms. It is used both in psychiatric and general clinical, and in other practices that are not directly related to medicine.

The test itself consists of 20 questions and asks the subject to answer only yes or no. For each answer, the system counts a certain number of points. The probability of diagnosing BPD appears if the respondent scored more than 25 points.

Treatment of borderline personality disorder (BPD)

Cherednichenko Andrey Nikolaevich

Chief doctor of the network of medical centers "Korsakov", psychiatrist-narcologist

Experience over 12 years

Consultation

Appointment

Like most other mental disorders, borderline disorder is not treated at home and requires complex occupational therapy, including both medication (taking antidepressants and antipsychotics) and psychotherapy. And only a psychiatrist, often in tandem with a clinical psychologist, can competently develop an effective course of treatment.

The drug course is developed in accordance with the individual characteristics of the patient's body and includes the following drug groups:

Selective inhibitors of are aimed at preventing depressive episodes and reducing anxiety/panic/borderlines.
Mood stabilizers .
One of the most popular remedies is Lamotrigine. It is also used to neutralize depression, mood lability and impulsivity.
Atypical antipsychotics .
Now the 2nd generation of drugs of this cluster has already been developed, which have proven themselves well in neutralizing the symptoms of the cognitive sphere, such as: aggression, distortion of perception of reality, paranoia, dichotomy of thinking and disorganization.

As for the group of benzodiazepines and stimulants, they are used in modern therapy extremely rarely due to the high risk of dependence and, accordingly, overdose.

Thus, the main task of drug therapy in borderline personality disorder is to reduce the severity of symptoms and alleviate the general condition of the patient.

It is worth noting that BPD is the most difficult to treat due to the patient's ego syntony, which we discussed above. It is the patient with BPD who is the most difficult to respond to any therapy due to the rigidity of the psyche and the clear conviction that everything is generally normal with them.

However, when it comes to Selective Inhibitors, Dialectical Behavioral Therapy (DBT), one of the varieties of Cognitive Behavioral Therapy (CBT), is considered the most effective method in the modern clinical community. As part of the treatment, the patient is taught to look at the problem from different points of view and evaluate the causal relationship in different ways. Due to satisfaction with their symptoms and rigidity, "border guards" are difficult to treat, so the psychotherapeutic process can be lengthy.

Most often, relatives suffer the most from relationships with patients with BPD, so another parameter that the specialist works on is the patient's socialization and adaptation, aimed at developing basic life skills and developing an adequate behavior for the situation. In psychiatry, this type of technique is called STEPPS (System Training Emotional Predictability & Problem Solution) and in translation means Systematic Training in Emotional Predictability and Problem Solving.

One of the well-established methods are meditation techniques aimed at teaching a person to control their emotions and the ability to relax.

Another effective method when working with a psychotraumatic factor is the gelstat technique, during which the patient returns to a stressful situation and looks at it from the other side, rebuilding the scenario or acting it out again. The task of a specialist in this aspect is to remove the negative emotional charge from the memory.

Borderline personality disorder: symptoms, treatment, communication tips

What is it
Test
Symptoms
Causes and risk factors
Is it being treated
How to communicate with a person with BPD
Expert commentary

What is borderline personality disorder

Borderline personality disorder (BPD) inevitably affects how a person thinks and feels, how he interacts with others [1]. The diagnosis is recorded in the ICD-10 and is considered a subspecies of an emotionally unstable personality disorder. The disorder manifests itself in problems with self-esteem, the management of emotions and behavior, high anxiety and desocialization, and leads to unstable relationships with others. With borderline personality disorder, a person experiences a fear of being alone or abandoned. Misplaced anger, impulsiveness, frequent mood swings can alienate potential partners.

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Deviations are usually recorded in young people and may worsen with age. However, many patients diagnosed with BPD are able to live a full life, having worked through the main problems.

Borderline Personality Disorder Test

Some of the symptoms may point directly to BPD, but only the attending physician will give exact information. If you suspect you have a disorder, answer a few questions:

Do you have a fear of being alone that makes you act inappropriately? For example, constantly call a partner, try to be always near him.
Have you ever had to change your mind in relation to your partner, move from love to hate for no particular reason?
Have you ever felt that you do not have a clear idea of yourself, that you are not sure of your self-worth?
Have you committed impulsive dangerous acts? For example, have you taken drugs, spent large sums of money recklessly, or had unprotected sex?
Have you harmed yourself, threatened suicide in the presence of loved ones?
Do you experience severe mood swings, from anxiety and irritability to days of depression and apathy?
Do you find it difficult to control your anger?
When you find yourself in a stressful situation, do you feel as if you are disconnected from reality and your own body, do not control your thoughts and behavior?

If you answered "yes" to more questions, it makes sense to talk to a therapist. Symptoms do not always point to borderline personality disorder and may be due to other health problems. Only a specialist can make a correct diagnosis and give competent advice.

Symptoms of borderline personality disorder

BPD affects how a person relates to himself and others, how he behaves in society. Signs and symptoms vary, there may be several, or just a couple from the list [2]:

Strong fear of being abandoned. A person is ready to go to extreme measures to avoid the real or imagined withdrawal or rejection of a partner.
Tendency to unstable relationships. For example, a person idealizes a partner, but at some point suddenly decides that the latter is cruel and unfair.
Rapid changes in self-identification and self-esteem. Goals and values switch disproportionately to the circumstances - abruptly and for no particular reason. A person tends to consider himself bad, he needs impulses from the outside in order to feel alive and needed.
Stress related paranoia. Loss of contact with reality lasting from several minutes to several hours.
Impulsive behavior, risk taking. Gambling, reckless driving, unsafe sex, alcohol abuse, overeating, drugs.
Sabotage of success. Sudden unreasonable rejection of positive relationships, good work.
Self-mutilation, suicidal tendencies. Often occur in response to separation anxiety or partner rejection.
Sudden mood swings lasting from several hours to several days. Bright, hypertrophied emotions: happiness, anxiety, shame and irritability.
Constant feeling of emptiness, lack of interest in what is happening.
Aggression - strong anger, cruel sarcastic remarks to interlocutors, fights.

Causes and risk factors

As with other mental health problems, the causes of borderline personality disorder are not fully understood. In addition to circumstances such as childhood abuse or neglect, borderline personality disorder may be associated with the following factors.

Genetics. Studies involving twins and their relatives suggest that BPD may be inherited and be part of a mental health complex [3].
Anomalies of the brain. Several studies have confirmed changes in certain parts of the brain involved in the regulation of emotions, especially impulsivity and aggression [4]. Patients with BPD may have malfunctions in the regulation of chemicals, such as the production of serotonin, which affects mood.

Is there a cure for borderline personality disorder

BPD is difficult to treat. But with the help of modern, evidence-based therapies, people with the disorder can be helped to manage their symptoms and improve their quality of life. It is good if the treatment is carried out by a licensed doctor who specializes in this disease. Sometimes the patient will need to interact not only with a psychiatrist, but also with a social worker who will help to adapt in the absence of loved ones.

The doctor usually conducts an interview and discusses the person's symptoms. Then there is a thorough medical examination and testing, which allows you to exclude other diseases. Comorbid disorders can make BPD difficult to diagnose and treat, especially if their symptoms overlap. For example, a person may show signs of depression, bipolar disorder, anxiety, substance use problems, or eating disorders. If a patient with borderline personality disorder does not receive proper treatment, they are more likely to develop chronic illnesses. And not only mentally, but also physically - patients with BPD tend to make choices in favor of an unhealthy lifestyle and self-harm.

Psychotherapy is the first line of treatment for a person with BPD. It can take place both individually and in a group. The second option helps the patient to interact with other people and express himself in society. Most often, the doctor uses one of two therapy options, or combines them:

Dialectical Behavioral Therapy (DBT). It uses the concepts of awareness and acceptance of the current situation and emotional state. DBT also teaches skills to control and reduce self-destructive behavior.
Cognitive behavioral therapy (CBT). This type of assistance allows you to identify and change the core beliefs that underlie inaccurate acceptance of yourself and others, as well as problems associated with communication.

Because their benefits are unclear, medications are not commonly used as the primary treatment for borderline personality disorder. However, in some cases, a psychiatrist may recommend medications to treat certain symptoms, such as controlling mood swings and depression. The psychotherapist should specialize in borderline personality disorder, that is, receive additional education in this area.

How to communicate with a person with BPD

People with BPD are often very suspicious and vulnerable. They need support, and it is important for them to realize that they have someone to turn to in case of exacerbations. Eliza Gordezki, a writer, artist and queer feminist with BPD, has developed a manual for interacting with people who have been diagnosed with BPD [5]. Here are the main recommendations.

Tell loved ones that you will take care of them.

People with BPD tend to think that if they don't hear this confirmation, then they are indifferent to those around them. Suitable phrases:

"Just writing to you to tell you I care about you."
"I wanted you to know that I'm thinking of you right now."
"I really like having you in my life and I wanted to make sure you knew that."

Take an interest in well-being and affairs

For people with BPD, this is a vicious circle: they are afraid of being rejected, so they do not share their experiences in order to eliminate the risks of negative reactions from others. Asking how you are doing is a good strategy for making contact.

“Hi, how are you?”
“I saw you posted a sad post on Facebook. I wanted to make sure you were okay."

Soften bad news with support and sympathy

When you tell your loved one some unpleasant information, try to remind him that he is important to you and that you will support him in any case. A person with BPD needs to be aware that his feelings are taken into account and not perceived as something feigned.

"It's not easy for me to support you in this crisis, but I need to know what to do to make it easier for you to deal with it."

Match words

Marsha Linehan, who developed the Dialectical Behavior Model (one of the most common treatments for people with BPD), uses specific vocabulary in her manuals [6]. Rather than characterize a person or their actions with judgmental words, she prefers adjectives such as "efficient, skillful, and wise" (or the reverse, "inefficient, inept, and unwise"). These words separate a person from his behavior, they name qualities that can be changed. If someone is being violent, negative, or insulting, you can say something like:

“I can see you're upset. I understand why you are upset, but these actions are very inefficient and will not bring you the desired results. Let's think together how we can achieve greater sense and achieve the desired prospects.

Compare this phrase with those that many people are used to using in similar situations: “It's not normal if you react like that!”, “It's impossible to communicate with you, there is too much drama”, “Why are you overreacting? You are always so sensitive!”

Be attentive to triggers

The only way to determine what is bothering a loved one is to ask and observe. Among people with BPD, two triggers are common (eng. trigger - a reason, a trigger; in psychology - an irritant that causes a certain reaction) - to be thrown and to be rejected. Simple situations that most people are used to can cause a strong negative reaction with borderline personality disorder. For example, if you reschedule a meeting or began to devote more time to other things, did not respond to a message for a long time, or forgot to call. Of course, changing plans is normal, but when communicating with a person with BPD, it is worth taking a little time to explain your actions to him:

“I remember that we planned to meet on Friday and have dinner together, and I'm sorry, but I have to cancel this meeting. I was assigned to make an urgent report, and I will be at work all evening. It will be great if, along with the cancellation of plans, you offer a quick alternative: “But I really want to spend time with you! Maybe we can meet on Saturday for lunch?

Repeat and confirm

People with BPD need to be reminded of your positive attitude. Frequent reinforcement and support is an important part of their well-being and confidence in the world. Be patient and focus on good moments, convince your loved one if he breaks into negative emotions, even if it seems to you that they are unreasonable. For example, your friend is upset that they don't reply to a message. At this point, he may seriously believe that the interlocutor hates him. Inform that this is not the case, most likely, the person is just busy, he will definitely write or call as soon as he has time.

What works well for one person may not work for another, so it's always best to talk to your loved ones and ask what they need.

Expert comment

Andrey Yudin, psychologist, Gestalt therapist, co-founder of Stemning Gestalt Center

It is not always possible to build relationships with a person with BPD [7]. But if it's not a destructive abusive relationship and it's important for you to keep the relationship going, you need to put in a lot of effort. First of all, set boundaries - when you can come or call, whether you can shout. Sometimes it can take years to rebuild, especially when it comes to older relatives. It will take a lot of labor and therapeutic support.

Borderline personality disorder is one of the three basic personality disorders in modern psychotherapy, the other two being schizoid and narcissistic. BPD is the most well studied and isolated, it is in the public eye due to its clinical manifestations. The disorder is included in the ICD-10, but the difficulty lies in the lack of uniform criteria for the diagnosis. There are three obvious signs of borderline personality disorder:

The person does not take care of himself. For example, he does not visit doctors, while experiencing guilt and shame for his choice. This factor applies to both hygiene and personal relationships.
Approach speed. People with BPD tend to quickly make contacts and just as quickly become disillusioned with new acquaintances, friends, and romantic relationships.
Extreme fear of rejection. If a person is afraid of being abandoned, being rejected by relatives, friends or partners, then this is a clear sign of BPD.

With BPD, there is a clear lack of self-activation - urging oneself to some kind of action. At the same time, it is difficult for a person to explain to himself why he cannot do this. Trying to rouse himself to action, he begins to worry. Borderline personality disorder begins in childhood, between 16 and 24 months. It is often the result of severe abuse, physical, emotional or sexual abuse, or a parent's negative response to a child's need for emotional closeness. In the case of premature separation, a mental structure is formed from two separate parts, which normally should be integrated into each other, but in BPD these are two separate modules.

BPD is often associated with drug addiction. Suffering, feelings of frustration, dissatisfaction encourage a person to chemically regulate his emotional state. This is alcohol, and drugs, and self-damaging behavior, and not only in relation to the body. For example, a person can spend all the money on payday.

With regard to BPD during adolescence, for this stage of human development, many of the "symptoms" are actually normal behavior. Severe emotional experiences, dulling the sense of self-preservation, experiments with substances and partners. But from the age of 16-18, when the transitional stage has been passed, the persistence of these signs may be a reason to contact a specialist.

Those close to people with BPD face, first of all, their emotional instability. The biggest difficulty is the chaotic influence on the lives of others. If a person with a narcissistic disorder extends his suspiciousness to the assessments of others, then with BPD people tend to have a different focus - love / not love, rejection / acceptance. A person may try to return the location of the partner or play ahead of the curve - break off the relationship, if he assumes that he may be abandoned. People with BPD may become abusers because of the unbearable emotional experiences they are trying to change in this way.

In the professional field, BPD can be suspected, for example, in rock stars. Moreover, the presence of such a feature for people in this profession will even be a plus. There will be a lot of life and pain in their work, it is very sincere and can be healing for other people.

If you encounter a person with BPD at work—a boss, a colleague, a subordinate—they are likely to have fairly loose boundaries because they find it difficult to set and maintain them. This may be a person who perfidiously treats other people's borders or, conversely, distances himself and avoids communication. People with BPD are very successful. Such bosses have reactive behavior, chaos in the department, and many will be uncomfortable. But there are qualities in BPD that are good for management: empathy, intuition, even being aggressive can be an asset for career advancement.

The diagnosis and treatment of borderline personality disorder requires a specific set of skills that are not taught in psychology departments, at least not in basic education programs. Most psychologists do not have such qualifications; a maximum of 10% of practicing specialists have it. Therefore, educational work is especially important so that people can find the understanding and support that are so needed. The peculiarity of therapy for BPD will be directed to the very two modules of consciousness (patterns) of the patient. A person with BPD may go to the doctor from their positive childhood pattern and talk about how well the treatment is working. He does this because he is used to being held in relationships in this way, he has learned that he must give positive emotional nourishment "so as not to be abandoned." The therapist must frustrate this pattern, help to go beyond it.

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