Treatment Of Borderline Personality Disorder

Borderline personality disorder is characterized by setting in motion a repertoire of non-adaptive behaviors in situations that generate frustration and discomfort. Misfit behaviors are linked to expectations that are too high and that, when not met, end up generating discomfort.

In this disorder, dichotomous thinking is also frequent, which conditions in these people their relationship and perception of the world. On the other hand, this would explain their rigid behaviors and limit their affective, work and social sphere.

It is true that people who enjoy emotional stability can react in an inappropriate way in a situation that causes them discomfort. The difference between people with optimal emotional stability and people with borderline personality disorder is that the former usually know how far they can ” get carried away ” by emotion; while, in the latter, reactivity to discomfort is usually greater, being able to carry out risky behaviors.

Borderline personality disorder

Borderline personality disorder is classified in cluster B of personality disorders in DSM V. It is characterized by a pattern of emotional instability that manifests itself in interpersonal relationships, personal image, and affectivity.

Impulsiveness is another of the key characteristics that manifests itself in full emotional escalation in the face of unpleasant events. Impulsivity, in the worst case, can lead to risky behaviors, one of the most serious being self-harm or aggression towards third parties.

What can roughly summarize the functioning of people with borderline personality disorder is that when faced with situations that generate unpleasant emotions, the emotional escalation is usually quite high. This emotional escalation would imply a high reactivity to the environment, with the return to the baseline being slower than normal.

Treatment of borderline personality disorder

Borderline personality disorder is often associated with other disorders (eating disorders, addictions, and other impulse control disorders). Therefore, psychological therapy is necessary and important in the entire process of treating borderline personality disorder.

The non-adaptive behaviors associated with borderline personality disorder are effective in the short term for the relief of discomfort, but not in the long term. In this sense, drugs can be a complement to any psychotherapy for borderline personality disorder, hospitalization or specific treatment of associated disorders being sometimes necessary.

Two of the borderline personality disorder treatments will be presented below.

Dialectical Behavioral Therapy

Dialectical Behavioral Therapy was developed by Dr. Marsha Linehan. Dialectical behavioral therapy links behavioral strategies with acceptance and change strategies through the dialectical model.

Thus, dialectics is included in the therapeutic program to exaggerate absolutist conclusions of dichotomous thinking, promoting the acceptance of discomfort and the change of certain dysfunctional patterns of behavior.

Treatment application modes

Standard Dialectical Behavioral Therapy for Borderline Personality Disorder is a very comprehensive program that includes four modes of therapy:

• Individual therapy. It is the basic format. A therapist is responsible for conducting individual sessions. The sessions are characterized by being once a week with a duration of between 50-60 minutes.

• Skills training. It corresponds to the group therapy modality and in addition to individual therapy. The therapist must be different in the two modalities. The skills that are trained in borderline personality disorder would be mindfulness skills, emotional regulation, tolerance to discomfort and interpersonal efficacy. The sessions would also be one a week with a duration of about 2-3 hours.
• Generalization of activities. Help the patient to integrate the skills learned in their natural context. This is done using phone calls between sessions while the person uses their skills in natural situations.
• Consultation teams. As a form of burnout prevention in the therapists responsible for carrying out the treatment. Supervision sessions are held weekly with the entire team.

Likewise, prior to entering the treatment program, a commitment is established to attend therapy for the estimated time (normally between 6 months and 1 year). Failure to attend four sessions in a row is usually a reason for cessation of therapy until the end of the contract, when entry to therapy is negotiated again.

Iconic therapy

The iconic therapy was born at the hands of Soledad Santiago López at the San Juan De Dios Assistance Center. This therapy works through an integrated model that includes an explanatory model on the lack of emotional regulation, a therapeutic model that includes the different strategies to use to work on non-adaptive behaviors and aspects of vulnerability that increase the risk of unstable behaviors.

Characteristics of iconic therapy and its application

Iconic therapy is based on the treatment of borderline personality disorder through icons. These icons are a way of verbalizing certain aspects of non-adaptive behavior in a non-judgmental way. In the same way, insight is promoted , allows the training of skills, such as tolerance to frustration and promotes acceptance strategies. In addition, it works on other aspects such as the feeling of emptiness, personal identity, self-esteem. etc.

Iconic therapy is made up of 32 icons that the individual can place on a kind of map that allows them to orient themselves from negative emotion to the most useful coping strategy. This coping strategy is in turn represented by an icon.

As for its duration, it is approximately 12 weeks and is carried out in conjunction with group, individual and family sessions once a week.