This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
Dialectical Behavior Theory as a Treatment for Borderline Personality Disorder by Derek Minor
It is not uncommon to come in contact with an individual with a personality disorder in the United States. Nearly 10% of the population qualifies for a diagnosis of one of the personality disorders listed in the DSM-5. One subset of disorders is the Cluster B personality disorders. This subset has been characterized by being erratic, dramatic or emotional in nature. One of the most well known disorders in this group is called borderline personality disorder (BPD). This disorder is characterized as having fears of abandonment, feeling empty, suicidal actions/self-harm, impulsivity, emotional lability, interpersonal difficulties, and disturbances in identity.
With such a personally and socially destructive disorder as BPD, a survey of its reach across American culture seems prudent. BPD’s prevalence rate has been found to be approximately 5.9% in the United States. It also effects females slightly more than males with prevalence rates at 6.2% and 5.6% respectively. Culturally speaking, Native Americans have the highest odds of developing BPD. While Hispanics and Asian women have the lowest odds of developing this disorder. The odds of blacks and whites developing BPD are equal. As can be seen, this disorder knows no race, no color, and no gender as all are affected. The difficulties this disorder represents are far-reaching and ever-present across American society.
One of the most prevalent and destructive symptoms of BPD is the tendency for the individuals to be very impulsive. For one, impulsive behaviors mixed with aggression is a high risk factor for those with BPD to engage in self-harm behaviors or even suicide. For instance, it is reported that about 70% attempt suicide and as many as 10% actually commit suicide. Impulsivity has also been implicated in many other destructive behaviors that are regularly associated with those with BPD. Sexual promiscuity and high-risk sexual behaviors are commonly associated with impulsivity. Also, borderlines tend to have high rates of substance abuse problems. With all of these destructive behaviors rampant in the borderline population, treatment is necessary to ensure that these individuals are kept safe and able to live as normal a life as possible.
One of the most evidence-based treatments for BPD is dialectical behavior therapy (DBT) which was created by Dr. Marsha Linehan. This type of treatment is a form of cognitive behavioral treatment (CBT), and as such, has many applications. For instance, it has been found to be an effective treatment for substance use, and even those dealing with suicidal thoughts/actions and other self-injurious behaviors. All of which are components central to the symptomatology experienced by those with BPD. It has also been shown to reduce the number of hospital visits and those dropping out of therapy prematurely. Overall, this type of therapy is ideal for those living with BPD due to its ability to target and treat the many destructive behaviors that are central to this disorder.
One difference DBT has from traditional CBT is that with DBT the therapist accepts the client as they are, and communicates to the client that their behaviors make sense in the context of their life. The therapist makes a special effort to point out instances when the client was acting or thinking in a normal manner. However, the therapist also highlights areas where change needs to take place if the client wants to live a better more meaningful life. This allows for a balance during the therapy session that causes the therapy sessions to move forward without as much resistance as would normally be seen with a borderline client. For example, it would not be uncommon for a session to become emotionally charged resulting in arguments and extreme negativity. The combination of acceptance and change works to counter that negativity.
For those going through the process of DBT, there are four stages that are worked through as a progression. During stage one, the client is engaging in destructive behaviors. This may include drug abuse, self-harm, suicidal thoughts and behaviors, and a range of other behaviors. At this point, the goal is to gain control over these behaviors. The second stage involves dealing with any emotional problems the client may have. For instance, if the client is suffering from PTSD, that would be dealt with during this stage. During the third stage, the client learns how to live a normal life. Goal are established and the client learns how to gain respect for him or herself. The fourth stage is optional. During this stage, the client works toward finding deeper, spiritual fulfillment. While working through these stages, the client will learn mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation that is needed for a successful life.
While working through these four stages, the client has various way of interacting with the therapist and learning the material. For instance, there is a DBT group where behavior skills are taught to the clients. This group is taught like a class, and homework is given to each client. Individual therapy is also a major component of DBT. In therapy, the client is able to use the skills learned in group in relation to their own life. One very important resource the client has is phone coaching. This allows the client to contact their therapist during difficult situations. When times get rough, the client knows that they have someone they can contact that will help them use their news skills effectively. Finally, the therapist has a consultation team where other therapists work together with the therapist to ensure they are providing the best care possible.
Those who experience the symptomatology of BPD are at a great risk of developing substance use disorders, causing self-harm, and committing suicide. However, by finding a therapist who is qualified in DBT, there is some hope of living a better more fulfilling life. It is possible to move from wanting death and having comorbid emotional problems to living a better life through the process of DBT. While the experience will not be easy, the opportunity has been made available by the development of this innovative therapy. Maybe with the passage of time, and more widespread use of this therapy, it will be possible to see the suicide rate for those with BPD begin to decline and the quality of life for those with BPD increase.