The Silver Lining
Despite this grim portrait of BPD, there is an encouraging side to the illness. Many do respond well to appropriate treatment, and psychologists no longer assume it to be the chronic illness they once thought.
As SAMHSA noted in a 2011 report on BDP to Congress:
“BPD symptoms can be severe, debilitating, and isolating, and individuals with this disorder suffer discrimination and bias. However, despite its severity and burden, BPD has a surprisingly good long-term prognosis with a high rate of recovery.”
This is especially true when the treatment and education extend beyond the sufferer to include his or her family, friends, employer, and community.
Though there is no targeted FDA-approved BPD treatment as of yet, there is help for those with the disorder through several avenues. Dialectical behavior therapy, for example, can teach skills for dealing with distress, regulating emotions, and relating more effectively with others. A 2004 study found it helped participants improve in a variety of areas, including anxiety, depression, global psychopathology, interpersonal functioning, self-harm and social adjustment. It can also help the person reduce behaviors that get in the way of change, such as alcohol and drug use. Medications such as antidepressants are also an option in some cases and doctors may prescribe them to help lift mood and lessen anger, impulsivity and irritability.
When seeking treatment, look for mental-health professionals experienced in dealing with BPD. They will know, for example, that BPD patients often bond strongly with their therapist, which can cause them to fear abandonment and lash out. Some patients will even sabotage recovery—sometimes consciously, sometimes not—to keep the therapeutic relationship from ending. In short, the person providing treatment must fully understand and be willing to manage the inherent challenges of committing to someone whose personality is geared for volatility.
At our BPD treatment center in California, we recognize that co-occurring conditions are common with BPD. We must be treating them along with the disorder to maximize chances of a successful recovery. One study found, for example, that 62% of those in treatment for BPD also met the criteria for a substance-use disorder. Such drug and alcohol abuse not only interferes with the work of therapy and is dangerous in its own right, but it can also boost the impulsivity, risk-taking, and suicide risk that comes with BPD.
Because those dealing with BPD are sometimes unaware that their emotions and behaviors fall outside the norm, or are reluctant to admit they are struggling, family members are often the ones who reach out for help. No matter who makes the first move, it’s important to make it. The disorder’s destructive power is real. We shouldn’t ignore it, nor the possibility of healing.
David Sack, MD, is board certified in psychiatry, addiction psychiatry and addiction medicine. He is Chief Medical Officer of Elements Behavioral Health, a network of mental health and addiction treatment centers that includes the Malibu Vista women’s mental health center and Lucida Treatment Center in Florida.