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Borderline Personality Support
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Tami Green's Fact Sheet On Borderline Personality Disorder (BPD)

Need for information about Borderline Personality Disorder

There's a substantive need for people with Borderline Personality Disorder (BPD) and their families to better understand the diagnosis, treatment, and chances of recovery to increase the incidence of treatment.^1,2
There's a shortage of therapists trained in the effective methods of Dialectical Behavioral Therapy, as well as other evidence-based therapies.³

Incidence

Some 5.9 percent of people in the United States have Borderline Personality Disorder in their lifetime.⁴
BPD is the most prevalent personality disorder in clinical settings.⁵
BPD is more prevalent than bipolar disorder (from which 4.4% of the U.S. population suffers sometime in their lifetime6) or schizophrenia (1%) combined.⁷
Rates of Borderline Personality Disorder are higher in people who are separated, divorced or widowed and among people with low income and education. It's not yet clear whether these represent risk factors for Borderline Personality Disorder or whether BPD is actually the risk factor for the others.⁸
About one in every four adults in the U.S. suffers from a mental disorder in a given year.⁹
One in five young adults (ages 19 to 25) has a personality disorder.¹⁰

Causes

Borderline Personality Disorder has significant genetic determinants, but it is not clear what exactly is inherited — most likely a combination of predisposing temperaments.¹¹
Childhood trauma or abuse may play a role.¹²
People are more likely to have Borderline Personality Disorder if a relative has BPD or similar traits (i.e., "Affective: affective instability or anger; Impulsive: impulsivity and suicidal or self-mutilative behavior; Interpersonal: intense unstable relationships, abandonment fears, emptiness."¹³
Imaging studies show the physical brain is involved; the brains of people with BPD perform differently from the brains of those without BPD.¹⁴

Remission

Remission in most studies is defined as a decline in the number of DSM-IV diagnostic criteria for Borderline Personality Disorder a patient meets, from five or more of the nine possible criteria (which constitutes a diagnosis) to four or fewer.¹⁵
About 50% of patients with Borderline Personality Disorder go into remission within two years. Reasons for remission vary but involvement in therapy/treatment is key.¹⁶
In one study, the rate of remission was 30% after one year, 50% after two years, and 75% after six years, with only six patients relapsing.¹⁷
Once in remission, few people relapse.¹⁸

Symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), published by the American Psychological Association, outlines the following symptoms of BPD:

Frantic efforts to avoid real or imagined abandonment.
Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating).
Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood.
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger.
Transient, stress, related paranoid ideation or severe dissociative symptoms.

BPD is associated with considerable mental and physical disability, especially among women.²⁰

Many people with Borderline Personality Disorder also suffer from "substance use, mood, anxiety, and other personality disorders."²¹

Up to ten percent of adults with BPD commit suicide.²²

A person with BPD has a suicide rate 400 times greater than the general public.²³

A young woman with Borderline Personality Disorder has a suicide rate 800 times greater than the general public.²⁴

More than half of adults with Borderline Personality Disorder self-injure their bodies.²⁵

Treatments

Five types of treatment for Borderline Personality Disorder have been empirically validated over the long term:^{26, 27}

Dialectical Behavior Therapy²⁸ (Lineham et al.) — "focuses on emotional control"
Mentalization-based Therapy ^{29, 30, 31} (Bateman and Fonagy) — "focuses on cognitive disabilities and learning new ways of thinking"
Transference-Focused Therapy³² (Yeomans et al.) — "focuses on distortions in perceptions of oneself and others"
Systems Training for Emotional Predictability and Problem Solving (STEPPS)³³ (Blum et al.)—"combines 20 weekly sessions of cognitive behavior and skills training elements with a systems component or approach that involves family members, significant others, and health care professionals with whom the patient interacts regularly"
Schema Therapy³⁴ (Young et al.) — helps patients "change their entrenched, self-defeating life patterns - or schemas - using cognitive, behavioral, and emotion-focused techniques," including "limited reparenting"

The moderate use of medications can also be beneficial.³⁵

Family members also benefit from Dialectical Behavioral Therapy as they learn to improve their interactions with, and ways to help, a relative who has BPD.³⁶

Role of Coaching

McLean Hospital, a psychiatric hospital affiliated with Harvard Medical School, launched the Coaching and Positive Psychology Initiative in August 2008 to educate "professionals and the public (about) the academic foundations of coaching psychology and the practical applications of positive psychology."³⁷
Research has found that "positive psychology coaching boosts the effects of traditional (therapy) treatment methods."³⁸
A leader at McLean Hospital predicts positive psychology will become as popular and well regarded as Cognitive Behavioral Therapy has over the past several years.³⁹

Citations

Need for information about BPD

¹Gunderson, J. (2008) "Borderline Personality Disorder: An Overview." Borderline Personality Disorder: Meeting the Challenges to Successful Treatment. Hoffman, P.D., Steiner-Grossman, P. The Haworth Press, pp. 5-12. Also in: Social Work in Mental Health. Vol. 6, No. 1/2, pp. 5-12.

²Hersh, R. (2008) "Confronting Myths and Stereotypes about Borderline Personality Disorder." Borderline Personality Disorder: Meeting the Challenges to Successful Treatment. Hoffman, P.D., Steiner-Grossman, P. The Haworth Press, pp. 13-32. Also in: Social Work in Mental Health. Vol. 6, No. 1/2, pp. 13-32.

³Breiling, J.P. (2008) "Foreward." Borderline Personality Disorder: Meeting the Challenges to Successful Treatment. Hoffman, P.D., Steiner-Grossman, P. The Haworth Press, pp. xxv-xxvi. Also in: Social Work in Mental Health. Vol. 6, No. 1/2, pp. xxv-xxvi.

Incidence

⁴Grant, B.F. et al. "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder: Result from the Wave 2 National Epidemiological Survey on Alcohol and Related Conditions." J Clin Psychiatry. March 11, 2008.

⁵Grant. Ibid.

⁶"More than 4 Percent of US Adults Have Some Form of Bipolar Disorder, Survey Estimates." Medical News Today (MedicalNewsToday.com). May 11, 2007.

⁷"The Numbers Count: Mental Disorders in America." National Institutes of Mental Health Web site:
http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml#Bipolar

⁸Grant. Op. cit.

⁹"Statistics." National Institutes of Mental Health Web site:
http://www.nimh.nih.gov/health/statistics/index.shtml. December 15, 2008.

¹⁰Tanner, L. Study: One in Five Young Adults Has Personality Disorder. Houston Chronicle. Dec. 2, 2008.

Causes

¹¹Gunderson. Op. cit.

¹²Evans, J. "Expert Cites Genetics as Key Component in BPD" (Report on John G. Gunderson, MD's American Psychiatric Association's Institute on Psychiatric Services). Clinical Psychiatry News. March 2005.
http://findarticles.com/p/articles/mi_hb4345/is_/ai_n29172792

¹³Ibid.

¹⁴Breiling. Op. cit.

Remission

¹⁵www.behavenet.com/capsules/disorders/borderlinepd.htm

¹⁶Gunderson. Op. cit.

¹⁷Evans. Op. cit.

¹⁸Gunderson. Op. cit.

Symptoms

¹⁹Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR-text revision). American Psychological Association. 2000.
http://www.behavenet.com/capsules/disorders/borderlinepd.htm

²⁰Grant. Op. cit.

²¹Grant. Op. cit.

²²NEA-BPD Flyer. May 2008.

²³Ibid.

²⁴Ibid.

²⁵Ibid.

Treatments

²⁶Gunderson. Op. cit.

²⁷John F. Clarkin, Ph.D., Kenneth N. Levy, Ph.D., Mark F. Lenzenweger, Ph.D., and Otto F. Kernberg, M.D. Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study Am J Psychiatry 164:922-928, June 2007

²⁸DBT: http://faculty.washington.edu/linehan/

²⁹Bateman, A.W., Fonagy, P. (2008). "Comorbid antisocial and borderline personality disorders: mentalization-based treatment." Journal of Clinical Psychology, Vol. 64, pp. 181-194

³⁰Fonagy, P., Bateman, A.W. (2006). "Mechanisms of change in metalization-based treatment of BPD." Journal of Clinical Psychology, Vol. 62, pp. 411-430.

³¹Bateman, A.W., Fonagy, P. (2004). "Mentalization-based treatment of BPD." Journal of Personality Disorders, Vol. 18, pp. 36-51.

³²An Interview with John Clarkin, Ph.D. on Transference-Focused Therapy For Borderline Personality Disorder
Posted by David Van Nuys, Ph.D. on Wed, Aug 1st 2007 (Text and podcast)
http://www.mentalhelp.net/poc/view_doc.php?type=weblog&id=257&wlid=9&cn=8

³³ Silk, K.W. (2008) "Augmenting Psychotherapy for Borderline Personality Disorder: The STEPPS Program." American Journal of Psychiatry Vol. 165, pp.413-415.
http://ajp.psychiatryonline.org/cgi/content/full/165/4/413

³⁴ Giesen-Bloo, J. et al. (2006) "Outpatient Psychotherapy for Borderline Personality Disorder: a randomized trial of Schema focused therapy versus Transference focused therapy." Archives of General Psychiatry, Vol. 63, No. 6, pp. 649-658.
http://www.schematherapy.com/id316.htm

³⁵Breiling. Op. cit.

³⁶Breiling. Op. cit.

Role of Coaching

³⁷http://www.mclean.harvard.edu/news/press/current.php?id=130

³⁸Goldberg, C. "Positive Psychology is Getting a Tryout at McLean." Boston Globe. Jan. 15, 2007.

³⁹Ibid.