Dr Jay Seitz

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), borderline personality disorder (BPD) has the following characteristics:

“A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts…”

Dr. Margaret Linehan, a pioneer in treating borderline personality disorder with a variant of cognitive-behavioral therapy called “dialectical behavior therapy,” has noted five (5) essential criteria for BPD:

Emotional dysregulation: Individuals with BPD have a emotional system that is very labile and overreactive and may include issues with anger management, irritability, and accompanying anxiety or depression.

Interpersonal dysregulation: Marked problems in interpersonal relationships.

Behavioral dysregulation: Impulsive and suicidal behaviors are common.

Cognitive dysregulation: Cognitive rigidity and deficient social cognition or the ability to understand others and use their social intelligence successfully in emotionally stressful situations.  Such individuals are not “manipulative,” however, because they have not necessarily sought that effect in others.  However, depersonalization, dissociation, and delusions are common.

Self dysregulation: Weak sense of a core self and often accompanied by shameful feelings due to the expression of negative and irrepressible emotions.

Typically, individuals who meet DMS-IV-TR criteria for BPD are female and also engage in self-injurious and parasuicidal behaviors.  Of the latter, the participation in self-injurious behavior may result in bodily harm, physical illness or risk of death.  BPD is often accompanied by a major affective disorder (e.g., bipolar disorder or depression) or dysthymia.

Dialectical behavior therapy (DBT)

DBT emphasizes the remediation of five essential emotional and social “skill” areas:

Emotional regulation: Learning to modulate one’s mood and lessening the tendency to be overreactive in interpersonal relationships.

Interpersonal effectiveness: Being more interpersonally effective in one’s close social relationships.

Distress tolerance: Learning to be more tolerant of distress in oneself through employing distracting activities, self-soothing by finding pleasure through one’s five sensory modalities, and living fully in the present moment by employing the use of imagery, relaxation techniques, and using self-encouragement, among other things.

Core mindfulness skills: These mental skills include being less judgmental towards others and one’s interpretation of events and instead observing, describing, and participating without judgment.

Self-management skills: Being realistic in one’s assessment of others and events  and attenuating crisis generating behaviors.

Some suggested reading:

American Psychiatric Association (2000).  Diagnostic and statistical manual of mental disorders (4th ed., text revision).  Washington, D.C.:  American Psychiatric Association.

Linehan, M. M. (1993).  Cognitive-behavioral treatment of borderline personality disorder. NY: Guilford Press.