“People With Borderline Personality Disorder Can’t Change”
Is it true that people with borderline personality disorder can't change?
Borderline personality disorder (BPD) is a condition characterized by emotional dysregulation.
There is no quick and easy fix for BPD, although it can be managed with a number of different therapies.
Contrary to popular belief, the prognosis for people with BPD is good, for those who are engaged in therapy.
Borderline Personality Disorder (BPD) is a condition characterized by emotional dysregulation. There are a wide range of symptoms that differ across individuals, although the core traits of BPD include unstable personal relationships, fear of abandonment, an unstable sense of self, impulsivity, and self-harming behaviors.
BPD is a chronic and debilitating disorder for sufferers, and often for those around them. Over five million people have been diagnosed with this disorder in the US alone, although the true numbers may actually be much higher. It can take a long time to obtain an accurate diagnosis, sometimes years or even decades. People with this condition are commonly misdiagnosed. BPD is often confused with bipolar disorder, ADHD, PTSD, anxiety, and depression, although it can be comorbid with these conditions.
BPD is a complex disorder that is difficult to treat. In the past, many believed that BPD was untreatable, and lumped it together with harder-to-treat conditions, including narcissistic personality disorder (NPD) and antisocial personality disorder (ASPD). Even today, BPD is thought to have a gloomy prognosis. It’s often said that people with BPD “don’t change.”
But is this true?
Is there a cure for BPD?
Unfortunately, there is no definitive “cure” for BPD. There isn’t a quick and easy fix, but there is hope. BPD can be successfully managed with a number of different therapies.
Dialectical Behavior Therapy (DBT) is the first-line of treatment for BPD. (O’Connell, 2013) Developed by psychologist Marsha Linehan in the 1970s, who was herself diagnosed with BPD, DBT is an evidence-based psychotherapy that focuses on thoughts, beliefs, behaviors, and actions. It provides training in critical skills, especially mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.
There are other treatments too, notably cognitive behavioral therapy (CBT) and transference-focused therapy (TFP). There is no targeted medication for the condition, although antidepressants and mood stabilizers are often used in conjunction with therapy. In some severe cases, sufferers might require a period of hospitalization. Marsha Linehan herself revealed that she had been institutionalized as a teenager for self-harming and suicidal behaviors.
What are the success rates for treatment?
Contrary to popular belief, the prognosis for people with BPD is good, that is, for those who are actively engaged in therapy. In controlled clinical trials, DBT has been shown to be effective for reducing and managing symptoms with a success rate of 50-70 percent. (Álvarez-Tomás, et al., 2019) DBT has also been shown to reduce hospitalizations, substance abuse, self-injury, and suicidal behavior. Heartening research suggests that up to 77 percent of people no longer meet the criteria for BPD after one year of treatment. Alternatively, some people notice a natural reduction in their symptoms over time. (Biskin, 2015)
These results are promising, although the road to recovery isn’t always easy. Many people with BPD are unlikely to ask for help or are in denial about their condition. The treatment is most effective for those who want to help themselves, rather than those who are forced into therapy. The treatment can be difficult too, for both the patient and the therapist. A commitment to recovery is important and people with BPD must do the work to see positive results.
The takeaway message is that BPD is treatable. With the right treatment, a person who has this condition can definitely change, which will drastically improve their quality of life.
Karen Stollznow, Ph.D., - Website -
References
O'connell, B. and Dowling, M., 2014. Dialectical behaviour therapy (DBT) in the treatment of borderline personality disorder. Journal of psychiatric and mental health nursing, 21(6), pp.518-525.
Álvarez-Tomás I, Ruiz J, Guilera G, Bados A. Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies. Eur Psychiatry. 2019;56(1):75-83.
Biskin RS. The lifetime course of borderline personality disorder. Can J Psychiatry. 2015;60(7):303-308.
