Borderline Personality Disorder: Doctor Advice & Tips

It’s estimated that as many as five million Americans have borderline personality disorder, although that number could be higher, as many people with this condition go undiagnosed and untreated. As a borderline personality disorder doctor, I know that this mental health condition is often misunderstood and I also know that this disorder can be treated successfully, despite myths to the contrary. Let’s take a look at this mental health condition and some of the current treatment options.

​What Is Borderline Personality Disorder?

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is produced by the American Psychiatric Association, borderline personality disorder is listed among 10 distinct personality disorders.
 
In general, a person with a “personality disorder” will experience different patterns of thought than most people. This includes how they perceive themselves as well as others, and how they respond and relate to other people. These disorders also affect behavior and emotional response. Most importantly, these disorders often cause distress and problems with daily life and relationships.
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Borderline Personality Disorder (BPD) is characterized by a pattern of unstable relationships, self-image, and emotions. People with BPD often have difficulties regulating their emotions and thoughts, suffer from severe mood swings and they may exhibit impulsive and reckless behavior. Here are the primary symptoms of borderline personality disorder:

• Fear of Abandonment: People with BPD often fear being abandoned or left alone. Even something as innocuous as a loved one arriving home late can trigger intense fear. This can result in frantic efforts to keep the other person close.
  
• Unstable Relationships: Individuals with BPD tend to have relationships that are intense and short-lived. They may fall in love quickly, but their idealization of others can quickly shift to devaluation.
• Unclear or Shifting Self-Image: People with BPD might frequently change their self-image, goals, values, or even their career plans. They may view themselves as evil or bad, and sometimes they may feel as if they don't exist at all.
• Impulsive Behaviors: Engaging in potentially harmful activities such as substance abuse, binge eating, reckless driving, or spending sprees can be common among those with BPD.
• Self-Harming Behavior: Suicidal behavior or threats and self-harm, like cutting, are potential symptoms. These distressing actions often result from feelings of emptiness and boredom, or as a way to cope with intense emotions.
• Extreme Emotional Swings: Unstable emotions and moods are common in people with BPD. While they can be joyful and loving one moment, they can become irritable or anxious the next, often lasting a few hours to a few days.
• Chronic Feelings of Emptiness: Individuals with BPD often express feeling empty which can be distressing.
• Explosive Anger: They may struggle with intense anger, often finding it challenging to control. This can result in shouting, throwing things, or becoming completely consumed by rage.
• Feeling Suspicious or Out of Touch with Reality: Periods of paranoia related to stress or feeling disconnected from oneself or reality, known as dissociation, can occur.

As a psychiatrist in Westlake Village who often treats patients with BPD, I find that It's important to note that BPD is a complex disorder, and not everyone with BPD will exhibit all these symptoms. The severity and manifestation of symptoms can vary widely among individuals. If someone suspects they or someone they know may have BPD, it's essential to seek a professional diagnosis and appropriate treatment from a borderline personality disorder doctor, such as a psychiatrist or psychologist (or ideally, both). 

​Common Myths About This Disorder

Borderline personality disorder (BPD) is a complex mental health condition that is often misunderstood. Several myths and misconceptions surround BPD, which can contribute to stigma and make it harder for those with the disorder to seek help and support.
 
Myth: People with BPD are just seeking attention.
Fact: BPD is a legitimate mental health disorder with specific symptoms. It's not about seeking attention but rather a struggle with emotional regulation, self-image, and interpersonal relationships.

​Myth: BPD isn't a real psychiatric disorder.
Fact: As stated above, BPD is recognized by major medical institutions and diagnostic manuals, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The Americans With Disability (ADA) Act also recognizes BPD as a disability.
 
Myth: Only women have BPD.
Fact: While BPD is diagnosed more frequently in women, men can and do suffer from it as well. The presentation of symptoms might differ between genders, leading to potential underdiagnosis in men.
 
Myth: People with BPD are manipulative.
Fact: While individuals with BPD might exhibit behaviors that seem manipulative, it's essential to understand these actions often stem from an intense fear of abandonment or rejection rather than a desire to manipulate others.
 
Myth: BPD is a result of bad parenting.
Fact: While childhood trauma or neglect can be risk factors, BPD's exact cause is unknown. It's believed to result from a combination of genetic, environmental, and neurological factors.
 
Myth: BPD and bipolar disorder are the same.
Fact: While both disorders involve mood disturbances, they are distinct conditions. BPD primarily affects interpersonal relationships and self-image, while bipolar disorder affects mood in terms of mania and depression.
 
Myth: People with BPD are violent and dangerous.
Fact: While some individuals with BPD might have aggressive outbursts, it doesn't mean they are inherently violent. Often, the anger is directed inward, leading to self-harm rather than outward violence. Self-harm, such as cutting, and suicidal thoughts and suicidal attempts are extremely common with BPD.
 
Myth: Individuals with BPD can't have healthy relationships.
Fact: While interpersonal relationships can be challenging for those with BPD, with therapy and support, many can and do have fulfilling, healthy relationships.
 
Myth: People with BPD are just being dramatic.
Fact: The emotions and reactions of someone with BPD are very real to them. Labeling them as "dramatic" invalidates their experiences and struggles.
Understanding and dispelling these myths is crucial for reducing stigma and providing appropriate support and care to those with BPD.
 
Myth: BPD is untreatable.
Fact: BPD is treatable, and many individuals with the disorder experience symptom relief and improved quality of life with appropriate therapy, such as Dialectical Behavior Therapy (DBT).

​Treatment Options

​Psychotherapy is the most common treatment option for people with BPD. There are several different types of psychotherapy that a borderline personality disorder doctor might suggest including dialectical behavior therapy (DBT), mentalization-based therapy (MBT), schema-focused therapy and other types of talk therapy.
 
While there are no FDA-approved medications available specifically to treat BPD, a borderline personality disorder doctor (a psychiatrist) can prescribe medications to treat some issues related to this disorder, such as antidepressants, mood stabilizers or antipsychotic drugs. There is also some evidence to suggest that ketamine might be a treatment option to consider.
 
Ketamine’s original purpose was as an anesthetic, but eventually, it was found to have a positive effect on reducing suicidal ideation as well as in patients with treatment-resistant depression. Ketamine must be administered in a doctor’s office; it cannot be used at home like other types of psychiatric drugs. However, for many patients, only a few treatments might be necessary to achieve a significant lessening of symptoms.
 
In general, the best approach with any mental health disorder is a combination approach that includes talk therapy and, possibly, medication. A therapist or psychologist can help with talk therapy, and a psychiatrist can help with both diagnosis and medication management. As a psychiatrist also is a medical doctor, they also can consider whether any physical issues might be contributing to your mental health issues.
 
In many cases, a person with BPD also will have a co-occurring disorder, such as anxiety, depression, an eating disorder, addiction or another type of mental illness. Your care team must address all of the issues you are facing for the treatment to be successful.
 
I find that many of my patients suffer from multiple mental health disorders and it’s crucial to dive deep and find a diagnosis and treatment plan that accounts for all of these issues. I recommend finding mental health professionals who specialize in personality and mood disorders to ensure that all of your needs are being met.
 
Borderline personality disorder can be overwhelming for patients, as well as friends and family. I highly recommend friends and family members learn all that they can about this disorder and how to help a loved one with this condition. Talk therapy also can be a helpful outlet for loved ones. This helps you discuss worries, hopes, and frustrations in a safe place and find strategies to help your loved one.
 
For patients, maintaining consistent therapy sessions is crucial. Opting for doctors who provide teletherapy or telepsychiatry is an excellent option. This allows you to keep a consistent therapy regimen even if you are away from home or unable to drive to an appointment, etc. A virtual psychiatrist or psychologist treat borderline personality disorder from anywhere you have an internet connection.
 
For some patients, skipping the occasional therapy session isn’t always a problem. However, for people with borderline personality disorder, consistency is crucial and helpful, so an online psychiatrist or therapist can be a good option.
 
I also recommend keeping life as simple as possible, maintaining a daily schedule that includes exercise, a healthy diet, a good sleep schedule and some mindfulness exercises, along with techniques you learn in therapy. Keeping a mood diary also can help you understand what types of events trigger emotional responses and help you to see these situations in a more detached way.
 
For instance, you might look through your mood journal and notice that certain situations consistently trigger feelings of fear, rejection or abandonment. You can discuss these situations with your therapist and come up with strategies that help you work through these issues. 
 
BDT is a complex mental health condition, but it is absolutely not untreatable. I firmly believe that with consistent treatment people with BDT can enjoy happier, more successful lives and see a significant reduction in symptoms. The key is to seek treatment and stay consistent with therapy and medications.
 
Despite what you may believe about yourself – you are a worthy human being, and you deserve to have a better life. Not one of us humans is perfect, and we all must work to become the best versions of ourselves. With BPD, it can be tough because you are struggling with a mental health disorder and that’s not your fault, but it’s not impossible to treat and help is out there.
 
If you are searching for a psychiatrist in Westlake Village, I treat patients in person from all over the Los Angeles area. If you live outside of this area or prefer telepsychiatry, I can provide diagnosis and treatment plans via telepsychiatry. In addition to BPD, I also work as an ADHD psychiatrist, addiction psychiatrist, and bipolar psychiatrist and treat anxiety, depression, eating disorders and many other mental health conditions. Give me a call today and let’s get you on a path toward wellness and a better life!