What is borderline personality disorder and how is it treated?

Mental health - What is borderline personality disorder and how is it treated

People with a personality disorder have a rigid and inflexible way of being that causes them problems to relate to. We explain the main symptoms of borderline personality disorder and the different approaches to its treatment.

Mental health - What is borderline personality disorder and how is it treated

If at this very moment I asked you to define yourself, how would you do it? What personality traits would you consider best describes you? Are you an emotionally stable, mature, reserved or sociable person? Are you predisposed towards the vehement expression of your feelings or perhaps shy and withdrawn in your expressions?


Psychologists base the description of a person on the existence of a regular and consistent way of relating to others, of thinking about life experiences, in short, of being.

Taking this into account, we establish what we have called “personality traits”, which are those characteristics of yours that remain stable over time and in different settings, so that all the people who interact with you know more or less what to expect. Of you in relation to how you will behave in different situations.


It may happen that this way of being yours does not contribute to an effective functioning because they are rigid and little adaptive traits to the context in which you move and cause difficulties and problems that interfere in your social, family, and work life.

One of the most pronounced difficulties that personality disorders entail is that, since the personality is built from our childhood and throughout life and this is consolidated over the years, people with a disorder do not see anything wrong in their way of acting because “they have always been like this” and they lack sufficient awareness that they have a problem. For them, it is others who suffer.


A variety of personality disorders have been identified, one of which is borderline personality disorder, which appears in early adulthood.

Following the Diagnostic and Statistical Manual of Mental Disorders, called DSM-V, suffering from Borderline Personality Disorder requires the appearance of five symptoms out of a list of nine:

  1. The person makes desperate efforts to avoid real or imagined helplessness.
  2. A pattern of unstable and intense relationships appears that are characterized by an alternation between the extremes of idealism and devaluation of people.
  3. There is an alteration of identity and there is an intense and persistent instability of the self-image and sense of self.
  4. Presence of high impulsivity.
  5. Behaviors, attitude or recurring threat of suicide or self-harm.
  6. Affective instability due to its high reactivity in its emotional reactions.
  7. Chronic feeling of emptiness.
  8. Inappropriate and intense anger or difficulty controlling anger.
  9. Transient paranoid ideas related to stress or severe dissociative symptoms.


We could go a little deeper into understanding how four major spheres are affected:


They are emotionally unstable people who are easily deregulated with their emotions and express them in a maladaptive way. They frequently experience a wide variety of negative emotions such as:

  • Go to
  • Pain
  • Shame
  • Panic
  • Terror
  • Continued feelings of emptiness and loneliness

They can undergo drastic mood swings in short periods of time, which is disconcerting. For example, it is relatively common for them to have suicidal thoughts accompanied by deep despair, only to feel reasonably positive a few hours later. Some people feel better in the morning and others in the afternoon. The pattern varies, but unpredictable mood swings are the key.


People with borderline personality disorder have distorted ways of perceiving and thinking, characterized by:

  • Negative thoughts: they may think that they are terrible people or feel that they do not exist for others.
  • They may have brief episodes of strange experiences such as hearing voices outside their head for a few minutes with instructions to harm themselves or others. They do not know very well if they are real or not.

Some of these irrational beliefs are psychotic in nature and clearly indicate that the person is getting worse because he loses his sense of reality. In this case, it is very important that they receive professional help.


The effects in this sphere are characterized above all by impulsiveness, which is expressed in two ways:

  • Through self-destructive behaviors. I still remember vividly working as a resident psychotherapist at the Arbours Crisis Center, a therapeutic community in London specializing in the treatment of serious personality disorders that offered support and emotional support 24 hours a day. There, part of my work routine consisted of running in the middle of the night to the emergency room to attend to patients who, immersed in the most critical phases of their despair, relieved their discomfort by subjecting their body to deep cuts or burns– On your arms, legs, stomach, or even your genitals. Many of these people had suffered serious experiences of sexual abuse in their childhood. When the feelings and emotions of depression, emptiness and despair were very intense, they could easily have suicidal thoughts or attitudes.
  • Engaging in reckless impulsive activities such as abusing alcohol or drugs, uncontrolled spending or gambling, or having sex with any stranger without any protection.


They have unstable relationships that easily lead to breakup.

  • They may feel that people are getting too close to them and they find it suffocating.
  • They may also experience an intense fear of abandonment, which causes them a lot of anxiety and also anger. This can lead them to make excessive efforts so that the other person does not leave them such as calling or writing insistently, telephoning in the middle of the night, threatening to commit suicide or harm themselves, etc.


Treatment of borderline personality disorder generally includes a group of professionals such as a psychotherapist psychologist and a psychiatrist specialized in these types of difficulties.

Different psychotherapeutic approaches can be used depending on the intensity and severity of the symptoms that the person deals with.

When the person has a long history of self-harm and long-term emotional problems, it is convenient that there is the option of living in a therapeutic community that offers a welcoming and structured environment where they can learn social coexistence skills and apply comprehensive psychological intervention approaches of greater intensity, which included treatments with: individual and group therapy, therapy through art, body therapy, analysis of coexistence relationships, etc.

  • Treatment should be aimed at creating a space for symbolizing and discussing your problems so that you can achieve a better understanding of your internal world, of how you feel and think.
  • It is key that you learn to better identify and self-regulate your emotions, to think about problems and difficulties in your life, in your relationship with others and in the construction of your self-concept.
  • You will be helped in different ways to approach, find, and explore appropriate ways to solve your problems, deal with frustration, and change maladaptive attitudes and behaviors.

            These disorders can be treated by psychotherapists trained in:

  • Psychodynamic models adapted to borderline personality disorders and severe dissociative states of consciousness created by Dr. Joseph Berke for the London Therapeutic Community “Arbours Crisis Center”.
  • Linehan’s Dialectical Behavioral Therapy.
  • Mentalization therapy, with Otto Kernberg as one of the greatest exponents.
  • Shoenberg & Hayes Acceptance and Commitment Therapy for Certain Psychotic Symptoms.
  • Therapy through art.
  • Body therapies.
  • Specific “Mindfulness” exercises.

All these therapies are suitable for the approach of these disorders and are designed to help patients in their serious difficulties from a new understanding. They will be endowed with internal psychological tools so that they relate to themselves and to others seeking to generate more kind, constructive, enriching, compassionate, and adaptive ways, always inspired by the luminous desire that they be able to use the treasure of their life in what is truly important and meaningful to them.


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