There Is No One Way to Have Borderline Personality Disorder
I have two nephews, Des and Landon, that I dote on considerably. During Thanksgiving, I visited Landon at his parents' house, Landon wanted to show me everything ("Fish! Tree! Light!") and gave me one of his toys. When I visited Des at my parent's house, I held out my arms and he screamed--he thought I was a stranger since I'm not around him every day.
Two one-year-olds. Two different phases of development.
So what does this have to do with borderline personality disorder (BPD)? Just as two one-year-olds may differ, so people with BPD may differ. There is no one way to have BPD.
Symptoms may differ
According to HealthyPlace.com, there are nine symptoms of BPD:
- frantic efforts to avoid real or imagined abandonment, excluding suicide attempts and self-injurious behavior(SIB)
- a pattern of intense, unstable relationships which alternate between extreme love and extreme hate
- unstable sense of self
- impulsiveness in at least two self-damaging areas (binge drinking, eating disturbances, reckless driving, and so forth), suicidal and SIB
- recurrent suicidal behavior and SIB
- unstable mood reactions
- chronic feelings of emptiness
- difficulty controlling intense anger
- stress-related paranoia or dissociation
In order to meet the criteria for a diagnosis of BPD, a person must meet at least five of the nine criteria. If I remember my math correctly, this means that there are more than 15,000 ways for a person to meet the diagnostic criteria of BPD.
Why the differences are important
The sheer number of ways to meet diagnostic criteria for BPD is part of the reason a "one size fits all" approach to treatment may not always be effective. In some cases, it can backfire. When I was at Richmond State Hospital, I told staff I felt suicidal. They ignored me because of their experience with a different person with BPD (their explanation, not mine). This nearly ended with my death.
An individualized treatment plan is important. The therapist and psychiatrist must take into account the person's strengths and weaknesses. It makes little sense to build the self-esteem yet ignore the fears of someone with a healthy self-image yet crippling fear of abandonment. Instead, the treatment team should use the person's healthy self-image to realize that he/she is a good person who will not always be abandoned.
This approach to treatment takes time, however, and therefore is not always the preferred way of doing things. As a result, it's "evaluate, medicate, vacate", as the movie Mr. Jones observed. This is like someone showing up to the ER with a gunshot wound and being treated with adhesive tape. Yes, the treatment may work in the short term for less severe cases, but it does nothing to solve the real problem of a person with significant damage.
Why individualized treatment works
An individualized treatment plan is vital to recovery. Treatment should be tailored to the individual's needs in order to be effective. Since there are more than 15,000 ways to meet the criteria for BPD, it makes little sense for there to be only one way to treat it.
Also vital is an individual's voice in treatment. This is so vital that I moved across county lines in order to be eligible for treatment at a community mental health center that would do just that. Deep inside, we know what we need. We know our strengths and weaknesses. After all, who is the one suffering from BPD? We are all experts on how our diagnosis is impacting our lives.
While some standards may be useful, they must never override an individual approach. No two people are alike. Therefore, no two treatment plans should be alike.Recovery should always be the goal--even if it means thinking and acting outside the proverbial box.
Oberg, B. (2011, November 29). There Is No One Way to Have Borderline Personality Disorder, HealthyPlace. Retrieved on 2022, August 19 from https://www.healthyplace.com/blogs/borderline/2011/11/there-is-no-one-way-to-have-borderline-personality-disorder
Author: Becky Oberg
This was an awesome post. Thanks.
This is absolutely true. At the annual ISITDBT (www.isitdbt.org) conference in 2009, we DBT therapists talked about the heterogeneity in the diagnosis. That said, a treatment like DBT is perfect for BPD because it's principle driven and not protocol driven. It's adaptable and responsive to each client's particular needs.
The flexibility of the treatment approach is reflected in the ways it can be delivered, too. The bottom line is that a treatment needs to be used outside of the therapy setting. To that end, I've created an iPhone app to help. I believe it does the best possible job getting the treatment in a portable form. Please check it out at http://www.diarycard.net or http://itunes.apple.com/us/app/daily-behavior-tracking/id479013889?mt=8