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Borderline Personality Disorder

What is borderline personality disorder (BPD)? How is it treated? Learn more about this condition and find support and educational resources.

For Patients and Families

Patient care at McLean

The Borderline Personality Disorder Patient and Family Education Initiative offers webinars and other educational resources for individuals and families affected by BPD.

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For Clinicians

McLean conference

The McLean Borderline Personality Disorder Training Institute offers training and resources for clinicians in an effort to make treatment methods for BPD more accessible.

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Condition Information

Borderline personality disorder (BPD) is a complex mental illness marked by unstable moods, behaviors, and relationships. People with BPD may struggle with self-image problems, feelings of self-doubt, intense fear of abandonment, and low self-worth. They often have trouble controlling their emotional reactions, which can lead to self-harm and suicidal behaviors. It is common for people with BPD to have high rates of co-occurring disorders, such as substance use disorders, depression, anxiety disorders, and eating disorders.

BPD can be provisionally diagnosed in adolescents when symptoms persist for more than one year. While by nature the personality of adolescents is still developing, the diagnosis of BPD can be made with great care and on the basis of a thorough history and evaluation of an adolescent’s thinking style, emotional coping patterns, and interpersonal mode of functioning.

Mental health experts agree that the name “borderline personality disorder” can be misleading; however, a more accurate term does not yet exist. The good news is that when BPD is accurately diagnosed, treatment can be successful and individuals can go on to lead meaningful and productive lives.

It’s estimated that 1.6% of the adult US population has BPD but it may be as high as 5.9%. Nearly 75% of people diagnosed with BPD are women, but recent research suggests that men may be almost as frequently affected by BPD. In the past, men with BPD were often misdiagnosed with PTSD or depression.

BPD in the News

Borderline Personality Disorder: Fact vs Fiction by Blaise Aguirre, MD

3East: McLean’s Unique Approach to Adolescent Dialectical Behavior Therapy

Why Do Teens Cut and What Can Parents Do To Help? by Michael R. Hollander, PhD

McLean Gives Self-Destructive Teen Girls the Attention They Need in The Boston Globe

Treatment for BPD focuses on behavioral therapies or psychotherapies and medications, as appropriate to the specifics of the individual’s symptoms. Learn more about types of treatment that may be used in care of those with BPD.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) was created as a treatment model for those with BPD. The method emphasizes the development of four skill sets: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Mindfulness practice involves increasing self-awareness by learning to focus on one’s experience of the present moment. A combination of cognitive behavioral techniques and mindfulness principles are employed to help people gain better control over their impulsive self-destructive behavior and to allow for a different way of managing intense feelings.

DBT was initially developed to treat suicidality in adults with BPD. However, it now is being used effectively in adolescents with similar self-harm behaviors as well as in other co-occurring psychiatric illnesses such as depression and anxiety. DBT has been clinically tested for its effectiveness in adolescents and adults.

Mentalization-Based Treatment

Mentalization-based treatment (MBT) is a manualized, evidence-based treatment that focuses on helping people to differentiate and separate their own thoughts and feelings from those around them. Individuals with BPD often find it difficult to recognize the effect their behavior has on other people, which can lead to interpersonal problems and impulsive behavior. Mentalization refers to the ability to focus and reflect on mental states (i.e., beliefs, intentions, feelings, and thoughts) in oneself and in others. MBT seeks to develop and strengthen the individual’s capacity for mentalization, with the goal of improving interpersonal relationships and affect regulation.

Medications

Currently, there are no medications approved by the US Food and Drug Administration (FDA) to treat BPD. However, many people with BPD are treated with medications, in addition to psychotherapy, that can be helpful in managing specific symptoms such as anxiety or depression.

General Psychiatric Management

General psychiatric management (GPM) for patients with BPD is an evidence-based treatment developed by John G. Gunderson, MD. GPM was designed to be an outpatient intervention that could be easily delivered by community mental health professionals. GPM includes education for patients and their families, a persistent focus on the patient’s life outside of therapy, and a focus on big goals (i.e., stable partnerships and vocations). The treatment is often delivered as once weekly individual therapy and combined with other treatments, such as medication management, family interventions, and group therapy.

Transference-Focused Psychotherapy

Transference-focused psychotherapy (TFP) is a manualized, evidence-based treatment. TFP focuses on the patient’s confused and contradictory sense of identity, which is associated with problems with interpersonal relationships, self-esteem, and mood regulation. TFP helps patients learn to verbalize what they are feeling, rather than acting impulsively on emotions. The ultimate goal of this treatment is to create more stable and realistic experiences of self and others, resulting in increased functioning and satisfaction with interpersonal relationships.

To complement our programs’ services and encourage individuals’ initiatives in their own recovery, many self-help groups are hosted by McLean, including for BPD.

National Education Alliance Borderline Personality Disorder
Thursdays, 6-7:30pm (monthly)
Location: de Marneffe Building, Room 132
Call 617.855.2680 for more information
Men and women are welcome to attend

More information about other groups at McLean can be found on the Support Groups page.

John G. Gunderson, MD
Watch McLean experts speak about borderline personality disorder at monthly NEABPD support groups hosted at McLean

You may find the following organizations useful for more information on BPD:

Behavioral Tech: Training for Mental Health Professionals
Behavioral Tech provides robust training for clinicians, especially in dialectical behavior therapy and other treatments for borderline personality disorder. Behavioral Tech also offers resources for providers and consumers in an effort to bring ever-better treatments to those in need. The organization also supports advocacy efforts and BPD research.

Borderline Personality Disorder Resource Center
The mission of the Borderline Personality Disorder Resource Center (BPDRC) is to promote BPD education and connect those affected by BPD to established resources for treatment and support. The BPDRC is affiliated with the Personality Disorders Institute at New York-Presbyterian Hospital/Westchester Division, and their efforts are overseen by innovators in the research and treatment of personality disorders. Among many resources, the BPDRC maintains a nationwide database of clinicians, agencies, and facilities that focus on treating BPD and co-occurring disorders.

National Education Alliance for Borderline Personality Disorder
This group provides education while raising public awareness and understanding, in an attempt to reduce stigma and promote research and enhance the quality of life of those affected by borderline personality disorder. They work with Congress to enhance the quality of life for those individuals affected by this serious but treatable mental illness.

NEABPD’s many resources include:

New England Personality Disorder Association
NEPDA's mission is to promote education, support, and advocacy in the field of personality disorders, with a concentration on borderline personality disorder (BPD). NEPDA sponsors workshops, conferences, and small-group meetings for family members, friends and other loved ones, consumers of mental health services, professionals, and the community at large in order to improve awareness of personality disorders and reduce the stigma that is often associated with them.

Personality Disorder Awareness Network (PDAN)
A not-for-profit organization dedicated to increasing public awareness of personality disorders, alleviating the impact of personality disorders on families, and preventing the development of personality disorders in children.

The Personality Studies Institute
The Personality Studies Institute is a community of clinicians interested in the relation between personality, emotional adjustment, and mental health. PSI provides training and resources for professionals.

Treatment and Research Advances Association for Borderline Personality Disorder
The TARA for Borderline Personality Disorder’s mission is to foster education and research in the field of personality disorders, specifically but not exclusively, borderline personality disorder. They support and encourage educational programs and endeavors targeting mental health professionals, consumers of mental health services, families, and communities in order to reduce stigma and increase awareness, to disseminate available information on etiology and treatment, and to advocate for accomplishments of these goals.

The following videos may be useful for more information on borderline personality disorder.

Be sure to also check out the webinar archive from the Borderline Personality Disorder Patient and Family Education Initiative.


“Validation”

BPD Family Education Workshop
Elizabeth T. Murphy, PhD, Adult Outpatient Services

Dr. Murphy defines and describes the dialectical behavior therapy (DBT) strategy of validation, with particular focus on how and what to validate as a family member. She reviews what is and is not validation and defines levels of validation.

Watch now


“Rejection Sensitivity in BPD”

BPD Family Education Workshop
Claire Brickell, MD, Gunderson Residence

Dr. Brickell discusses the transactional model of BPD as it relates to attachment styles and vulnerabilities in patients with borderline personality disorder. She reviews the common BPD symptoms rejection sensitivity and abandonment fears within relationships.

Watch now


“Suicide in BPD”

BPD Family Education Workshop
Igor Weinberg, PhD, Adult Outpatient Services

Dr. Weinberg discusses suicidality, a symptom that many patients with borderline personality disorder struggle with. He identifies types of suicidality, ways of responding to each, and relevant research in the field.

Watch now

McLean Hospital faculty have penned more than 50 books in recent years, including several titles on BPD, DBT, and related topics.

Coping with BPDCoping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder
by Blaise Aguirre, MD and Gillian Galen, PsyD
(New Harbinger, 2015)


Mindfulness for Borderline Personality DisorderMindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy
by Blaise Aguirre, MD and Gillian Galen, PsyD
(New Harbinger, 2013)


Borderline Personality Disorder in AdolescentsBorderline Personality Disorder in Adolescents: a Complete Guide to Understanding and Coping When Your Adolescent Has BPD
by Blaise Aguirre, MD
(Fair Winds Press, 2007)


Borderline Personality and Mood DisordersBorderline Personality and Mood Disorders: Comorbidity and Controversy
edited by Lois W. Choi-Kain, MEd, MD, and John G. Gunderson, MD
(Springer, 2015)


Beyond BorderlineBeyond Borderline: True Stories of Recovery from Borderline Personality Disorder
By John G. Gunderson, MD, Perry D. Hoffman, PhD
(New Harbinger Publications, 2016)


Handbook of Good Psychiatric ManagementHandbook of Good Psychiatric Management (GPM) for Borderline Patients
by John G. Gunderson, MD, with Paul S. Links, MD, FRCPC
(American Psychiatric Association Publishing, 2014)


Understanding and Treating Borderline Personality DisorderUnderstanding and Treating Borderline Personality Disorder: A Guide for Professionals and Families
by John G. Gunderson, MD, and Perry D. Hoffman, PhD
(American Psychiatric Association Publishing, 2005)


Borderline Personality DisorderBorderline Personality Disorder: A Clinical Guide
by John G. Gunderson, MD
(American Psychiatric Association Publishing, 2001)


Psychotherapy for Personality DisordersPsychotherapy for Personality Disorders
by John G. Gunderson, MD, and Glen O. Gabbard, MD, eds.
(American Psychiatric Association Publishing, 2000)


Indentifying and Understanding the Narcissistic PersonalityIdentifying and Understanding the Narcissistic Personality
by Elsa F. Ronningstam
(Oxford University Press, 2005)


Borderline Personality DisorderBorderline Personality Disorder
by Mary C. Zanarini, ed.
(Taylor & Francis, 2005)

McLean has a number of treatment options for adolescents and adults focused on treatment for BPD:

3East
McLean’s adolescent dialectical behavior therapy programs, collectively known as 3East, provide specialized care for teens and young adults who require treatment for depression, anxiety, post-traumatic stress disorder (PTSD), and emerging borderline personality disorder (BPD). The programs in the 3East continuum are specifically designed to accommodate patients in different phases of the treatment and recovery process, from highly focused residential treatment to outpatient care. We have intensive treatment tracks for both boys and girls, and our day program (partial hospital) and outpatient program are coed.

Gunderson Residence
This specialized, self-pay, residential treatment program is ideal for women ages 21 and older with personality disorders, including those whose personality disorders are complicated by one or more other psychiatric illnesses such as depression or anxiety. Located in Cambridge, Massachusetts, Gunderson offers structured, tailored treatment in a comfortable, supportive setting designed to foster independence and optimal functioning. Our expert clinical care and psychiatric services are supplemented by rich community resources for academic, occupational, and social opportunities in the greater Boston area.

Hill Center for Women
The insurance-based program offers psychiatric and psychological services for women with histories of trauma and related disorders such as post-traumatic stress disorder, dissociative disorders, borderline personality disorder, and mood and anxiety disorders. Empathy, compassion, collaboration, and empowerment are emphasized in order to help women build strength and regain control of their lives. The program provides intensive dialectical behavior therapy (DBT) with a specialized emphasis on the treatment of self-destructive or impulsive behavior and emotional dysregulation as they present in survivors of early, repeated traumatic experiences. Both residential and partial hospital (day program) levels of care are available.

Gunderson Outpatient Program
A self-pay program for adults with borderline personality disorder as well as other complex personality disorders or co-occurring conditions such as depression, anxiety, trauma, eating disorders, and substance use disorders. The program offers individualized care in an outpatient setting with a focus on establishing stability and safety while working towards encouraging patient self-reliance. A staff of expert clinicians provides diagnostic assessment, individual and group therapy, medication management, family therapy, case management, and ongoing treatment review.

McLean Hospital has been at the forefront of BPD research. Our researchers have provided critical insight into the causes and treatment of BPD, and today continue to look for more knowledge on the disorder in order to find improved treatment methods.

John G. Gunderson, MD, is a pioneer in BPD research. His seminal studies on BPD helped transform the diagnosis from a psychoanalytic construct into an empirically validated (scientifically proven) and internationally recognized disorder and earned him recognition as the “father” of this disorder. He also developed the evidence-based therapy general psychiatric management (GPM), which he and fellow McLean clinicians teach throughout the country.

Lois W. Choi-Kain, MEd, MD, is the medical and program director of the Gunderson Residence and director of the Borderline Personality Disorder Training Institute at McLean Hospital. Her areas of specialization include attachment, personality disorders, and psychotherapy, along with an integration of evidence-based treatments for BPD. In addition to her clinical work, she actively conducts research and publishes papers on BPD while also providing training for clinicians in general psychiatric management (GPM) and mentalization-based treatment (MBT) approaches.

Mary C. Zanarini, EdD, is the director of the Laboratory for the Study of Adult Development, which has been a part of many landmark discoveries in the field of BPD research. Her group of clinician-scientists was integral to the validation of BPD as a psychiatric disorder, and their work has also led to a now widely held theory of the causes of BPD. Dr. Zanarini has created numerous scales for assessing BPD in individuals and is a lead investigator in a number of longitudinal studies collecting research data on BPD over time.