McLean Hospital – 115 Mill Street, Belmont, MA 02478
What is borderline personality disorder (BPD)? How is it treated? Learn more about this condition and find support, treatment options, and educational resources.
Borderline personality disorder 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.
Individuals with BPD 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.
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.
At McLean Hospital, we know what it means to have borderline personality disorder (BPD), and we are here to help. We combine the highest quality care, research, and clinical training to provide unparalleled specialty services for adolescents and adults living with BPD. Offering individual and family services that have proven results, McLean has specialized residential and partial hospital (day) programs and outpatient care—as well as an array of treatments for coexisting diagnoses and symptoms such as depression, anxiety, addiction, and trauma.
Our specialized therapeutic approaches, including dialectical behavior therapy (DBT) and mentalization-based treatment (MBT), help patients with the goal of improving interpersonal and relationships skills and reducing self-destructive behaviors.
Services include individual and group therapy, family therapy, comprehensive psychiatric and medical assessments, customized treatment plans and aftercare planning, medication evaluation and management, and patient education and support.
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.
The Gunderson programs—Gunderson Residence and Gunderson Outpatient Program—offer highly specialized therapeutic approaches for individuals with borderline personality disorder and other severe personality disorders, including those who experience co-occurring psychiatric conditions such as substance use, eating disorders, depression, or anxiety. These self-pay programs are best suited to those who have BPD and other complex personality disorders, who are seeking treatment for core issues related to personality disorders such as emotion dysregulation, self-harm, suicidality, and relationship difficulties, and who struggle with self-image problems, feelings of self-doubt, intense fear of abandonment, and low self-worth.
Hill Center for Women
This 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.
Behavioral Health Partial Hospital Program
This day program helps individuals to develop skills that improve their mood and ability to function in hopes of allowing them to better cope with life circumstances. To achieve this mission, the BHP utilizes cognitive behavior therapy (CBT) approaches (including dialectical behavioral therapy skills) for a wide range of conditions such as mood and anxiety disorders, depression, personality disorders, bipolar disorder, and substance use disorders. BHP is useful as a step-down transition from acute inpatient care or as an alternative to inpatient treatment.
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.
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.
Treatment for BPD focuses on behavioral therapies or psychotherapies and medications, as appropriate to the specifics of the individual’s symptoms.
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 (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 (e.g., 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.
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 (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 (e.g., 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 (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.
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.
You may find the following resources useful for more information on BPD:
Borderline Personality Disorder Patient and Family Education Initiative
Thanks to philanthropic support, McLean Hospital launched this initiative in 2015 to provide interactive and on-demand resources to support individuals and families affected by BPD. This series of original, clinician-led webinars provides patients and families with an array of information specific to living with and helping someone with BPD. Topics include DBT, symptoms in adolescents, treatment resistance, intersection of BPD with other conditions like PTSD and addiction, narcissistic personality disorder, and much more. Other resources, including in-depth information about BPD and access to referral information for treatment, further equip family members with the skills, knowledge, and confidence to support a loved one with 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 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 BPD Family Guidelines, The Family Connections Program, and Family Education Workshop videos.
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.
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.
McLean Hospital faculty have penned more than 50 books in recent years, including these books about borderline personality disorder:
Beyond 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 Management (GPM) for Borderline Patients
by John G. Gunderson, MD, with Paul S. Links, MD, FRCPC
(American Psychiatric Association Publishing, 2014)
Borderline Personality Disorder in Adolescents: a Complete Guide to Understanding and Coping When Your Adolescent Has BPD
by Blaise Aguirre, MD
(Fair Winds Press, 2007)
Understanding 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)
Identifying and Understanding the Narcissistic Personality
by Elsa F. Ronningstam
(Oxford University Press, 2005)
Borderline Personality Disorder
by Mary C. Zanarini, ed.
(Taylor & Francis, 2005)
Borderline Personality Disorder: A Clinical Guide
by John G. Gunderson
(American Psychiatric Association Publishing, 2001)
Psychotherapy for Personality Disorders
by John G. Gunderson and Glen O. Gabbard, eds.
(American Psychiatric Association Publishing, 2000)
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