Effective Treatment for Borderline Personality Disorder and Self-Harm

Available with English captions.

A conversation with Karen L. Jacob, PhD, and Anna Precht, PsyD, on research-backed treatments for BPD.

Successfully Treating BPD & Self-Harm

While borderline personality disorder (BPD) is treatable, it is a serious condition that needs to be managed effectively. Jacob and Precht offer an in-depth look at proven treatment methods and what is important to know about them.

Watch now to learn more about:

  • Which treatments are available for BPD
  • How diagnosis and treatment for BPD have evolved in recent decades
  • How patients and families can find effective treatment

In this session, Jacob and Precht review the myths of BPD, such as the belief that the condition only affects women. They point out that one of the biggest misperceptions surrounding the disorder is that people who experience the condition are “manipulative” when they engage in self-harm or use other ineffective means to express themselves or seek validation.

“To label [the behavior] as ‘manipulative’ in this pejorative way makes the patient feel really terrible,” Precht says. She offers an alternative way of looking at the behavior: “When we frame it as ‘they’re trying to get their needs met, and they don’t know how else to do it,’ the judgment falls away.”

Jacob and Precht clarify the function of self-harm in BPD, and how to differentiate it from suicidal behaviors. They also discuss how self-harm can present differently in BPD than in other conditions, such as self-harm OCD.

“What I would encourage us to do as practitioners is to really look at the function of what self-harm is and why people may be self-harming,” Jacob explains. “It may actually align with a borderline diagnosis or it may align with other diagnoses, and therefore would guide treatment very, very differently.”

In their talk, the experts review the history of BPD diagnosis and treatment within the profession. They provide a detailed overview of BPD treatments, including:

  • Dialectical behavior therapy (DBT), the first empirically supported treatment for BPD, merges cognitive behavioral therapy with mindfulness and includes four treatment modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation
  • Mentalization-based treatment (MBT) is rooted in attachment theory and encourages patients to focus on understanding their own thoughts and feelings, as well as the thoughts and feelings of other people
  • Transference-focused psychotherapy (TFP) is a form of psychodynamic therapy that concentrates on the relationship between the therapist and the patient as a means to change the patient’s behavior and emotions
  • Good psychiatric management (GPM), also known as general psychiatric management, is a manualized treatment that helps non-specialist practitioners treat BPD in a nonjudgmental, validating way

To conclude their talk, Jacob and Precht discuss how people with BPD and their loved ones can find helpful treatment. In addition to providing resources, the experts stress how important it is for family members to receive support, especially if their loved one is resistant to treatment.

Precht states, “For the family members, having the validation skills, the curiosity skills, to be able to manage their own emotions too, is going to be really helpful.”

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Audience Questions

  • What do BPD and self-harm have in common, and when are they separate issues?
  • What should we know about the most common presentations of both BPD and self-harming behaviors?
  • What do we know about the relative prevalence of BPD and self-harming behaviors?
  • What are some of the major misconceptions around BPD?
  • What would you say is stigmatizing about having the diagnosis of BPD?
  • How has treatment for BPD developed over time?
  • What is dialectical behavior therapy (DBT)? How does it work?
  • What is it about DBT that makes it so effective?
  • Can you give us a specific example of what skills coaching might look like for any of these particular skills?
  • Any advice for clinicians to help engage patients in trying new skills?
  • What do group dynamics look like in DBT for BPD?
  • Can you give us a quick overview of MBT, TFP, and GPM? What are those treatment methods and how do they work?
  • What levels of care are common for BPD treatment? When is one a more appropriate choice?
  • Is medication used to treat people with BPD?
  • How do clinicians weigh which BPD treatment option to start with?
  • In a residential setting, how do you manage individuals triggering other individuals?
  • Do the treatment methods outlined work the same with both teens and adults?
  • How can family members and loved ones help someone with BPD find effective treatment?
  • What if that individual is reluctant to start treatment?
  • Any thoughts for clinicians with patients reluctant to try DBT skills in their BPD treatment?
  • Can you share your favorite most-used skill from skills group?
  • Can you discuss in more detail how to assess and respond to non-suicidal self-injurious (NSSI) behaviors such as cutting when they come up during treatment?
  • How can a clinician understand whether someone is using substances in response to a personality disorder?
  • Can you speak to the relationship between manipulation and BPD and what we should know?
  • Any tips for distinguishing between BPD and autism spectrum disorders?
  • Can you walk us through a hypothetical treatment case for someone with BPD?
  • We have spoken about how a BPD diagnosis can be relieving for many people, but what if it creates distress? Why do you think that is, and how can that best be addressed?
  • Is it possible to treat young adults with BPD effectively if their family members are unwilling or unable to engage in the treatment?
  • Is anyone using ECT or TMS to treat self-harm or BPD?
  • What should generalist clinicians know about treating patients with BPD? When should they refer to a BPD expert for support?
  • Is it common for teens to “collect” diagnoses? How can parents approach adding BPD as another label?
  • Can you speak to any important considerations regarding the patient and family’s cultural background when treating BPD?
  • Can you speak to some of the success stories you’ve seen through proper BPD treatment?

The information discussed is intended to be educational and should not be used as a substitute for guidance provided by your health care provider. Please consult with your treatment team before making any changes to your care plan.

Helpful Links

You may also find this information useful:

About Dr. Jacob

Karen L. Jacob, PhD, is the program director of McLean’s Gunderson Residence, a treatment program for individuals with borderline personality disorder and other severe personality disorders. Dr. Jacob’s clinical training has focused on cognitive behavior therapy (CBT) for patients struggling with mood, anxiety, and personality disorders, as well as mindfulness, mentalization, dialectical behavior, and biofeedback therapies.

About Dr. Precht

Anna Precht, PsyD, is a clinical psychologist and a senior clinical consultant at McLean’s Arlington School, a high school for students with mental health challenges. Dr. Precht specializes in the use of evidence-based treatments including DBT and CBT and is particularly interested in the treatment of borderline personality disorder and self-injurious behaviors. She has extensive experience treating adults and adolescents using DBT in a variety of treatment settings.

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Series

BPD & Self-Harm Course 2025

Mental Health Webinars