Borderline Personality Disorder (BPD): What Started Dialectical Behavior Therapy (DBT)

Mood swings with feelings of euphoria to deep depression. Intense anger that causes you to lash out immediately followed by extreme guilt. Impulsive and potentially dangerous behavior. Chronic feelings of emptiness and suicidality. These are some common characteristics of Borderline Personality Disorder (BPD). BPD is categorized as a personality disorder. These mental disorders are typically categorized by an unhealthy pattern of thinking, functioning, and behaving. 

Dialectical Behavior Therapy or DBT was created by Marsha Linehan who was diagnosed with BPD herself. Initially diagnosed with schizophrenia and treated with electroconvulsive therapy, Linehan felt that she should have instead been diagnosed with BPD, especially since she dealt with suicidal behavior, a common symptom of BPD. 

Linehan studied psychology in her undergraduate and graduate programs and continued on to teach psychology, psychiatry, and behavior sciences. During her work, Linehan realized two important concepts within mental health:

1. To achieve meaningful and happy lives, people must learn to accept things as they are.
2. Change is necessary for growth and happiness

These two concepts laid the foundation for DBT. Using concepts from Cognitive Behavioral Therapy (CBT) and her own experience with mental health, DBT was born.

For individuals with BPD, it can be incredibly difficult to manage emotions. This lack of control then often leads to impulsivity and can affect how the individual sees themself. DBT sought to give individuals skills to help navigate these emotions and interrupt impulsive thoughts and behaviors. The four key skills of DBT are mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. Below are how each skill can help with BPD.

Mindfulness

Mindfulness skills are broken up into two types, “what” skills and “how” skills. “What” skills teach you how to be fully present in the moment; observe, describe and participate fully in what is currently going on. These skills help resolve impulsive or emotion-driven behaviors as you are present without awareness of impulsive thoughts. “How” skills focus on being effectively present in the moment without having a judgmental mindset and focusing on one thing at a time. Individuals with BPD often ruminate on the past or future and these skills help keep you focused on what is the “here and now.”

Interpersonal Effectiveness

Relationships can be a difficult thing to maintain for someone who struggles with BPD. Often, individuals have a history of abuse, neglect, or invalidation that leads to insecure attachment which affects relationships later in life. Interpersonal effectiveness teaches people how to ask for what they need, how to say “no” to inappropriate demands and cope with interpersonal conflict. The goal is to maintain respect for yourself in addition to holding onto meaningful relationships. 

Emotional Regulation

people who are diagnosed with BPD struggle with intense emotions that often feel uncontrollable. These intense emotions can often lead to dysfunctional behaviors, especially behaviors that work to avoid negative emotions. Emotional regulation helps you to regain control over personal emotions. By working to identify emotions, you can begin to understand the function of the behavior the emotion leads to. Once you’ve identified the emotions, you can begin to change emotions and behaviors. 

Distress Tolerance

Distress is something everyone experiences. But for people with BPD, this distress can feel chronic or debilitating. Distress Tolerance teaches you how to experience your current situation non-judgmentally without trying to change it. It is important to note that accepting your situation does not mean you must approve it. Through crisis survival and acceptance strategies, you can learn how to soothe and adjust your thoughts in the moment. 

While there is no cure for BPD, Dialectal Behavior Therapy can begin to provide hope and the tools to support people struggling with BPD. Schedule a session with a DBT specialist today.

Sources:

Dialectical Behavior Therapy | Behavioral Research & Therapy Clinics. (n.d.). Retrieved March 16, 2023, from https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/

Linehan, M. (2015). DBT skills training manual (Second edition). The Guilford Press.

May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The Mental Health Clinician, 6(2), 62–67. https://doi.org/10.9740/mhc.2016.03.62

Moeller, F. G., Barratt, E. S., Dougherty, D. M., Schmitz, J. M., & Swann, A. C. (2001). Psychiatric Aspects of Impulsivity. American Journal of Psychiatry, 158(11), 1783–1793. https://doi.org/10.1176/appi.ajp.158.11.1783