At this point in time, clinical theorists believe that biogenetic and environmental components are both necessary for the disorder to develop. These factors are varied and complex. Many different environments may further contribute to the development of the disorder. Families providing reasonably nurturing and caring environments may nevertheless see their relative develop the illness. In other situations, childhood abuse has exacerbated the condition. The best explanation appears to be that there is a confluence of environmental factors and a neurobiological propensity that leads to a sensitive, emotionally labile child.
Borderline Personality Disorder rarely stands alone. BPD occurs with, and complicates, other disorders.
Co-morbidity with other disorders:
Major Depressive Disorder -- 60 percent
Dysthymia (chronic, moderate to mild depression) -- 70 percent
Eating Disorders -- 25 percent
Substance Abuse -- 35 percent
Bipolar Disorder -- 15 percent
Antisocial Personality Disorder -- 25 percent
Narcissistic Personality Disorder -- 25 percent
One of the preliminary questions confronting families/friends is how and when to place confidence in those responsible for treating the patient. Generally speaking, the more clinical experience the treatment provider has had working with borderline patients, the better. Most often, a good "fit" with the primary therapist is the "key" to successful therapy intervention.
A discussion of hospitalization and treatment techniques, including specialized treatment for BPD, follows:
A. Hospitalization: Hospitalization in the care of those with BPD is usually restricted to the management of crises (including, but not limited to, situations where the individual’s safety is at risk). It is not uncommon for medication changes to take place in the context of a hospital stay, where professionals can monitor the impact of new medications in a controlled environment. Hospitalizations are usually short in duration.
B. Medications play an important role in the comprehensive treatment of BPD. For more on this topic, refer to the section on this website "Medications Used and Studied in the Treatment of BPD".
C. Psychotherapy: Psychotherapy is the cornerstone of most treatments for Borderline Personality Disorder. Although development of a secure attachment to the therapist is generally essential for the psychotherapy to have useful effects, this does not occur easily with the BPD diagnosed individual, given the intense needs and fears about relationships. The standard recommendation for individual psychotherapy involves one to two visits a week with an experienced clinician. The symptoms of the disorder can be as difficult for professionals to experience as those experienced by family members. Some therapists are apprehensive about working with individuals with this diagnosis.
There are currently three major psychotherapeutic approaches to treatment of BPD:
D. Group Modalities: DBT and CBT interventions are often like classes with much focus and direction offered by the group leader(s) and with homework/practice exercises assigned between sessions based on the material presented during the session. DBT, for example has a manual that is followed each week where both the lectures and the practice exercises are put together for easy access. Some patients with BPD may be resistant to interpersonal or psychodynamic groups which require the expression of strong feelings or the need for personal disclosures. However, such forums may be useful for these very reasons. Moreover, such groups offer an opportunity for borderline patients to learn from persons with similar life experiences, which, in conjunction with the other modalities discussed here, can significantly enhance the treatment course. Many individuals with BPD find it more acceptable to join self-help groups, such as AA. Self-help groups that provide a network of supportive peers can be useful as an adjunct to treatment, but should not be relied on as the sole source of support.
E. Family Therapy: Parents, spouses and children bear a significant burden. Often, family members are grateful to be educated about the borderline diagnosis, the likely prognosis, reasonable expectations from treatment, and how they can contribute. These interventions often improve communication, decrease alienation, and relieve family burdens. Some mental disorders, as in the treatment of schizophrenia, require close family involvement in the treatment process to be optimally effective. There are now preliminary research data that suggest that family involvement is also very important in the effective treatment of borderline disorder.
Several organizations offer education programs and/or support to families challenged with mental health issues. The National Alliance on Mental Illness (NAMI), The National Education Alliance for Borderline Personality Disorder (NEA-BPD), The Depression and Bipolar Support Association (DBSA) and the Mental Health Association(MHA) offer programs across the nation.
Family training and support programs such as NAMI’s Family to Family and NEA- BPD’s Family Connections (www.neabpd.org) are in great demand. Nonetheless, too often many psychiatrists and other mental health clinicians continue to deny meaningful input from family members of a client with BPD. This situation is especially frustrating for family members, who often provide the sole financial support for everyday living and treatment expenses, and much of the moral support, but who receive little or no response from the treating professionals. Families are especially distressed when the treatment plan is not effective, and their loved one isolates them from their therapists. Given the importance of the family in establishing functional relationships in the lives of people with borderline disorder, families should actively seek "family friendly" treatments and/or treatment providers and investigate family classes and support groups in their communities.