Borderline Personality Disorder (BPD) - Treatments
What are the treatments for BPD?
You and your doctor will decide what treatment to try. The main treatment for borderline personality disorder (BPD) is psychological therapy, also called ‘talking therapy’. This may be one-to-one or in a group. There can be long waiting lists for therapy.
We have listed some types of psychological therapies below. Not all of these will be available on the NHS in your area.
Dialectical Behaviour Therapy (DBT)
DBT is helpful for people with BPD. DBT helps you to build skills to deal with distress. Therapists call this ‘emotional regulation’. DBT can help you learn how to control harmful ways of coping with distress, such as self-harming or using drugs or alcohol.
The NHS may offer you a place on a mindfulness course. Mindfulness can help you to manage your emotions by focusing on the ‘here and now’. You may also do mindfulness in DBT (see above).
Cognitive Analytical Therapy (CAT)
CAT helps you to understand problems you have in relationships. You and your therapist will work together to understand these patterns and try change them. This may be useful if you ‘switch’ between liking and disliking people who are close to you.
This sort of therapy may help you if you make assumptions about what other people think or feel. You may base these assumptions on the worst-case scenario rather than more likely explanations. For example, if someone you care about wants to do something by themselves, you might think they don’t care about you, hate you or they will never want to come back. These feelings might make you panic and feel angry.
Mentalising is about understanding other people’s behaviour and your reaction to it. You do this by thinking about thoughts, intentions, needs and desires. It is about being aware of what’s going on in your own mind. This will help you to try to take a more balanced view about what might be going on in other people’s minds. This kind of therapy might help you if you worry about being abandoned.
Schema therapy looks at patterns of behaviour and emotional states. You may act in different ways in different situations, and your therapist might call these ‘modes’. The therapy tries to find the right ‘mode’ for you to move forward and deal with situations in the best way you can.
This therapy focuses on your unconscious. Your unconscious is the part of your mind that controls beliefs, emotions or behaviours without you thinking about them.
Therapists think that past experiences, especially those in your childhood, can affect your unconscious. The therapist will try to link your current problems to past events. This may help to explain why you feel the way you do.
Therapeutic communities are not a treatment themselves. They are places you can go to have treatment. They may be specific for certain groups of people. For example, some may be for young women who have problems with alcohol or drugs. They sometimes have a religious link.
You may stay for a few weeks or months, or you may visit for just a few hours a week. You may have group therapy and self-help sessions. There may also be other group activities such as gardening and help with daily living skills.
Therapeutic communities vary a lot because they are often run by the people who use them and they shape them based on what they want.
There is no medication to treat borderline personality disorder (BPD). But your doctor may give you medication if you have another mental illness like anxiety or depression as well as BPD. They may offer you medication in a crisis, but this isn’t helpful as a long-term treatment.
What treatment should the NHS offer me?
The National Institute for Health and Care Excellence (NICE) offers guidance on what the NHS should offer you. You can find this guidance here. The NICE guidance sets out best practice for the NHS.
You cannot force the NHS to offer you a service that NICE recommends. But if your local NHS doesn’t offer you appropriate treatment then you can complain.
The NICE guidance says your doctor might offer you therapy if your borderline personality disorder (BPD) causes you significant problems. This therapy should not be less than three months. The guidance says that the NHS should offer dialectical behaviour therapy (DBT) to women with BPD if they self-harm regularly.
You may get support from a specialist service if your symptoms are getting worse. The NHS should not refuse to give you specialist help because of your diagnosis. They should have services to support people with BPD.
What if I am not happy with my treatment?
Patient Advice and Liaison Service (PALS)
If you are unhappy about your NHS care or treatment, you could call your local PALS. They can try to help answer your questions about the complaints procedure. You can find PALS’ details here.
An advocate is independent from mental health services. They can help you to voice your opinion and resolve problems. They may be able to help you to write letters or go to appointments or meetings with you.
If you are unhappy with your diagnosis, you could ask for a second opinion. You do not have a legal right to a second opinion, but it is important to ask if it is important to you.
If you cannot resolve the problem, you can make a complaint to have your concerns investigated in more detail.
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