How to recognize borderline personality disorder and determine if someone can benefit from DBT

1. Recognizing Borderline
Personality Traits:
How to know if someone
can benefit from DBT
Paula Mendenhall, LMHC, LPHA

2. Personality Disorder
An enduring patter of inner experience
and behavior that deviates markedly
from the expectations of the individual's
culture. This pattern is manifested in two
or more ways:
Cognition
Affect
Interpersonal Functioning
Impulse Control

3. Borderline Personality Disorder
Pervasive pattern of instability in:

Interpersonal relationships

Self Image

Affect

Marked Impulsivity

Beginning in early adulthood

Present in a variety of contexts


4. Five or More of these
Frantic efforts to avoid abandonment

Pattern of intense, unstable relationships –

idealization & devaluation
Identity disturbance: unstable image of self

Impulsivity in at least 2 areas that are potentially self

damaging
Recurrent suicidal gestures, threats OR self

mutilation
Mood instability, reactivity of mood

Chronic feelings of emptiness

Inappropriate intense anger or difficulty controlling

anger
Transient, stress related paranoid ideation or severe

dissociative symptoms

5. BPD in a nutshell
“Borderline individuals are the psychological equivalent of third-
degree-burn patients. They simply have, so to speak, no emotional
skin. Even the slightest touch or movement can create immense
suffering.”
Marsha Linehan
“The methods of self-harm that borderlines choose can be
gruesomely creative. One psychologist related to me an incident of
a woman who used fingernail clippers to pull off slivers of her skin.”
“BPD is a disorder that could be called the ‘I don’t fit in’ disorder”.
“Back from the Edge”, Borderline Personality Disorder Resource
Center
quot;Everyone talks about [BPD], but it usually seems that no one
knows quite what to do about it.“
Duke University Psychiatrist

6. Emotional Chaos
“People with BPD seem to have no internal governor.
They are powerfully connected to the people close
to them and terrified by the possibility of losing them
- yet they attack those people so unexpectedly that
they often ensure the very abandonment they fear.
When they want to hold, they claw instead! What
defines BPD -and makes it so explosive - is the
sufferers' inability to modulate their feelings and
behavior. When faced with an event that makes
them depressed or angry, they often become
inconsolable or enraged”.

7. BPD ~ What to Look For
• History of hospitalization or baker acts;
• Suicide attempts and other self destructive,
impulsive threats/acts;
• Demanding or aggressive behavior;
• Problems with identifying a sense of self (self
invalidation);
• Problems regulating their emotions: over or
undercontrolled emotions;
• Unrelenting crises: DRAMA
• Apparent competence, Active Passivity
• Pervasive problems with interpersonal relationships
– very limited support system, isolation;

8. Things you may notice
• You are becoming uncommonly frustrated/angry at
the individual;
• You become uncommonly close to the individual
(wanting to rescue);
• Symptoms tend to improve spontaneously as they
age
– They may tell you they USED to cut
– They may have had a decrease in
hospitalizations
– They may no longer keep suicide as an option
when they have children
– They may find a stable relationship, eventually

9. Facts of BPD
Effects 1-2% of population; but is grossly under diagnosed;

Mostly female 70%;Males are often diagnosed with anti-social

personality
75% engage in deliberate self-harm such as cutting, burning,

picking skin;
73% attempt suicide; 4 - 10% commit suicide;

Affects all cultures, levels of intelligence and social classes;

Co-exists with other disorders (bipolar disorder, mood, anxiety,

eating disorders, substance abuse,PTSD, dissociative, and
psychotic); About 69% have a substance abuse problem
versus 9.5% in general population
Increased family history for Substance-Related Disorders (e.g.,

drug abuse), Antisocial Personality Disorder, and Mood
Disorders, like depression or bipolar disorder;
Quite often a history of abuse(75%): sexual, emotional or

physical; early loss of parent or sibling (38%).

10. How Does BPD Cause Problems
Borderline personality disorder makes it hard for the

person to maintain relationships, sometimes jobs,
and in general, stability. People with this disorder
often cause a great amount of stress or conflict in
relationships with others, especially significant
others and close family members.
It is not uncommon to see many unrelenting crises

in the BPD’s life: divorce, physical, sexual or
emotional abuse, substance abuse, additional
emotional problems (such as an eating disorder or
depression), self-harm, job instability, estrangement
from one’s family, and much more.

11. You might be dealing with BPD IF:
They tell you things have been
You can’t seem to get them to think 

bad for a long time and they are
differently about things – Black and
always misunderstood. They say
White, “all or nothing” thinking.
they have been in therapy a long
Their emotions seem to get the best

time.
of them and they are highly reactive
They are acting in self defeating,
and can’t seem to calm down. 
impulsive or emotionally extreme
Their lives are in chaos, or they have

ways and they are NOT on drugs
many crises.
or alcohol.
They tell you there is nothing wrong 

They try to play you against
with their behavior and attitude --
another person.
it’s the other person who doesn’t
They are obviously trying to
understand! 
manipulate – and don’t disguise it
They just don’t seem to be able to

well. If they were skilled at it, you
function in a consistent way.
wouldn't know you were being
manipulated.

12. Linehan, Marsha M. 1993. Skills Training Manual for Treating Borderline Personality Disorder. The Guilford Press, New York, NY.

13. WWHY I FEEL SO BAD GRAPH
I
10
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E
5
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NEW BASELINE
S
I
T
Y
0
TIME IN HOURS 1 2 3 4 5

14. Two levels of functioning:
High Functioning-Acting Out Low functioning-Acting In
•Episodes of raging •Episodes of self harm
•Holds a job – with •Threats of suicide or attempts
responsibility •Unable to hold job or working
•Is capable of maintaining below level
friendships •Trouble with ADLs
•Can act “normal” when •Risky behaviors
necessary
•Primary emotion:
•Primary emotion: ANGER FEAR/ANXIETY

15. The Four Sub-Types
Ego centric, narcissistic type: Attention
seeking; high expectations of others.
Anti-social type: Self hatred, can be cruel to
others without remorse. Jealous, critical, easily
slighted.
Shame based type: Overwhelming feelings of
worthlessness, helplessness, hopelessness and
despair. Very fearful.
Isolative type: Fearful, seek control, potential
for disaster everywhere. Critical of others -
reflects their inner shame.

16. Criteria for DBT
Borderline personality disorder OR borderline traits

Ability to comprehend written material

Cognitively functioning at at least an 8th grade level

Ability to remember and apply new learning

Substance abuse manageable

Refer for SA first if severe

Motivation for treatment

Voluntary

Ability to attend classes eventually and to keep

regular appointments

17. ONLINE TEST FOR BPD
http://www.slshealth.com/behavioral
•
Self help
•
Exclusive self tests
•
Borderline Personality Disorder
•

18. References
American Psychiatric Association, 1994. Diagnostic and Statistical
Manual IV, Washington, DC
Back from the Edge, Borderline Personality Disorder Resource Center,
New York Presbyterian Hospital, Westchester Division, White
Plains, NY.
BPD Today Newsletter, Available on line:
www.borderlinepersonalitydisordertoday.com
Linehan, Marsha M. 1993. Cognitive Behavioral Treatment of
Borderline Personality Disorder, The Guilford Press, New York, NY.
Kreger, R. & Shirley, JP, 2002. Walking on Eggshells, New Harbinger
Publications, Oakland, CA.
The Angry Heart Therapy Center for BPD, BPD Facts.
Available on line:
http://www.slshealth.com/angryheart/theangryheartbpdcenter.asp