Frequently Asked Questions about Borderline Personality Disorder (BPD)

In honor of the month of May being Borderline Personality Disorder (BPD) Awareness Month, we sat down with the Founder & CEO of Cincinnati Center for DBT, Dr. Nikki Winchester, to ask her some frequently asked questions about BPD.

 

Dr. Nikki Winchester, Cincinnati DBT therapist, sits behind two tumblers that read "DBT Boss" and two DBT Teams books.What should loved ones be looking for if they suspect their loved one may be living with borderline personality disorder (BPD)?

One thing would be self-harm and suicide attempts.  The tricky thing about self-harm is that often people can be discrete about self-harm, so it may not be obvious to the family.  Other potential signs are if there seem to be a lot of out-of-control, up-and-down that seem inexplicable, or fears of abandonment when the person doesn’t want to be alone without them. If the person is using very dysfunctional ways to cope with significant problems with emotion regulation, that’s a big sign to look out for.

 

Four DBT books used by Comprehensive DBT therapists at Cincinnati Center for DBTWhat are the first steps someone should take to get help for borderline personality disorder?

The number one thing is to start researching and find a clinician who is well-trained in dialectical behavior therapy (DBT). Seek out a DBT clinician in your area.  It’s really important that the person is working with someone who is well-trained in how to work with BPD.  There are a lot of clinicians out there who might take a brief training or workshop in DBT and then advertise as providing DBT but they don’t know how to do DBT adherently.  To be able to provide DBT as it was designed by Dr. Marsha Linehan, clinicians must receive a lot of training and supervision and work with a team of DBT clinicians.  Unfortunately, a lot of clients don’t know to look for that – they see that DBT is checked off on a clinician’s profile and they don’t know what to look for or what questions to ask.  Depending on where the clients is at, they may not have the energy or desire to do that research, but it could be a life-or-death matter  We know that the outcomes are better when clinicians provide DBT adherently. Is the clinician part of a team of other DBT clinicians that’s meeting weekly?  Are they providing all four modes of DBT?  The resource to look for is the DBT-Linehan Board of Certification:  dbt-lbc.org.  Clients can find DBT-LBC certified clinicians and programs on the website, which is important because DBT-LBC is the only DBT certifying body that’s endorsed by Dr. Marsha Linehan, who created the treatment.  DBT-LBC certification is a rigorous process to go through and is the gold-standard in knowing that your clinician is doing what they say they’re doing.

 

Dr. Nikki Winchester, DBT therapist at Cincinnati Center for DBT, sits on a couch and writes in a notebook, considering what questions clients should ask their prospective DBT therapistsWhat advice do you have for someone seeking treatment for borderline personality disorder?

When someone has BPD, they may not know about DBT, they’ve probably tried a lot of treatments and may have even been in therapy since they were kids – they can get to the point where they feel like nothing’s going to work.  Don’t give up.  An evidence-based treatment is out there that can be helpful.  There is hope and I personally have seen so many people who thought that this was the end of the line and they did DBT and they built a life that they experienced as worth living.  It’s truly a life-changing treatment and it’s really focused on helping people have that life worth living.   Find adherent DBT (Dbt-lbc.org). Look for all four modes of treatment and all four skills modules.  Ask questions (you can find a list of relevant questions at this link: What is Comprehensive DBT?), Don’t be afraid to ask about the training your prospective clinician has had, if they provide phone coaching, or if they’re on a DBT consultation team.  DBT is an investment – financially, emotionally, and with time and energy; you want to make sure you’re getting what you think you’re paying for.  A lot of clinicians will offer DBT only after a few days of training but they don’t really get the spirit and principles of DBT and that’s critical.  We’ve got research that shows that suicide attempts go down when DBT is done adherently.  You want to ask those questions to make sure you’re getting DBT as it was designed by Dr. Linehan.  I know cost can be a factor, but one thing to consider is that when you get adherent DBT, there’s a lot of research that shows cost-effectiveness, meaning that, yes, it may be a big investment upfront, but people end up saving money by avoiding inpatient hospitalizations, emergency room visits, and years of therapy that doesn’t work. If you look at it that way, the investment is very much worth it.



Dr. Nikki Winchester, DBT therapist at Cincinnati Center for DBT, sits on a windowsill considering myths about borderline personality disorder (BPD)What are some myths that people believe to be true about borderline personality disorder that are actually false?

There are a lot of myths out there.  Unfortunately, there are a lot of misconceptions and stigma about BPD that I wish would be corrected.  One is that people with BPD will never get better.  That’s completely false.  I have seen, through DBT, people improve and no longer meet criteria for BPD.  You can get better and we have research that shows that as people with BPD get older, their symptoms tend to decrease over time.  It’s not something that is always around forever.

Another myth is that people with BPD are all the same and manipulative or over-the-top.  Remember, there are nine criteria and a person has to meet five criteria to receive the diagnosis, so that means there are a ton of different combinations of symptoms and it can look very different from person to person.  As far as the manipulation piece, this is a large part of the stigma associated with the disorder.  When it comes down to it, all humans are manipulative.  We all do things to influence other people to get what we want and that can be truly effective.  If someone with BPD is manipulative, they’re not very good at it because they tend to be really obvious.  Usually, they don’t really know how to get what they want effectively.

To learn more about Borderline Personality Disorder (BPD), click here: Borderline Personality Disorder Treatment

To learn more about Dialectical Behavior Therapy (DBT), click here: What is Comprehensive DBT?