Borderline Personality Disorder – Where Angels Fear to Tread

Several years ago I was invited to give a presentation on Borderline Personality Disorder (BPD). I titled the presentation ‘Busting the Myth of BPD” primarily because many clinicians struggle to treat a BPD diagnosis due to the complexities in dealing with someone who is usually reactive, challenging, and emotionally dysregulated.  In a few weeks, I, together with our Clinical Director, Dr Sarah Lyndon, will be presenting at The Meetings of the Minds conference in Anaheim on Borderline Personality Disorder in a workshop titled “Where Angels Fear to Tread”. Our major objective is to help those in the mental health profession better understand effective treatments for this population and develop empathy towards them. These clients are considered “difficult clients” and frequently do not respond positively to the well-intentioned clinician who can feel emotionally drained working with them.  If clinicians could grasp how much a client with BPD feels misunderstood and alienated, how very much they endure internal suffering, and as Marsha Linehan, the founder of Dialectical Behavior Therapy conveys it, “People with borderline personality disorder (and those like them) are like people with third-degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.” They experience a continuum of unstable interpersonal relationships and a tendency to push people away from them which is contraindicated by their fears of rejection and abandonment. Marsha Linehan, the developer of Dialectical Behavior Therapy, offers four modules in the Dialectical Behavior (DBT) skills-based treatment she designed for people endorsing strong emotions and heightened sensitivity. The Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness Modules are beautifully curated to teach and support those suffering from severe emotional dysregulation. 

Personality Disorders are believed to evolve from a pattern of early childhood invalidating experiences. If you have been given a personality disorder diagnosis you are more likely than most people to have experienced difficult or traumatic experiences growing up, such as neglect, losing a parent or experiencing a sudden bereavement, emotional, physical or sexual abuse.

The Linehan model of Dialectical Behavior Therapy is designed to target emotional escalation by building insight through mindfulness practices, learning skills to improve interpersonal relationships, and learning skills to manage and combat emotional dysregulation.  DBT may not be applicable to everyone, yet everyone can benefit from the learning and embracing the skills taught by the model.

Written By: Dr. Michele Lob LMFT – Executive Director, DBT Center of Orange County

Photo Credit: James Handley on Unsplash

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