Using Mindfulness to Help Clients Overcome Borderline Personality Disorder

Using mindfulness to treat the suffering that comes with the symptoms of borderline personality disorder is a difficult task because it requires you to attend to what’s going on in your mind. The explicit application of mindfulness used in dialectical behavior therapy provided a way for people with BPD to get unstuck from their judgments and the intense emotions that lead to suffering. Mindfulness also provides BPD sufferers with an effective way to apply other useful coping skills in the midst of emotional pain, because mindfulness teaches people to notice the emotion without reacting in ways that perpetuate suffering. 

Research shows that avoidance of suffering leads to more suffering (Chapman, Gratz, and Brown 2006). Numbing yourself against the torments of life is a solution, but not a very effective one. BPD sufferers are encouraged to use mindfulness to notice their emotions and develop the ability to describe the experience rather than simply act upon it. Recognizing difficult emotions without acting on them can slow one down enough to allow a choice in how one behaves, rather than instinctive action that might make an already miserable situation worse. This also gives one time to validate his or her own emotional experience as authentic and understandable.

Once mindfulness takes hold and the practice is established, suffering begins to melt away. In their book Mindfulness for Borderline Personality Disorder Blaise Aguirre, MD, and Gillian Galen, PsyD, use the example of Patrick, a young man with BPD who had struggled with various forms of treatment before they’d introduced him to the idea of mindfulness and how he could get out of his head and pay attention to the reality of the world around him. Patrick threw himself into the practice, and after three months reported a significant decrease in his overall anxiety, as well as an increased awareness of both the nature of situations and the impact his anxiety has on his life and relationships. He also reported feeling less depressed. Suffering is neither permanent nor inevitable, and paying attention to things as they are is a proven path to happiness.

But developing new habits and ways of using your mind can be difficult. It’s important to emphasize that clients remain curious, and take time to observe their experiences before and after doing mindfulness practices. This will be easier for some than for others, and not all practices will be effective for each client. Encourage them to personalize their practice, and be patient in finding what works for them.

Clients with borderline personality disorder have an intimate understanding of what it means to be tossed about by their emotions and to have conflict-ridden relationships with the people they love the most. They may struggle with the fear that people will abandon them even when they are reassured otherwise. They may know what it is like to feel so miserable that suicide seems like the only way out of their suffering. Thus, for people suffering from BPD, it is easy to get discouraged. A moment of intense emotional pain can feel like an eternity. But the reality is that the vast majority of people with BPD get better and, with the right treatment, go on to live fulfilling lives. 

Some quick statistics about borderline personality disorder:

• Somewhere between six and fifteen million people in the United States suffer from BPD (Leichsenring et al. 2011).

• If you are in an outpatient clinic, about 10 percent of your fellow patients will have BPD. If you end up on an inpatient unit, nearly 25 percent of the other patients will meet the criteria for diagnosis (ibid.).

• While there is little research on BPD in men, there is growing debate about previous, long-standing data that indicates that BPD affects women more than men by a ratio of three to one.

• Research by Bridget Grant and her colleagues (2008) looked at more than thirty-four thousand adults and found that there was no difference in the rate of BPD between men and women.

• Some (Giacalone 1997) believe that clinicians have a subtle gender bias toward females with regard to BPD diagnoses, but other research has disputed this.

• Another possibility (Bjorklund 2006) is that research on the prevalence of BPD is often conducted in psychiatric settings; and because women engage in more self-harming behaviors, there tends to be more women than men with BPD in mental health settings, which makes it appear that women suffer from this disorder more than men do.

• More women than men seek treatment for BPD.

References

Bjorklund, P. 2006. “No Man’s Land: Gender Bias and Social Constructivism in the Diagnosis of Borderline Personality Disorder.” Issues in Mental Health Nursing 27 (1):3–23.

Chapman, A. L., K. L. Gratz, and M. Z. Brown. 2006. “Solving the Puzzle of Deliberate Self-Harm: The Experiential Avoidance Model.” Behaviour Research and Therapy 44 (3):371–94.

Giacalone, R. C. 1997. “A Study of Clinicians’ Attitudes and Sex Bias in the Diagnosis of Borderline Personality Disorder and Post-traumatic Stress Disorder.” Dissertation Abstracts International 57:7725B.

Grant, B. F., S. P. Chou, R. B. Goldstein, B. Huang, F. S. Stinson, T. D. Saha, S. M. Smith, D. A. Dawson, A. J. Pulay, R. P. Pickering, and W. J. Ruan. 2008. “Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.” Journal of Clinical Psychiatry 69 (4):533–45.

Leichsenring, F., E. Leibing, J. Kruse, A. S. New, and F. Leweke. 2011. “Borderline Personality Disorder.” Lancet 377 (9759):74–84.