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Borderline personality disorder is experienced in individuals in many different ways. Often, people with this disorder will find it more difficult to distinguish between reality from their own misperceptions of the world and their surrounding environment. While this may seem like a type of delusion disorder to some, it is actually related to their emotions overwhelming regular cognitive functioning, which is likely to create many conflicts with others.

People with this disorder often see others in "black-and-white" terms. Depending upon the circumstances and situation, for instance, a therapist can be seen as being very helpful and caring toward the client. But if some sort of difficulty arises in the therapy, or in the patient's life, the person might then begin characterizing the therapist as "bad" and not caring about the client at all. Clinicians should always be aware of this "all-or-nothing" ability most often found in individuals with this disorder and be careful not to validate it.

Another feature of this disorder is a strong fear of being abandoned by others in relationships. Unfortunately, because those with Borderline personality disorder often have poor interpersonal skills, in which they ultimately tend to push those that they care about away from them. This situation results in a self-fulfilling prophecy in which they fear the person leaving them, so they engage in many extreme and confusing behaviors of over-possessiveness or being unavailable, which ultimately makes their partner leave them in the end. These dynamics create many challenges in the therapeutic relationship for the therapist for a careful balancing act must be done to avoid giving any cues of possible emotional abandonment to the client while also setting down firm therapeutic boundaries.

Therapists and doctors should learn to be a "rock" when dealing with a person who has this disorder. That is, the doctor should offer his or her stability to contrast the client's liability of emotion and thinking. Many professionals are turned-off by working with people with this disorder, because it draws on many negative feelings from the clinician. These occur because of the client's constant demands on a clinician, the constant suicidal gestures, thoughts, and behaviors, and the possibility of self-mutilating behavior. These are sometimes very difficult items for a therapist to understand and work with.

Psychotherapy is nearly always the treatment of choice for this disorder; medications may be used to help stabilize mood swings. Controversy surrounds over medicating people with this disorder.


Like with all personality disorders, psychotherapy is the treatment of choice in helping people overcome this problem. While medications can usually help some symptoms of the disorder, they cannot help the patient learn new coping skills, emotion regulation, or any of the other important changes in a person's life.

An initially important aspect of psychotherapy is usually contracting with the person to ensure that they do not commit suicide. Suicidality should be carefully assessed and monitored throughout the entire course of treatment. If suicidal feelings are severe, medication and hospitalization should be seriously considered.

Like all personality disorders, borderline personality disorder is intrinsically difficult to treat. Personality disorders, by definition, are long-standing ways of coping with the world, social and personal relationships, handling stress and emotions, etc. that often do not work, especially when a person is under increased stress or performance demands in their lives. Treatment, therefore, is also likely to be somewhat lengthy in duration, typically lasting at least a year for most.

Other psychological treatments, which have been used to lesser effectiveness, to treat this disorder include those that focus on social learning theory and conflict resolution. These types of solution-focused therapies, though, often neglect the core problem of people who suffer from this disorder -- difficulty in expressing appropriate emotions (and emotional attachments) to significant people in their lives due to faulty cognitions.

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