Question 1

Can you explain how BPD is a spectrum disorder?

Daniel Fox · Accepted Answer

BPD is made up of traits and characteristics and each of these is not the same in all individuals.  For example, abandonment is a common characteristic of those with BPD, but some individuals experience it at different levels of intensity.  This is what is meant by BPD being on a spectrum.  Each of the traits that make up BPD is at a different level of severity for each individual, and that individual copes and manages their issues in a variety of ways.

Question 2

Can someone just have borderline tendencies?

Daniel Fox · Accepted Answer

I hope my answer above is helpful.

Daniel Fox · Answer

Yes, most people do not meet enough criteria for the full BPD disorder, so they are said to have just traits.  These can be quite impactful and challenging for many individuals and treatment can be highly effective to learn to manage these issues.

Question 3

Would it be okay to refer your BPD workbook to a client who has CPTSD?

Daniel Fox · Accepted Answer

Absolutely.  There is some overlap between BPD and C-PTSD and understanding core content and managing surface content can be very helpful.

Question 4

What is splitting in the context of PDs?

Daniel Fox · Accepted Answer

Splitting is seeing yourself, others, and your world in extremes, such as seeing others as heroes or zeros or situations as all good or all bad.  For example, when you first meet someone you may see them as perfect, amazing, kind, etc. and then if they do something to offend you or disappoint you, you see them as evil, devilish, and the worst person you’ve ever met.  Those with BPD are often associated with and exhibit splitting, but individuals with other PDs, and those without mental health issues, split as well.

Question 5

Is medication an option for BPD?

Daniel Fox · Accepted Answer

There is no medication for personality or personality disorders.  Medication treats what I call surface content only.  Surface content is depression, anxiety, psychosis, rage, etc.  It cannot treat emptiness or abandonment, as these tend to be more central, or core content, issues.  Medication does not treat core content.  Medication is often helpful in lessening surface content enough so the individual can access, work on, and learn strategies to manage core content.

Question 6

Does depression feel and look the same for someone with BPD versus not?

Daniel Fox · Accepted Answer

Individuals with BPD have depressive episodes and they may or may not have major depressive disorder (MDD).  Timing of the depressive episodes, identifying presence or absence of triggering events, and severity are all important factors to consider when determining if MDD is a co-occurring condition with BPD or not; MDD is a common co-occurring condition.  The look and feel of depression tends to be specific to the individual, BPD or not.  In general, depressive episodes and MDD likely add to the complexity and struggle the individual experiences.  With that in mind, it’s different.

Question 7

I have a diagnosis of BPD. The hardest part to deal with is the feeling of emptiness. What advice do you have for dealing with this?

Daniel Fox · Accepted Answer

Emptiness is often associated with core content and unstable self-image.  Exploring the root of your emptiness, discerning it from loneliness, fear of abandonment, confusion about interests, and decrease in drive to achieve can all be relevant factors.  I would suggest learning about where your emptiness comes from and when present, but be mindful of when it is not present as well.  What is different?  Are certain people around?  Do you notice particular mood fluctuations or times of day?  Also, monitor sleep and fatigue.  Lack of sleep and fatigue tend to increase maladaptive patterns and issues.  Make sure you’re getting good sleep.

Question 8

Is there evidence supporting self-help approaches for BPD?

Daniel Fox · Accepted Answer

There is research to support the efficacy of bibliotherapy (self-help books and workbooks), but I’m not aware of specific data related to BPD.  I can say that one the greatest issues individuals with BPD encounter is a lack of adaptive strategies to manage maladaptive beliefs, behaviors, and patterns.  Self-help resources provide this and they also allow for the individual to learn at their own pace.

Question 9

Does your self-help book use a DBT framework?

Daniel Fox · Accepted Answer

It does not pull directly from DBT but touches on the more general theoretical approach.  My goal in writing it was to provide individuals with BPD a step-by-step model of what it’s like working with me.  I’ve been fortunate to have success over the last two decades with many individuals with varying degrees of BPD and BPD traits. When working with me, we focus on how we conceptualize issues and concerns, build insight, provide empowerment, and address and manage core and surface content as it relates to BPD.  I put this into the workbook.  Theoretically, I pull from many modalities, such as interpersonal, object-relations, schema therapy, CBT, transference-focused, and DBT.

Question 10

Do people with BPD (or anyone experiencing psychological distress) have the motivation to sustain self-help?

Daniel Fox · Accepted Answer

I think motivation is a critical component for anyone seeking therapy, change, and self-help.  I have had clients intensely motivated to address core content, build insight, and beat their BPD.  I’ve had others who explore their core content and choose not to change their surface content and stop therapy for a wide variety of reasons.  Change is hard, but never impossible. I believe we should “strike while the iron is cold” in regards to distress.  This means that when you’re in the middle of spiralling or an emotional episode it is not the time to expect your skills to be impactful, particularly if you have not practiced or honed them.  I tell my clients that it is critical to treat adaptive skills like ice skating at the Olympics.  You don’t put on your skates for the first time and go to the Olympics and expect gold.  It takes time, effort, patience, and practice, practice, practice.  Don’t practice only when you’re at the Olympics, or when your activated and in distress, practice all the time, several times a day.  Build those adaptive skills and then when you need them you’re ready to manage the distress.

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