Question 1

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.

Question 2

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 3

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 4

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 5

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 6

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 7

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 8

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 9

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 10

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 11

Isn't it better for people with BPD to seek professional help?

Daniel Fox · Accepted Answer

It is always best to be sure that the information you get about BPD is from someone who understands the disorder and who is up-to-date with the research and treatment options that are efficacious and available.  There are many myths and misunderstandings about BPD and those who have it are often wrongfully stigmatized and seen as untreatable. BPD is treatable, it is the most successfully treated personality disorder.  Many people, including some professionals, holds onto old data that shows that individuals with BPD are treatment resistant, but most individuals with BPD are treatment seekers and want to challenge their BPD and manage it to make their life better.

Question 12

Is BPD a form of PTSD? Can I have both?

Daniel Fox · Accepted Answer

BPD is not a form of PTSD, they are separate disorders but do often co-occur. BPD is not a form of trauma, although many individuals with BPD have trauma in their past.  Not everyone who meets criteria for BPD has PTSD or a history of trauma.  There is a type of PTSD, called Complex PTSD (C-PTSD) that has a greater semblance to BPD, and is often confused with it.  C-PTSD has all the aspects of PTSD along with emotional dysregulation, belief one is worthless and less important because of their traumatic past, harbor guilt, shame, and sense of failure because of their trauma, and these issues negatively impact relationships and intimacy.  Lastly, C-PTSD is not BPD either, as BPD has some overlap with C-PTSD but is different.  For example, those with C-PTSD only do not self-harm, fear abandonment, and idealize and devalue others.

Question 13

Can BPD be cured or do people need to learn to manage the symptoms?

Daniel Fox · Accepted Answer

There is no “cure” for BPD or any other personality disorder.  BPD can be successfully managed.  This means that symptoms can be controlled with adaptive strategies, as opposed to maladaptive strategies that reinforce BPD issues and behaviors. In fact, BPD is the most successfully treated personality disorder.

Question 14

How do you identify early signs of borderline personality disorder in teens and intervene early/help them help themselves sooner?

Daniel Fox · Accepted Answer

Early signs for BPD is tricky because at one point or another most teens would meet criteria for BPD.  To identify fledgling individuals with BPD, symptoms must be present for a year of longer, outside the ordinary severity and frequency, and not in response to specific acute stressors, and no one should be diagnosed with a personality disorder before age 16.  These symptoms include extreme acting out, self-harm, confusion about self beyond the typical that may manifest as joining different peers groups, promiscuity, intense issues of abandonment and emptiness, and splitting – seeing things in black and white or others as heroes or zeros.  The earlier these symptoms can be addressed the better and family therapy is always a good first approach that focuses on building the family unit, not over-focusing on the “identified patient”.

Question 15

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

Daniel Fox · Accepted Answer

Yes and no.  Most individuals with BPD have depressive spirals, but fewer and many have major depressive episodes.  This can be very confusing, because medication can help attenuate the depressive episodes, but tends to have little impact on the depressive spirals.  Depressive spirals have triggers, tend to be of shorter duration, and less severe that depressive episodes.  This is why knowledge of what symptoms are present, are there triggers, and how long the depressive instances (either spirals or episodes, or both) occur.  I address this issue in my new book: Complex BPD. https://www.amazon.com/Complex-Borderline-Personality-Disorder-Coexisting-ebook/dp/B08WHM5GXT

Self-Help for Borderline Personality Disorder