Cognitive Behavioral Therapy is a therapy based on the assumption that dysfunctional cognitive schemas are responsible for the development and maintenance of Borderline Personality Disorder. The aim of Cognitive Behavioral Therapy is to learn adequate and helpful cognitive schemas and structures that allow one to better deal with the extreme emotions and problem behavior that are characteristic of Borderline.
What is Borderline Personality Disorder?
Borderline Personality Disorder falls under the category of personality disorders in the DSM (Diagnostic Statistical Manual), one of the most commonly used classification systems in mental health care. The DSM has established a number of criteria that someone must meet to be diagnosed with a Personality Disorder .
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a |
An enduring pattern of inner experiences and behaviors that clearly deviate from expectations within the individual’s culture |
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b |
The sustainable pattern is rigid and manifests itself in a wide range of personal and social situations |
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c |
The enduring pattern significantly leads to suffering or limitations in social and occupational functioning in other important areas |
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D |
The pattern is stable and long lasting and its onset can be traced back to at least adolescence or early adulthood |
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E |
The lasting pattern cannot be attributed to a manifestation or consequence of another psychological disorder |
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F |
The lasting pattern is not the result of the direct physiological effects of a substance (drug, medicine, etc.) or a general medical condition (skull trauma, etc.) |
As the above diagnostic criteria show, a Personality Disorder is a psychological condition that you carry with you for a long time. It is not yet clear whether a Personality Disorder can be cured or not and opinions differ widely among doctors and psychologists.
The Problems of a ‘Borderliner’
What exactly does someone with Borderline Personality Disorder encounter? Against a wall of problems and misunderstanding , you could say. Not only do people with Borderline have inner problems and conflicts, because of these inner problems and conflicts they also regularly encounter problems on a social level . Not surprising, if you consider that the behavior of someone with Borderline is completely strange and unrecognizable to someone without Borderline. It is difficult to understand someone. This is especially true if you are not really that personal with the person with Borderline.
The diagnosis of Borderline Personality Disorder
The DSM has also established a number of criteria that someone must meet to be diagnosed with Borderline Personality Disorder . To receive this diagnosis, one must meet at least five of the criteria below.
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1 |
Trying desperately to avoid actual or perceived abandonment |
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2 |
A pattern of unstable and intense interpersonal relationships characterized by alternations between excessive idealization and belittling |
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3 |
Identity disorder: Markedly and persistently unstable self-image or sense of self |
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4 |
Impulsiveness in at least two areas that have the potential to harm the person concerned |
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5 |
Recurrent suicidal behavior, gestures or threats, or self-harm |
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6 |
Affect lability due to marked mood reactivity |
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7 |
Chronic feeling of emptiness |
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8 |
Inadequate, intense anger or difficulty controlling anger |
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9 |
Transient, stress-related paranoid ideation or severe dissociative symptoms |
Treating Borderline Personality Disorder with Cognitive Behavioral Therapy
If Borderline Personality Disorder is not treated, there is a good chance that the problems will get out of hand at some point and result in (life) threatening situations for both the person involved and those around them. Treatment is necessary to teach the person concerned to deal with the personality disorder in such a way that the disorder causes significantly less suffering. A possible form of treatment for Borderline Personality Disorder is Cognitive Behavioral Therapy.
As mentioned in the introduction, Cognitive Behavioral Therapy focuses on dysfunctional, unhelpful schemas in human cognition. In other words, the treatment focuses on thoughts and reflections of the person concerned that cause or maintain the disorder.
Cognitive schemas
Cognitive schemas are a kind of mini working models of the world and events in the world. These schemas structure the world and guide our behavior and thoughts. Schemas are developed and adjusted through experience. Schemas are therefore important tools in our existence.
Disrupted cognitive schemas
While cognitive schemas can be very useful and practical, they can also lead us in the wrong direction in our thoughts and behaviors. Examples of disrupted, unhelpful cognitive schemas include:
- I should never express my feelings, others can take advantage of that
- I’m a bad person and don’t deserve to live
- The world is dangerous and no one can be trusted
Disrupted cognitive schemas are often characterized by words such as ,nobody,, ,always,, ,never,, ,everything,, ,everyone, and ,everywhere,. The schemas are often overgeneralizations that are not tested against reality but are clung to.
The five modes
Young has drawn up a model in which five possible modes (plural of mode) are described. According to Young, Borderlines are always in one of these five modes and switch between them in rapid succession. People with Borderline Personality Disorders are indeed often described as time bombs and it is difficult to estimate what to expect.
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Mode |
Thoughts |
Feelings |
Behaviour |
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The protector |
Keep your distance from others, they cannot be trusted and it is dangerous if I express my feelings and thoughts |
Flattened affect, cool, very distant |
Don’t think, just act, escape into drink, drugs, self-harm |
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The punitive parent |
I’m evil, my opinion makes no sense and I deserve that punishment |
Anger, guilt, self-loathing |
Punishing oneself (self-mutilation), transgressive behavior |
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The abandoned/abused child |
No one can be trusted, I am powerless, I keep people at a distance otherwise they will take advantage of me |
Sadness, hopelessness, fear, panicky |
Desperation, upset, seeking lots of comfort and support |
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The angry/impulsive child |
I have to fight for my place, people take away my rights (such as love, being allowed to make mistakes and having my own opinion) |
Indignation, anger, impatience |
Physical and verbal aggression, fits of rage, egocentricity, self-mutilation |
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The healthy adult |
I can be there and I can learn and grow, I am worth it, I can trust people |
The whole range of feelings |
Actively seek help, form relationships, have fun |
The client must learn to recognize the five modes in themselves and learn how to enter the mode of a healthy adult.
Therapeutic techniques
There is a wide range of therapeutic techniques to treat Borderline Personality Disorder. The first step is identifying dysfunctional thoughts and cognitive schemas . This can be done using imagination exercises:
- Safe place : the client closes his eyes and imagines himself in a safe place. What feelings and thoughts arise? Who is the client with? What does the safe place look like?
- Abandoned/abused child : the client feels like a child again. Where is the child? How old is the child? What is happening? What would the child like to do?
- Rewriting : The client imagines himself or herself at a time of a traumatic event. The client acts as a healthy adult and advises the child within him
Schedule change
By reinterpreting traumatic events and emotional disturbances, dysfunctional schemas can be recognized and changed. Some techniques are:
- Write letters to parents/abusers (do not send!)
- Devise new, more adaptive responses
- Role playing (psychodrama)
- Challenging cognitions with the G-training