Borderline personality disorder is characterized by unstable and intense relationships, fluctuating self-image, impulsive self-damage (such as substance abuse or sexual excesses), emotional instability, intense anger, suicidal gestures and often paranoid ideation.

Borderline Personality Disorder is generally considered to have a biological root, further complicated by childhood trauma. Treatment has always been considered complex and problematic.

This characterological disorder affects 2 percent of the general population and 10 percent of outpatients with psychological disorders. Some feel it is the most common of the personality disorders.

Borderline patients do not know the true cause of their mood swings, dysphoric periods or self-destructive tendencies. They will falsely attribute causation to others, to outside events or to circumstances other than their own fragile personality development.

The injured borderline patient may rapidly change from idealizing to disparaging their treating physician, demand narcotics, and exhibit mood swings that are puzzling to their health care providers. Sudden anger and accusations are common.

Such patients are frustrating to their doctors since they are seen as resistant, manipulative, denying and needy.

These patients alternate in their thinking about themselves and others. As noted,They may initially idealize their doctor, noting that they have seen many physicians, but all are inadequate in comparison to whom they are now seeing. Not surprisingly, the current provider then suddenly falls from favor and is disparaged.

One of the most problematic aspects of caring for these patients is their recurrent suicidal gestures and attempts. These behaviors are addressed in a recently developed clinical treatment procedure referred to as dialectical behavioral therapy (DBT) designed for the chronically suicidal borderline patient.

The goal of such treatment is to validate the emotions of the patient while concurrently attempting to change the patient’s behavior.

In treatment, the patient first learns alternative means of expressing the extremes of their thoughts and behaviors. Patient and doctor work together in determining the means available to afford the patient the emotional expression needed without the endless cycle of recurrent risks of self-harm. The goal is to bring destructive behaviors under control.

Secondly, the patient’s past trauma are then examined with the patient to determine how these events are interfering with the experience and processing of current events. These past events (trauma) have, for the borderline patient, invalidated their concept of their own identity , leading them to wide ranges in emotional expression and impulsive actions. Recognizing past trauma and its effect on current behavior is essential.

In the final stage of treatment, the patient is taught to look internally for their responses, rather than seeking validation and cues from the people around them. They learn to trust their own responses and new control.

These treatment steps, when successfully implemented, have resulted in a decrease in suicide attempts, hospitalizations and need for medication, as well as reduction in drug abuse and extremes of anger. The treatment is short-term and cost-contained in comparison to repeated hospitalizations. Still, the timeframe ranges from 40 to 80 sessions.