How can borderline syndrome be treated?
There are various forms of therapy for the treatment of borderline syndrome:
Dialectical Behavioral Therapy (DBT).
The breakthrough in borderline treatment was made by the US therapist Marsha M. Linehan. She developed Dialectical Behavioral Therapy (DBT), which is specially tailored to borderline patients. This is a special form of cognitive behavioral therapy.
In the first phase of therapy, borderline patients are first stabilized. The focus is on strategies that prevent the patient from further self-harm or from prematurely discontinuing the therapy. Various new behaviors and ways of thinking are then trained as part of group therapy. Goals are:
- To improve the patient’s perception of himself/herself and of others
- To practice measures for self-control and for dealing with crises
- To reduce extreme black and white thinking
- To learn how to deal with stress and control one’s own emotions
The third stage of therapy focuses on applying what has been learned to everyday life, increasing self-esteem, and developing and implementing personal life goals.
Psychodynamic-conflict-oriented psychotherapy
In addition to behavioral therapy, psychodynamic therapy methods are also an option for borderline patients. Studies confirm their effectiveness, at least for adult patients. Like all therapies that have their roots in psychoanalysis, the focus here is on insight into connections between biographical experiences and current problematic relationships and behaviors. They are intended to lead to a psychological reappraisal of the traumatic experiences.
Within the framework of psychodynamic-conflict-oriented psychotherapy, targeted:
- Overcome traumas
- @ The patient’s self-image is strengthened or built up in the first place
- The ability to relate to others is improved
- The typical black-and-white thinking is reduced
- The ability to control one’s own feelings and impulses strengthened (affect regulation)
Family therapy
It is particularly important to involve the family if the disorder has its roots at least partly in the family. If pathological relationship patterns exist in the family, this makes family therapy particularly meaningful.
Other forms of therapy
Other therapy methods used for borderline disorders include:
Mentalization-based therapy (MBT): it helps the patient cope better with himself and others. Borderline patients have difficulty assessing their own behavior and that of other people. In this form of therapy, those affected learn to better interpret and understand the background of behaviors.
Schema therapy/schema-focused therapy: It is based on the fact that every person develops patterns from childhood to deal with experiences. When a child’s basic needs are not met, he or she forms unhealthy strategies and thinking patterns. Borderliners, for example, often assume they will be abandoned and are therefore suspicious of others. The goal of schema therapy is to identify and work on negative thought and feeling patterns.
Inpatient or outpatient
For patients who are prone to self-injurious behavior (automutilation) or are even suicidal, inpatient treatment is important at first. Especially younger people with borderline benefit from the structured life in an institution.
The advantage of outpatient borderline therapy is that patients learn to work through the conflicts in their familiar environment. However, the availability of outpatient borderline therapy is very limited.
Medication
Some patients receive medication therapy in addition to psychotherapy. However, borderline is not treatable by medication alone – there are no specific borderline medications. Mood stabilizers such as lithium, however, help some patients manage extreme emotional states.
Patients with borderline who suffer from severe anxiety are often prescribed benzodiazepines, such as lorazepam, by their doctor or psychiatrist. However, these drugs are highly addictive and it is recommended to use them only for a short time.
Is borderline curable?
For a long time, the therapy of borderline patients was considered particularly problematic. As in the relationship with all other people, borderline patients tend to idealize the therapist at the beginning, only to devalue him extremely at the slightest disappointed expectation. Frequent changes of therapist and therapy dropouts are the result.
The prospect of a complete borderline cure is admittedly low. But in the meantime, the chances for patients to get the most serious effects of the disorder under control have increased significantly thanks to improved therapy methods.
Whether borderline is curable also depends on the severity of the symptoms and the social situation. Motherhood and marriage, for example, are said to support recovery. After the age of 30, the impulsive symptoms subside and dealing with the mental disorder becomes easier.
How do people with borderline syndrome help themselves?
For example, the following strategies help many borderline patients:
- Do not overexert yourself at work or in your free time, but manage your energy (e.g., schedule breaks).
- Sometimes admit mistakes and lower the high expectations
- Healthy lifestyle with enough sleep, a regular, healthy diet and sufficient exercise.
- Relaxation training: e.g. mindfulness exercises, massages, warm baths
- Talking about one’s feelings with trusted people or writing down thoughts (diary)
- Stop negative thoughts by distracting oneself (e.g. by exercising, listening to music, going out into nature)
- Punching a pillow when feeling aggressive, playing sports, yelling loudly (into a pillow), etc.
- “Emergency kit” for distraction and calming: with help cards, letter to self, scented oils, wrist gum (to flick), hedgehog ball, plasticine, favorite music (e.g., on CD or MP3 player), etc.
