What is BPD?
What is BPD?
BPD stands for Borderline Personality Disorder, a mental health disorder characterized by unstable moods, behavior, and relationships. People with BPD may struggle with intense emotions, impulsivity, relationship difficulty, and a poor sense of self-identity and often experience extreme reactions to everyday stressors.
People with BPD often struggle with regulating their emotions and may experience extreme mood swings, including feelings of emptiness, anger, anxiety, or depression. They may also have difficulty forming and maintaining stable relationships and engage in impulsive behaviors such as substance abuse, reckless driving, or self-harm.
Other common symptoms of BPD include:
- Fear of abandonment or rejection
- Intense and unstable relationships
- Unstable sense of self or identity
- Difficulty controlling anger or temper
- Suicidal thoughts or behavior
- Intense feelings of shame, guilt, or self-loathing
- Dissociation or feeling detached from reality
BPD often develops in early adulthood, affecting more women than men. The exact cause of BPD is not fully understood, but genetics, brain chemistry, and early life experiences such as trauma or neglect are believed to play a role in its development.
How do you diagnose BPD?
Diagnosing BPD can be challenging, as many symptoms overlap with other mental health conditions, such as depression, anxiety, or bipolar disorder. A mental health professional may use a combination of interviews, questionnaires, and other assessments to help make a diagnosis and rule out other possible explanations for the individual’s symptoms. You need to receive a diagnosis from a licensed, qualified mental health professional. Self-diagnosis of BPD is discouraged.
A mental health professional needs to get to know you as a client to get an accurate diagnosis of BPD. Diagnosis of any personality disorder is a thorough, lengthy process. You should also note that you may have traits of BPD, but that does not necessarily mean you meet the full criteria for BPD.
The diagnostic criteria for BPD are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This is only a starting point, and diagnosis of BPD (or any mental health disorder) is an art and subjective on the part of the mental health professional. Therefore, I do not offer an immediate/one session diagnosis of BPD.
BPD Assessment Process
BPD Screening vs. Comprehensive Assessment
A BPD screening is an initial, one-session interview and self-reported questionnaire I will give you. It is designed as a screening tool to determine if further testing is needed for personality disorders. It looks at 25 different domains of personality and looks at six different personality disorders:
- Avoidant Personality Disorder (AvPD)
- Borderline Personality Disorder (BPD)
- Narcissistic Personality Disorder (NPD)
- Obsessive-Compulsive Personality Disorder (OcPD)
- Schizoid Personality Disorder (SPD)
- and Antisocial Personality Disorder (APD)
a BPD Comprehensive assessment is described below
Session One (Intake)
Before the first session, I will send you a “PID-5” The PID-5 is an initial screener for different personality disorders. It is not a test, but it can give me an idea of the direction for assessing/testing. It consists of 220 questions; you should expect to spend 20-30 minutes on it.
We will begin by introducing ourselves during the actual session, and I will explain the purpose of the intake session and assessment. As part of the BPD assessment, I will conduct a clinical interview with you to gather information about your mental health history, including your family history, past hospitalizations, and previous experiences in therapy. I will also ask about any past diagnoses you have received.
Family history is important because some mental health conditions, including BPD, may be genetic or run in families. Knowing about past hospitalizations and therapy experiences can help me understand your previous treatment and what has worked or not worked for you. Additionally, understanding any past diagnoses, you may have received can help me better understand your symptoms and guide treatment planning.
In addition to gathering information about your family history, past hospitalizations, previous experiences in therapy, and past diagnoses, I will also ask if you have any documentation about past psychological tests or assessments that you have had. This can include official diagnoses or reports from mental health professionals. Therefore, if you have any relevant documentation, I encourage you to bring it to the intake session or share it with me later. I aim to gather as much information as possible about your mental health history and current symptoms to provide the best possible assessment and treatment plan. Please let me know if you have any questions or concerns about providing documentation.
At the end of the first session, I will provide you with instructions on testing. Depending on the circumstances, I will ask you to complete one or more of several tests. I have been trained to administer a select few psychological tests relevant to personality disorders (MCMI, MMPI-III, PAI, and a few others.)
As part of the BPD assessment process, I will discuss the results of the self-report questionnaire I gave you before our first session. I understand that discussing personality traits can be a sensitive topic, and I want to reassure you that the questionnaire results are not meant to label or diagnose you. Rather, they are intended to provide insight into your personality functioning and help guide treatment planning.
Together, we will review each personality domain and what they mean. These domains include Negative Affectivity, Detachment, Antagonism, Disinhibition, Psychoticism, and more. We will discuss your scores within each domain and how they may impact your daily functioning.
It is important to note that the questionnaire is just one tool we will use to understand your symptoms and personality functioning better. I will also consider other aspects of your mental health history and current symptoms to develop a comprehensive assessment and treatment plan. Please feel free to ask any questions or express any concerns you may have during our discussion. I aim to ensure you feel informed and comfortable with the assessment process.
I may ask you to complete additional questionnaires further to explore specific aspects of personality or other symptoms. Several of these may be completed during this session, as some are “clinician-administered,” meaning I give them to you and record your responses. These questionnaires can help better understand your personality traits and how they may impact your daily functioning. I aim to work with you to ensure you feel comfortable and informed throughout the assessment process. If you have any questions or concerns about the questionnaires or any other aspect of the BPD assessment, please do not hesitate to let me know.
Sessions Three through Five
During the third session, I will begin a structured clinical interview to assess the severity of reported Borderline Personality Disorder (BPD) symptoms. It is a comprehensive tool that covers a wide range of symptoms and provides a standardized method for assessing the severity of each reported symptom. This aims to gather more detailed information about your BPD symptoms. The interview covers a variety of domains, such as affective instability, identity disturbance, self-harm behaviors, and interpersonal relationships. This clinical interview will last more than one session and is called the BPDSI-IV (The Borderline Personality Disorder Severity Index)
The BPDSI-IV assesses the severity of reported Borderline Personality Disorder (BPD) symptoms by looking at the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. The DSM-5 is a widely recognized and accepted diagnostic manual that mental health professionals use to diagnose and classify mental health conditions.
During the assessment, we will discuss the DSM criteria for BPD, including intense mood swings, impulsive behavior, unstable relationships, and a chronic sense of emptiness. We will explore how often you experience each symptom and the severity of your symptoms in each area currently and in the past.
However, it’s important to note that the BPDSI doesn’t rely solely on the DSM criteria. It also considers other aspects of your personality functioning and individual needs. For example, you may experience symptoms not specifically listed in the DSM but still significantly impact your daily life.
Please know that the BPDSI-IV is just one tool we will use to understand your symptoms and personality functioning better. We will also consider other aspects of your mental health history and current symptoms to develop a comprehensive assessment and treatment plan. It is not uncommon for the BPD assessment process to continue for six or more sessions. Personality disorders take time to diagnose.
If you have any questions or concerns about the BPDSI-IV or any other aspect of the BPD assessment process, please do not hesitate to let me know.
Session Six (Treatment Planning and Conclusion)
During the last session of your BPD assessment, we will discuss the assessment results and develop a comprehensive treatment plan tailored to your specific needs. This will involve identifying areas where you are experiencing the most distress and setting goals to address these areas. We will review the results of the various testing, assessments, and questionnaires you completed throughout the assessment process, the clinical interview, and the time we worked together.
Based on these results, we will identify specific treatment approaches that may be helpful for you. This may include individual therapy, group therapy, and/or other forms of treatment. I will provide information on these options and work with you to develop a comfortable and manageable plan. We will also discuss any referrals for more in-depth psychological testing if needed. This may include additional testing to explore specific aspects of your personality further or assess for other conditions that may impact your mental health. I will also provide you with an assessment summary. Due to copyright laws and ethical considerations, I cannot provide a copy of the exact (raw) results from several tests.
Depending on the next course of action, any of the following may take place depending on individual situations:
- If you remain with me, we will set goals for treatment and discuss what to expect moving forward. We will establish a plan for ongoing monitoring and feedback to ensure you receive the support you need throughout treatment.
- If you are going to return to a different provider (i.e., you were referred to me for testing only.) I will provide an assessment summary you can give to your next provider. This summary will include the results of the assessments and questionnaires that we went through, as well as a summary of our discussions during the assessment process. This summary can help ensure that your next provider understands your current symptoms, needs, and treatment goals. It can also be a helpful reference for you as you progress with treatment.
- I may refer you to a Clinical Psychologist if further, more in-depth/intensive psychological testing may be needed.
- I may refer you to an in-person or higher level of care if needed.
We will always discuss your options.
What is DBT?
What is DBT?
DBT is often considered the “gold standard” treatment for BPD. DBT stands for Dialectical Behavior Therapy, a type of psychotherapy often used to treat Borderline Personality Disorder (BPD) but can also be helpful for other mental health conditions.
DBT was developed by psychologist Marsha Linehan and emphasized the importance of balancing acceptance and change, recognizing that people with BPD often struggle with intense emotions and impulsive behaviors. Dr. Linehan herself has BPD and created it to help her overcome it.
The four main components of DBT are:
- Mindfulness: DBT emphasizes mindfulness practices as a way of helping individuals become more aware of their thoughts, feelings, and physical sensations in the present moment without judgment. Mindfulness can help people with BPD develop more effective coping strategies and increase their ability to tolerate distressing emotions.
- Distress tolerance: DBT includes specific skills for tolerating distressing situations, such as self-soothing techniques, distraction techniques, and acceptance-based strategies.
- Emotion regulation: DBT focuses on helping individuals learn to identify and regulate their emotions, particularly intense or difficult emotions that can lead to impulsive behavior.
- Interpersonal effectiveness: DBT teaches individuals skills for communicating effectively with others, setting boundaries, and building healthy relationships.
DBT aims to help individuals develop the skills they need to manage their emotions and behaviors, build positive relationships, and improve their overall quality of life. DBT is typically delivered in a structured format, often in a group setting, with individual therapy sessions included. During DBT, individuals typically learn and practice specific skills in each of the four components of the therapy, often using workbooks or handouts.
What is a DBT Skills Group?
DBT (Dialectical Behavior Therapy) skills group is a type of therapy group designed to help individuals learn and practice the skills taught in DBT. DBT is a type of cognitive-behavioral therapy that was originally developed to treat borderline personality disorder, but has been shown to be effective for a wide range of mental health conditions.
DBT skills groups typically involve a combination of didactic teaching, group discussion, and experiential exercises, such as role-playing and mindfulness practices. Participants are also typically encouraged to practice the skills they learn in between group sessions.
DBT skills group is typically conducted in a structured format with a specific curriculum that progresses over time. The curriculum is designed to build upon previously learned skills and gradually increase the difficulty level as participants become more proficient.
In addition to teaching skills, DBT skills groups provide a supportive environment where participants can connect with others struggling with similar issues. This can help individuals feel less alone and isolated, and can also provide an opportunity for individuals to practice social skills and build relationships.
What materials are required for group?
To participate in the DBT group, it is essential that you obtain a copy of the DBT Skills Training Handouts and Worksheets, Second Edition by Marsha Linehan. This workbook is an essential resource for the group, and we will be using it extensively throughout the sessions.
You can purchase this workbook at any major book retailer, and I highly recommend getting a physical copy rather than an electronic version, as we will be writing in the workbook and filling out worksheets during the group sessions.
If you prefer, I also have copies of the workbook available for purchase for $25, which includes shipping. This way, you don’t have to worry about finding a copy on your own or waiting for shipping from an online retailer.
Please let me know if you have any questions about obtaining the workbook or if you would like to purchase a copy from me. I want to make sure that you have all the resources you need to get the most out of the DBT group.
What DBT Services do you offer?
I offer individual DBT and group therapy sessions as part of my services. Our group meets bi-weekly, and each module runs for 12 sessions.
The four modules of DBT are:
1. Mindfulness: This module focuses on developing mindfulness skills to increase awareness of thoughts, feelings, and physical sensations. It includes techniques for staying present in the moment, managing distressing thoughts and emotions, and improving concentration.
2. Emotion Regulation: This module focuses on developing skills to effectively identify, label, and manage emotions. It includes techniques for reducing emotional vulnerability, increasing positive and decreasing negative emotions.
3. Interpersonal Effectiveness: This module focuses on developing skills to build and maintain positive relationships with others. It includes techniques for assertiveness, effective communication, and setting healthy boundaries.
4. Distress Tolerance: This module focuses on developing skills to tolerate and survive difficult situations. It includes techniques for accepting reality, radical acceptance, distraction, and self-soothing.
In addition to the four modules, we will discuss the importance of building a life worth living and incorporate skills to help you achieve your long-term goals.
Whether you participate in individual DBT therapy or group therapy sessions, my goal is to provide the support and tools you need to manage your emotions, improve your relationships, and lead a fulfilling life. If you have any questions about the different options for DBT therapy, please don’t hesitate to ask.
Assessment & Testing Information
Types of testing
As part of a comprehensive personality disorder assessment, I may include any of several psychological tests I have been trained to administer. During the assessment process, I may administer any and all of the following:
- MCMI-IV– Millon Clinical Multiaxial Inventory. This self-report inventory assesses a wide range of personality disorders and other mental health conditions. It is designed to be used by mental health professionals to aid in diagnosis and treatment planning.
- MMPI-III – The test is designed to detect abnormal personality traits, such as narcissism, histrionism, and antisocial behavior (I do not use this one very often)
- PID-5 This is the “screener” that is part of the initial BPD assessment.
- PAI – This test measures a broad range of personality traits and is often used to assess for personality disorders. It includes several scales specifically designed to detect the presence of disorders such as borderline, narcissistic, and antisocial personality disorder.
- Others that may be helpful
Testing services may be purchased on their own. They will be included as part of the comprehensive personality disorder assessment package. It is important to note that no single personality test can diagnose a personality disorder independently. A comprehensive evaluation by a mental health professional is necessary to arrive at an accurate diagnosis.