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Articles: Emotional

Crossing the Borderline

Barton Goldsmith, Ph.D., MFT

Several renowned researchers have written books and dedicated their careers to trying to understand and remedy one of the most confounding psychological maladies: borderline personality disorder (BPD). It is considered to be a very difficult condition to treat and a number of therapists actually refuse to take on these patients.

The statistics about BPD are a bit striking. According to the BPD Central web site (www.bpdcentral. com), the condition is 50 percent more common than Alzheimer's disease. The site also estimates that over 30 percent of those in the mental health system suffer from BPD and that the suicide rate of individuals with this disorder is about 10 percent.

The causes can be anything from environmental influences, such as sexual abuse and long-term isolation, to impaired brain chemistry. Trauma or anxiety can trigger symptoms, so maintaining a low-stress lifestyle is recommended.

Though the treatment of BPD is difficult, success has been found through the use of medication, such as antidepressants and mood stabilizers in combination with talk therapy. Cognitive-behavioral, especially dialectical behavior therapy, has been show to be the most effective. But many people who suffer from this condition refuse treatment, since denial is another symptom of the disorder.

Interacting with a person who has BPD can be extremely challenging. According to the book "Stop Walking on Eggshells" (the title may say it all), by Paul Mason, M.S. and Randi Kreger, the people in the lives of borderlines can feel that anything they say or do will be twisted against them. They can also feel manipulated, controlled, and lied to. Some also have the experience of being continually blamed and criticized. Because of this, it can become necessary to conceal thoughts and feelings to avoid arguments.

Setting strong boundaries is one of the best tools you can use if someone you know has BPD. If he or she refuses therapy, you may choose to see a therapist yourself. In any case, remember that only a licensed mental health professional can accurately diagnose and appropriately treat this condition. I recommend finding a specialist as the symptoms are fairly broad and case management can be complex.

Finding a lifestyle where choices are made for them can be a stabilizing factor for some. Others with this condition need to have loved ones close to them at all times to create a sense of security.

People with BPD are often very successful and great to talk with, as it has no bearing on intelligence, creativity or even the ability to be empathic.

Making wise decisions if you or someone you love has BPD can be daunting, but with proper guidance, you can learn to find balance and live life to the fullest.

Barton Goldsmith, Ph.D., has resided and practiced in Westlake Village for a decade. He can be reached at 818-879-9996 or via e-mail at Hear him live on KCLU Radio, 88.3FM, or online at from 2 to 3 p.m. PST every Monday.