Psychotherapy can treat borderline personality disorder

DEAR DOCTOR K: My daughter is in her 20s. She had a hard time during her teenage years and was recently diagnosed with borderline personality disorder. Can you tell me what this is?

DEAR READER: Borderline personality disorder is a mental health condition that involves poor self-image, a feeling of emptiness and great difficulty being alone. BPD is surprisingly common: About 6 percent of the U.S. population suffers from it at some point in their lifetime.

People with BPD have intense moods and unstable relationships. They can be impulsive and have unsafe sex, drive dangerously, eat and drink too much, and squander money.

Unfortunately, people with BPD are more likely than others to harm themselves. In fact, they are more likely than average to attempt or commit suicide.

We really don’t understand what causes BPD. Most doctors think that it, as with many psychiatric illnesses, is a combination of genes and life experience. A person is born with a genetic vulnerability to develop the condition if he or she has certain life experiences. In particular, many teens and adults with BPD have experienced some form of abuse in childhood, whether verbal, physical or sexual, as well as being separated from one or both parents.

Psychotherapy is a key part of treatment. But this treatment itself can present challenges because people with BPD tend either to idealize the therapist or become easily frustrated with them. As a result, it may be difficult for them to sustain a relationship with a therapist.

Also, people with BPD may understand interpersonal problems or coping strategies on an intellectual level, but they may still be unable to successfully manage intense emotions.

Medication is another treatment option. No single drug clearly helps treat BPD; instead, medication is usually used to treat symptoms as they emerge.

Most people experience at least some improvement in symptoms with treatment. Significant numbers even recover from the disorder. That means they no longer meet the criteria for having BPD, and they function well.