Borderline personality disorder (BPD) can be challenging to live with, but it’s possible to manage distressing symptoms and take better care of yourself. Seeking professional treatment is recommended, but even if you’re working with a therapist or attending groups, you will still need to practice specific skills in everyday life. Here are some tips that can help you:
An Overview of Professional Treatment Options
BPD is a complex personality disorder that is often misunderstood and can be misdiagnosed. If you identify with certain BPD symptoms, it’s important to seek guidance. BPD shares many characteristics with other clinical diagnoses, such as bipolar disorder, anxiety, and other personality disorders. It can also closely parallel symptoms of complex PTSD.
Psychoeducation: Learning about BPD is essential for understanding your symptoms and needs. Educating yourself is also the first step toward feeling more empowered in helping yourself. At MedCircle, we have an original series intended to support individuals and their loved ones.
Dialectical Behavior Therapy (DBT): DBT is an evidence-based psychotherapy model specifically designed for people with borderline personality disorder. DBT contains four modules rooted in mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Treatment includes a combination of individual therapy, phone consultations, and skills training groups.
Transference-focused psychotherapy (TFP): TFP helps people with BPD by focusing on the relationship between a therapist and a client. Transference refers to how clients project certain emotions or expectations onto a therapist. Through this transference work, therapists understand how clients relate to others, and this insight offers guidance in changing problematic interactive patterns.
Schema-Focused Therapy: In therapy, a schema refers to problematic thinking or behavioral patterns. It’s assumed that people develop schemas in early childhood as a response to unmet needs. Schema-focused therapy teaches clients how to recognize how and when these schemas are enacted. The therapist will respond compassionately to schemas as they emerge and provide tools for changing or reducing their presence.
Medication: There are no FDA-approved medications for treating BPD. However, many clients with BPD also have comorbid diagnoses, and treating those symptoms can help improve overall emotion regulation and mood.
Group therapy: People with BPD can benefit from groups focused on psychoeducation, coping skills, self-esteem, and interpersonal connection. Groups with trained facilitators ensure an inherent level of respect and appropriate communication among members.
Coping Skills for BPD
Many skills can help you if you’re feeling overwhelmed by your BPD symptoms. It’s important to practice these skills consistently and make them part of your routine. That way, if you’re facing a crisis, you have more insight into knowing what to do next to help yourself.
Meditation/Mindfulness Coping Strategies
Mindfulness can be extremely beneficial when you feel upset or emotionally triggered. Mindfulness refers to intentionally being aware of your body, thoughts, and feelings. Rather than trying to “busy yourself,” you simply allow things to be.
Rub ice on your legs or arms: If you are in a dissociated state- or if you feel triggered to engage in self-harm- this quick technique can offer a physical sense of relief without you hurting yourself.
Single-task focusing: Sometimes it’s helpful to focus on being present with a specific activity like brushing your teeth or folding your clothes. Pay attention to your five senses. Notice what thoughts and feelings emerge. As much as possible, try not to judge yourself for any of your reactions. Instead, allow yourself to fully immerse in the current moment.
Conscious breathing: Conscious breathing simply refers to being aware of your breath. Consider narrating how breathing feels as you inhale air and then exhale it. Some people also choose to count while breathing, which is known as boxed breathing. Start with just a minute at a time and then work your way up to longer sessions.
Radical acceptance: Choosing to radically accept a situation means embracing your current reality for what it is. This does not mean you necessarily like what’s happening, but you’re not trying to resist or change it. Many people find that the more they choose acceptance in daily life, the less stressed and more satisfied they feel.
Riding the wave: Riding the wave is a metaphor for embracing how emotions enter and pass. This is part of the distress tolerance module in DBT. You basically accept that you’re having a strong emotion, but it will eventually fade into a more neutral stance.
Interpersonal/Communication Coping Strategies
People with BPD face difficulties in their relationships. Because the fear of being hurt can be so intense, you may struggle with unwanted responses, like lashing out at others, disconnecting, or becoming clingy. Practicing emotion regulation and
Taking a break: If you’re having a heated conversation with someone, it may be in your best interest to step away for a few minutes. This can help you avoid saying something you will later regret. It can also give you the space to reflect on what you most want to convey in the discussion.
Opposite action: Opposite action refers to acting differently than you normally would to a specific emotion. For example, if you usually isolate yourself from others when you feel sad, you would instead choose to spend time with friends. Or, if you respond passive-aggressively when your partner hurts your feelings, you would aim to communicate your needs assertively.
DEAR MAN: Dear Man is an acronym within DBT that stands for describe, express, assert, reinforce, mindful, appear confident, and negotiate. Aim to describe the situation simply and express what you need. Assert why it’s important in a respectful way and reinforce others when they meet your needs. Try to stay mindful of the present moment, appear confident (even if you feel nervous or insecure), and be willing to negotiate if a compromise must be made.
Distraction Coping Strategies
Although you shouldn’t solely rely on distraction to move through difficult emotions, it certainly has its benefits. Focusing on something else- just until the strong feelings pass- can make a big difference in preventing you from engaging in self-destructive behavior.
Focusing on helping someone else: If you’re feeling anxious, upset, or dysregulated, turning your attention to another person can help. Research shows that we feel good when we make others feel good, and this distraction effect can smooth over intense emotions. Focus on doing a small act of kindness, such as sending a text to let someone know you’re thinking about them.
Taking a nap: Being tired can make you feel more susceptible to intense emotions. Research shows that a brief nap (20-30 minutes) can improve cognitive performance, help you feel recharged, and give you better clarity on managing stressful situations.
Doing chores: Spend 30-60 minutes engaging in a household task, such as vacuuming, organizing your closet, or cleaning the kitchen. These tasks are mindless enough that they don’t require intense planning or emotional energy, but completing them can provide a sense of satisfaction that can feel empowering.
Crisis Coping Strategies
When a crisis occurs, it’s important to be prepared. Crises can come on very suddenly, and without the right strategies in place, you may feel even more overwhelmed. Most of all, it’s important to remember that emotions always pass, even when they feel unbearable.
Avoid/limit mood-altering substances: As much as possible, try to reduce your reliance on drugs or alcohol. While these substances may provide initial relief, they tend to perpetuate mental health distress, making you more prone to making dangerous, impulsive choices.
Play the tape: Sometimes it’s helpful to imagine the entire crisis playing itself out. For example, what happens if you actually do the actions you want to stop doing? Who might get hurt as a result? How would you feel knowing you made that choice? What consequences might you face?
Make a safety plan: Have a safety plan that you can refer to during difficult moments. Ideally, your safety plan should include a list of supportive people you can reach out to, coping skills that provide quick relief, and emergency resources for crisis hotlines and the local hospital. It may be helpful to share a copy of this plan with your therapist and/or a trusted loved one.
Important Lifestyle Considerations for Borderline Personality Disorder
Along with developing coping strategies, it’s important to consider embracing a holistic approach to taking care of yourself and valuing your emotional well-being. Here are some tips that can help you stay on track.
Know your emotional triggers: Everyone is prone to various triggers that exacerbate certain emotional states. There’s nothing wrong with having these triggers, but it’s important to be aware of their function and impact. While you may not be able to avoid them altogether, knowing them can help you plan for them.
Seek trauma-informed support: BPD often has roots in complex, childhood trauma. In fact, research shows that people with BPD are 13x more likely to indicate a history of childhood trauma than people without mental health problems, and one study found that nearly half of people with BPD had a history of either physical neglect, emotional abuse, or both. Getting help for your trauma may significantly decrease the intensity of your BPD symptoms.
Hold yourself accountable as much as you can: You may still hurt others as you’re healing your wounds. When you notice this happen, acknowledge your wrongdoing and try to apologize as quickly and succinctly as you can. Even though this may feel uncomfortable, the more you practice it, the healthier your relationships will become.
Reflect on your progress: It’s important to validate how you integrate progress into your recovery plan. A diagnosis is not an identity, and many people with BPD learn how to live fulfilling lives. You deserve to celebrate success along the way.
Recommended Workbooks and Materials
Self-help books and programs can support you in keeping your recovery on track. You may choose to work through these with a supportive therapist or on your own.
The Borderline Personality Disorder Workbook: An Integrative Program to Understand and Manage Your BPD: This workbook is often recommended by therapists, as it offers practical guidance on navigating your symptoms with a combination of DBT and acceptance and commitment therapy (ACT).
Sometimes I Act Crazy: Living with Borderline Personality Disorder: This book compassionately normalizes the intense emotions and difficulties associated with BPD. It will also give you more insight into some of your frustrating symptoms.
Mindfulness for Borderline Personality Disorder: Relieve Your Suffering Using the Core Skill of Dialectical Behavior Therapy: This workbook focuses exclusively on integrating mindfulness as a way to feel more present and cope with distressing emotions.
Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder: This book acts as a practical guide for loved ones who want to understand BPD and also maintain healthy boundaries for themselves.
I Hate You- Don’t Leave Me: This book includes emerging research on BPD and its relationship with other mental health conditions, including PTSD, ADHD, and eating disorders. It also offers practical tools for individuals and their loved ones.
It’s possible to cope with distressing BPD symptoms, whether you’re working with a professional or managing your recovery on your own. Remember that you are not alone or broken- healing is always possible, and the more you try to take care of yourself, the better you will likely feel.