Borderline personality disorder (or BPD) can be challenging (but certainly not impossible) to treat.
As an intensively-trained DBT therapist who specializes in BPD and self-harming behaviors, I want for individuals and their families to know that BPD is highly-treatable, and that most people will see significant improvement using evidence-based treatments for this disorder.
Below I’ve organized some treatment plan goals organized by DSM-5 criteria. This approach may be helpful for some but I also want to acknowledge that alternative models for diagnosing and understanding BPD (or traits of BPD) exist.
While this list was created for mental health professionals, peer support providers, and graduate students in mind, individuals who are taking a self-help approach are strongly encouraged to use these ideas to create their own personalized treatment plan. Readers will note that many of the treatment plan ideas may also be applicable for individuals with a diagnosis of PTSD, depression, anxiety, and even ADHD.
Finally, this is an incomplete and imperfect list. Your expertise and clinical wisdom will help fill in the many gaps that are inherent in any proposed treatment plan.
Note: Please also check out my article How to Recover from Borderline Personality Disorder.
Fear of abandonment
☐ Work toward building healthy relationships
☐ Learn about creating healthier relationships by reading books like The High-Conflict Couple and The Relationship Cure
☐ Spend time connecting with friends and family members for at least one hour each week
☐ Become involved in community activities (volunteer at an animal shelter, join a theater group, find a book club, get involved in a community chorus, use MeetUp to find groups)
☐ Engage in religious services or activities
☐ Attend local support, self-help groups, or 12 step groups
☐ Identify cognitive distortions in relationships
☐ Consider the role of forgiving or receiving forgiveness in renewing important relationships
☐ Learn about attachment styles and theory by reading Attached: The New Science of Adult Attachment and How It Can Help You Find and Keep Love, The Highly Sensitive Person in Love, and The Attachment Theory Workbook
☐ Use DBT skills like GIVE, FAST, check the facts, and mindfulness of others
Unstable and Intense Relationships
☐ Identify core relationship values
☐ Learn about creating healthier relationships by reading books like The High-Conflict Couple and The Relationship Cure
☐ Practice validating others
☐ Practice self-validation and self-acceptance
☐ Commit to safety in unsafe relationships
☐ Be proactive in reaching out to people who are important
☐ Identify cognitive distortions in relationships
☐ Use DBT skills like mindfulness of others, GIVE, FAST, and DEAR MAN
Identity Disturbance or Unstable Sense of Self
☐ Identify core values
☐ Create list of personal and professional strengths
☐ Read inspiring recovery stories
☐ Practice self-validation and self-acceptance
☐ Read or listen to Self-Compassion for Borderline Personality Disorder
☐ Create a personal mission statement
☐ Establish short-term and long-term goals
☐ Use DBT skills like accumulating positives, problem solving, and mastery
Impulsive Behaviors
☐ Practice self-validation and self-acceptance
☐ Learn how to self-soothe
☐ Use crisis resources
☐ Create a relapse prevention plan
☐ Reach out to a sponsor, friend, or therapist before engaging in impulsive behaviors
☐ Use mindfulness and distress tolerance (pros and cons) skills from DBT
Suicidal Behavior, Suicidal Threats, or Self-Harming Behaviors
☐ Practice self-validation and self-acceptance
☐ Learn how to self-soothe
☐ Make a list of reasons to stay alive
☐ Create safety plan
☐ Practice suffering well
☐ Keep a gratitude list to help increase desired emotions
☐ Use coping statements when urges to self-harm are high
☐ Use crisis resources
☐ Read How I Stayed Alive When My Brain Was Trying to Kill Me
☐ Read Yes to Life: In Spite of Everything
☐ Use mindfulness and distress tolerance skills from DBT
☐ Address self-injury with a separate treatment plan
Emotional Instability
☐ Practice self-validation and self-acceptance
☐ Learn how to self-soothe
☐ Reach out to support persons during a crisis
☐ Practice naming and describing emotions
☐ Learn how to reduce shame, guilt, and embarrassment
☐ Journal as a way to track and understand emotions
☐ Accept emotions instead of avoiding or pushing them away
☐ Use distress tolerance and emotion regulation skills from DBT
Emptiness or Boredom
☐ Read inspiring stories about people who have overcome obstacles
☐ Learn how to self-soothe
☐ Use tools to help manage time and schedules
☐ Volunteer at least once a week
☐ Practice behavioral activation
☐ Engage in religious services or activities
☐ Read (or listen to) Viktor Frankl’s Man’s Search for Meaning
☐ Create art, write, or play music to alleviate boredom
☐ Use mindfulness and distress tolerance skills from DBT
Intense or Inappropriate Anger
☐ Practice self-validation and self-acceptance
☐ Learn how to self-soothe
☐ Find ways to practice relaxation and reduce stress
☐ Practice self-forgiveness
☐ Improve sleep hygiene with ideas from CBT for insomnia
☐ Run, walk, swim, climb stairs, or jump rope to safely release anger
☐ Respond with curiosity. Ask, “What is underneath the anger?”
☐ Use mindfulness, opposite action, radical acceptance, and distress tolerance skills from DBT
Paranoia or Dissociative Symptoms
☐ Practice grounding exercises
☐ Learn how to self-soothe
☐ Increase present moment awareness
☐ Use ideas from somatic experiencing to address trauma and reduce dissociative symptoms
☐ Read Coping with Trauma-Related Dissociation
☐ Use mindfulness, check the facts, and distress tolerance skills from DBT
General Well-Being
☐ Exercise four to six times a week for a minimum of 20 minutes
☐ Pay attention to nutrition and diet
☐ Practice sleep hygiene
☐ Refrain from using drugs or alcohol to manage emotions
☐ HALT: When emotionally dysregulated, ask, “Am I hungry, angry, lonely, or tired?”
☐ Attend support or recovery groups
☐ Consider the role of mentors and coaches to enhance treatment
☐ Read articles and books about BPD and related symptoms (depression, anxiety, and trauma)
☐ Keep all therapy/treatment appointments
Additional Considerations for the Therapist
☐ Help provide a framework to define mental health for the client and family members
☐ Use tools such as the Ways of Coping Checklist (pdf) to focus on strengths
☐ Take advantage of opportunities for additional consultation and supervision
☐ Provide resources to family members
☐ Use caution when making assumptions about what the client can (or cannot) do
☐ Rule out medical causes for emotional dysregulation
☐ Assess for excessive shame within the therapeutic relationship (“I am bad for needing help.”)
☐ Remain hopeful
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