Borderline Syndrome: Therapy

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Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of ​​enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

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For a long time, borderline therapy was considered particularly problematic - the disease poses great challenges for both patient and therapist. In addition, patients are quickly disappointed and often give up treatment too quickly. Thanks to special therapeutic concepts, the prognosis for borderline syndrome is much better today. Read everything you need to know about borderline therapy here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F60

Is borderline curable?

For a long time, the therapy of borderline patients was considered particularly problematic. As in the relationship with all other people, borderliners tend to idealize the therapist at the beginning in order to devalue him extremely at the smallest disappointed expectation. Frequent changes of therapist and discontinuation of therapy are the result.

The prospect of a complete borderline cure is slim. However, thanks to improved therapy methods, the chances for patients of getting the most serious effects of the disorder under control have increased significantly.

Whether borderline is curable also depends on the severity of the symptoms and the social situation. This is how motherhood and marriage are designed to aid recovery. From the age of 30, the impulsive symptoms subside and dealing with the mental disorder becomes easier.

Inpatient or outpatient

Inpatient treatment is important for patients with a tendency to self-harming behavior (automutilation) or even suicidal. Younger people with borderlines in particular benefit from the structured life in the facility.

The advantage of outpatient borderline therapy is that patients learn to deal with conflicts in their familiar surroundings. However, the range of outpatient borderline therapies is very limited.

Borderline Therapy: Dialectical Behavioral Therapy (DBT)

The American therapist Marsha M. Linehan made the breakthrough in borderline treatment. She developed the Dialectical Behavioral Therapy (DBT), which is specially tailored to borderliners. This is a special form of cognitive behavior therapy.

In the first phase of therapy, the borderline patients are initially stabilized. The focus is on strategies that prevent the patient from harming themselves further or stopping therapy prematurely. As part of group therapy, various new ways of behaving and thinking are then trained. The goals are:

• The perception of oneself and that of other people should be improved.
• Measures for self-control and for dealing with crises are practiced.
• Extreme black-and-white thinking is being dismantled.
• You learn how to deal with stress and how to control your own emotions.

Only in a second phase of therapy do the stressful life events that have contributed to the disorder come into focus. In contrast to psychoanalytically sound therapy, the aim is not to relive the traumatic experience and come to terms with it, but to be able to accept this experience as part of the personal but closed past.

The third level of therapy is aimed at applying what has been learned in everyday life, increasing self-esteem and developing and implementing personal goals in life.

Borderline therapy: psychodynamic-conflict-oriented psychotherapy

In addition to behavioral therapy, psychodynamic therapy methods are also an option for borderline patients. Studies confirm its effectiveness, at least for adult patients. Like all therapies that have their roots in psychoanalysis, the focus here is also on the insight into the connections between biographical experiences and current problematic relationships and behaviors. They should lead to a mental reappraisal of the traumatic experiences.

In the context of psychodynamic-conflict-oriented psychotherapy, the following are targeted:

• Coping with trauma
• the patient's self-image is strengthened or even built up at all
• the ability to relate improves
• the typical black-and-white thinking broken down
• the ability to control one's own feelings and impulses strengthened (affect regulation)

Borderline therapy: family therapy

In the borderline therapy of adolescents in particular, it is crucial to include the family. On the one hand, because it makes it easier for relatives to deal with the affected family member. Above all, however, because working with the family is an essential prerequisite for the young person to be able to successfully change his or her thinking and behavioral patterns.

Family involvement is particularly important if the disorder has at least some of its roots in the family. If there are pathological relationship patterns in the family, this makes family therapy particularly useful.

Borderline therapy: other forms of therapy

Further therapy methods that are used for borderline disorders are:

• Mentalization-Based Therapy (MBT): It helps the patient to get along better with himself and with other people. Borderliners have difficulty assessing their own behavior and that of other people. In this form of therapy, those affected learn to better interpret and understand the background to behavior.
• Schema therapy / schema-focused therapy: It is based on the fact that every person develops patterns from childhood in order to deal with experiences. When a child's basic needs are not met, they develop unhealthy strategies and thought patterns. Borderliners, for example, often assume they will be abandoned and are therefore suspicious of others. The aim of schema therapy is to recognize and work on negative thought and emotional patterns.
• Transfer-focused psychotherapy (TFP): Borderline patients often have a pronounced black-and-white or good-or-bad way of thinking. The therapist is either idealized or perceived as threatening. The patient transfers old relationship experiences (e.g. with parents) to the therapist. For example, the therapist could be seen as a strict father. Transfer focused therapy works with the patient to recognize and change these transferences.

Borderline therapy: medication

Some patients receive drug therapy in addition to psychotherapy. Borderline cannot be treated with medication alone - there are no special borderline medications. Mood stabilizers like lithium can help you get extreme emotional states under control.

The doctor or psychiatrist often prescribes benzodiazepines such as lorazepam for borderline patients who suffer from severe anxiety. However, these drugs are highly addictive and should only be used for a short time.

If patients also have depression, the borderline therapy is supplemented by antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs).

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