Tamar June, LCSW, MPH

Borderline personality disorder (BPD) is a disorder that causes emotional instability. Once triggered, people with BPD experience more intense feelings that influence how they treat others and themselves. Essentially, people with BPD "hear" amplified emotions at a higher volume and for longer periods of time than those without BPD. Some who have BPD describe "being on the border," often feeling insecure and split between both negative and positive feelings. Mood swings, impulsivity, and insecurity are all hallmark symptoms of borderline personality disorder. No single cause of BPD is known, but it may arise from factors such as:

• Physical brain development: Researchers have found that people with BPD had differences in the frontal cortex, hippocampus, and amygdala - the parts of the brain that control decision making and behavioral and emotional regulation. Brain differences in people with BPD typically occur during childhood development.
• Neglect and abuse: Neglect from one or more caregivers and any form of abuse (both in childhood and adulthood) are factors that may contribute to BPD.
• Genetics: People with a family history of BPD, mental health problems, or addiction problems are more prone to be diagnosed with BPD.

As BPD is rooted in an unstable sense of self and intense personal emotions, symptoms of BPD may vary between patients. Common symptoms of BPD include:

• Rapidly changing moods
• Black and white thinking
• ntense and unstable relationships
• Distorted self-image
• Self-harming behavior
• Dissociation (feeling detached from one's environment, body, and/or thoughts)
• Anger issues

Dialectical behavior therapy, or DBT, is a form of cognitive behavior therapy (CBT) that was originally developed to help the most severely mentally ill and depressed patients accept therapy. It relies on the same concept in CBT that examines the relationship between thoughts, feelings, and actions, but in DBT the emphasis is first on acceptance rather than change. There is also an emphasis on mindfulness, 'being in the moment,' and relaxation techniques such as yoga. These are combined with a great deal of validation and encouragement from the therapist.

The word 'dialectical' means acting through opposing forces, and this word refers to a few different opposing concepts in DBT:

• The therapy combines traditional Western psychotherapy techniques with Eastern religious philosophy.
• Patients must learn that life, thoughts, and feelings are not all black and white -- there are many shades of grey.
• The therapy works on accepting and validating the patient for being where they are at the moment while also encouraging them to change for the better.