People with borderline personality disorder, as psychologist Marsha M. Linehan puts it, “are like people with third degree burns over 90 percent of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement.”
Indeed, this extreme sensitivity, coupled with feelings of deep emptiness and emotional lability, wreaks havoc on those dealing with borderline personality disorder (BPD) and those who love them.
Up to fifteen million Americans struggle with BPD. Interactions that others might brush off and forget about can leave someone with the disorder feeling raw and exposed. In their new book, Coping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder, Blaise Aguirre and Gillian Galen offer guidance.
The book is divided into fifty-three different scenarios, grouped together into fourteen chapters, each covering different manifestations of the disorder. Aguirre and Galen break each situation down into what they call “The Problem,” “What it Looks Like,” “The Practice,” and “Checklist.” For instance, Aguirre and Galen describe a young woman who, fearing her boyfriend is cheating on her, makes the emotion-laden decision to dump him, but at the same time cannot imagine life without him. “Swinging between desperately trying to cling to a relationship and impulsively threatening to break up can put even further strain on the relationship,” they write.
This gives them the opportunity to introduce the idea of mood-dependent decisions and their shortcomings. In the “practice” section, they describe specific ways to deal with such emotion-driven decisions. These include skills like taking a timeout and having a calm discussion when the emotions have settled down. They also address more cognitive components, such as recognizing the importance of anger and discouraging self-blame. The checklist offers a quick review of the key points in bullet form. By identifying problems and offering solutions, Aguirre and Galen encourage the reader to think more creatively about their situation while also seeing it as part of a larger pattern.
In the chapter on negative self-thoughts, the authors address some of the core issues those with BPD struggle with, including comparing yourself to others, feeling no one loves you, and feeling toxic. “You find yourself always comparing yourself to other people in your life,” Aguirre and Galen write. “In each comparison you find yourself not as smart, not as pretty, not as creative, not as interesting, not as special, not as good a friend and so on and so on. These types of comparisons can lead to dangerous spirals in thinking that drive self-loathing, self-hatred, hopelessness, and dangerous and self-destructive behavior.”
In this section, Aguirre and Galen offer a number of CBT and DBT approaches to attempt to thwart this spiral of thoughts, feelings, and behaviors. They describe a series of skills of increasing difficulty: simply noticing the comparisons, identifying and validating the emotions, balancing those comparisons with more positive ones, and comparing the present self to a past self.
The authors speak from extensive training and clinical experience. Aguirre is an assistant professor of psychiatry at Harvard Medical Center and the founding medical director of McLean 3East, which specializes in intensive DBT for teens and young adults suffering from self-injury, impulsivity, and other features of borderline personality disorder. Gallen also has extensive experience in DBT and teaches psychology at Harvard Medical School.
The authors note that the book does not address suicidality or self-injury, and urge those who are dealing with either of those issues to seek professional help or go to an ER. While these behaviors are a significant part of BPD, Aguirre and Galen point out that as “many of the problems highlighted in this book can lead to the emergence of suicidal thinking and self-injury urges, addressing these problems in the moment can mean that suicidal thinking and self-injury urges will be less likely to show up.” Catching the thoughts before they cascade out of control may help to decrease such personal endangerment.
Often, individuals with BPD elicit frustration from friends, family members, and clinicians as their actions can be both disruptive and confusing, their self-endangerment terrifying for those who care about them. In this book, Aguirre and Galen’s compassion towards those dealing with BPD comes through. The writing is straightforward, without talking down to the reader, and one gets the sense that Aguirre and Galen understand the level of distress those with BPD experience as they navigate their daily lives. The book is practical, incorporating components of CBT and DBT, without being pedantic. This is a book that can be read on its own but would also serve as a good tool to use during therapy, as each situation offers many points of discussion.
Coping with BPD: DBT and CBT Skills to Soothe the Symptoms of Borderline Personality Disorder
New Harbinger Publications, November 2015
Paperback, 224 pages