A Proposed Treatment Connection for Borderline Personality Disorder (BPD): Dialectical Behavior Therapy (DBT) and Traumatic Incident Reduction (TIR)

By Ashley Doyle

A large percentage of the population experiences some type of trauma in their lifetime; however, they don't all develop a diagnosable disorder. Even though no research can definitively predict what types of traumas will elicit a diagnosable disorder, there has been some indication as to who is more at risk for the development of trauma-related disorders, specifically Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD). Yet other disorders may also be elicited such as anxiety disorders, depressive disorders, or personality disorders. Children, the elderly, and the disabled are labeled at-risk due to their dependency on others, sparse coping strategies and resources, and economic disadvantages. Additionally, individuals who experience extra stressors, low-self esteem, and have a poor sense of self are also at risk of developing a disorder rather than use resiliency (Petersen & Walker, 2003). One extreme reaction to trauma exposure is the elicitation of a personality disorder, specifically Borderline Personality Disorder (BPD).
The focus of this paper is three-fold. First, it compares two treatment approaches: Dialectical Behavior Therapy (DBT) and Traumatic Incident Reduction (TIR). These are different in technique and philosophy when regarding the processing of traumatic events. Second, it reviews the evidence for co-morbidity (simultaneous occurrence) between BPD and PTSD. Finally, this paper will propose a strategic plan for the most effective treatment for individuals with BPD and PTSD symptoms.
Metapsychology Monographs #8

• Language: English
• Publisher: Loving Healing Press
• Release date: Mar 28, 2012
• ISBN: 9781615998722

Book preview

Borderline Personality Disorder

Overview of Disorder

Characterized by a pervasive pattern of unstable interpersonal relationships, lack of self-image, impulsivity, and unstable affects that cause impairment in functioning, BPD individuals report constant misery. Due to the manifestation of a fear of abandonment, individuals with BPD express a lack of sense of self, and often will take on the characteristics of others they encounter. Changes in the sense of self are common, through the expression of shifting goals, values and aspirations. Within relationships, which increase in intensity rapidly, the individual can shift from being needy and demanding of attention, to someone who is avoidant and distant. Mood dysregulation and depression are characterized by feelings of emptiness, loneliness and anger. Fear of abandonment is typically expressed through anger outbursts, avoidance, panic, suicidal ideation, parasuicidal, or other self-harming behaviors, or impulsive actions (Linehan, 1993a). [Ed note: parasuicide is a any intentional self-harm resulting in tissue damage, without the intent to die.]

There are two kinds of impulsive behavior. External impulsions may include gambling, binge eating, substance abuse, hypersexual activities, excessive spending, and reckless driving. The focus of the impulsivity is directed outward into the environment, rather than toward the individual person. Internal impulsivity, however, directs the focus on the individual’s sense of self or body. The most commonly noted internal impulses are suicidal ideation and/or para-suicidal actions (Diagnostic and Statistical Manual of Mental Disorders, 2000). The vast majority of BPD individuals report histories of abuse; specifically, incest and childhood sexual abuse at 75% and 86% respectively. The high prevalence of sexual abuse, as opposed to other forms of abuse, is thought to be uniquely correlated with BPD. Much of the abuse takes place in childhood, which may change the physiology in the central nervous system of individuals, leaving them vulnerable to emotional dysregulation (Linehan, 1993a).

The effect of sexual abuse depends on the perception of the victim. The perception that the abuse may result in physical or emotional pain can cause negative repercussions on the individual’s integrity, sense of self, or perceived sense of control over life events (Palmer & Edmunds, 2003). Child abuse victims have a tendency to split when thinking about their abuse. Their abusers are all bad for abusing them, or they are all bad for allowing the abuse to continue. Splitting, which originated after the abuse, can eventually transfer into other areas of life for someone with BPD. Assigning absolute value labels to individuals in their lives is not uncommon for BPD clients. Additionally, individuals with BPD can dissociate as a coping mechanism in order to alleviate pain. Dissociation at one point is effective for the