Borderline Personality Disorder (BPD) is a complex and deeply challenging mental health condition. A hallmark of BPD is emotional instability, which often stems from an inability to integrate experiences over time into a coherent narrative. In healthy relationships, we tend to use past interactions and experiences to build trust, predict behavior, and understand the intentions of others. However, for individuals with BPD, each interaction can feels as if it exists in a vacuum. They are unable to see the consistency in someone’s actions and may interpret small setbacks as massive betrayals or evidence of abandonment.
For example, imagine a BPD patient in a close friendship. If their friend cancels a plan due to an unavoidable reason, rather than considering the history of reliability and friendship, this might be interpreted as evidence that the friend no longer cares for them or is about to leave them. The inability to place the friend’s behaviour in the broader context of their past reliability means they experience the cancellation as a catastrophic event, and misread the others intention. They might react with intense anger, sadness, or even a desire to cut ties entirely. This leads to a cycle of emotional volatility and unstable relationships that is characteristic of the disorder.
Therapy provides an avenue to address the core problems related to this lack of continuity. At the behavioural level, therapy aims to help individuals develop more adaptive responses, and at the very least delay or interupt more potentially unhelpful behaviours to emotional triggers. Since emotional reactions of anyone can be extreme and disproportionate to the event from time to time, skills like mindfulness, distress tolerance, emotional regulation, and interpersonal role-plays and feedback in therapy can be helpful. Mindfulness, in particular, helps patients to learn to observe their emotions and thoughts without immediately reacting to them. This skill can reduce impulsive behaviours and allow the individual to pause before reacting to an event based on an immediate emotional response. Over time, this mindful approach can help people recognise patterns in their interactions and develop a sense of continuity.
At the cognitive level, Psycholigical disorders are often driven by distorted beliefs and maladaptive schemas—deeply ingrained patterns of thinking and feeling that shape how a person interprets the world. People with mental health difficulties commonly hold core beliefs such as “I am unlovable,” “Others will abandon me,” or “People cannot be trusted.” These beliefs distort how they interpret the behaviour of others and fuel the lack of continuity in their experiences. For instance, even small disagreement can be seen as proof that they are unloved or will be abandoned, regardless of the context of their relationship; because however intolerable our beliefs are, we still suffer a confirmation bias of sorts where information that supports them is readily accepted, whilst information that doesn't is distorted or rejected.
Therapy directly addresses these deep-rooted cognitive distortions. The therapist helps the individual identify these maladaptive schemas and replace them with healthier, more balanced beliefs. This process often involves looking at past experiences and relationships to understand where these schemas originated and how they have been reinforced over time. By recognising and challenging these beliefs, the individual can begin to place the behavior of others in a more balanced, historical context. For example, rather than seeing a cancelled plan as proof of abandonment, and instead might come to view it as a normal part of life, reflecting a temporary inconvenience rather than a sign of rejection.
One of the most critical aspects of therapy for anyone is the relationship between the patient and the therapist. People with BPD often struggle with trust and fear of abandonment, which will manifest in their interactions with their therapist. At the same time, the therapeutic relationship offers a unique opportunity for honest emotional experiences, where the patient can learn to build trust, experience continuity in a relationship, and explore their fears and real experiences of abandonment in an honest environment.
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