Borderline Personality Disorder Treatment in Baltimore

Psychotherapy for Borderline Personality Disorder

Patients (or their family members) often seek me out to learn whether they have borderline personality disorder.

As with many disorders, we now recognize that BPD is a on a spectrum.

If you’re asking “am I borderline?” there’s a good chance you identify with some of symptoms listed below, even if you don’t meet full diagnostic criteria, and may benefit from working with a specialist.

Signs and symptoms or Borderline Personality Disorder may include:

  • An intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
  • A pattern of unstable intense relationships, such as idealizing someone one moment and then suddenly believing the person doesn’t care enough or is cruel
  • Rapid changes in self-identity and self-image that include shifting goals and values, and seeing yourself as bad or as if you don’t exist at all
  • Periods of stress-related paranoia and loss of contact with reality, lasting from a few minutes to a few hours
  • Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive relationship
  • Suicidal threats or behavior or self-injury, often in response to fear of separation or rejection
  • Wide mood swings lasting from a few hours to a few days, which can include intense happiness, irritability, shame or anxiety
  • Ongoing feelings of emptiness
  • Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or having physical fights

Is Borderline Personality Disorder Treatable?

It’s very treatable! But there’s a caveat. It reminds me of the old joke: how many shrinks does it take to screw in a lightbulb. One, but the lightbulb has to want to be changed. If you are willing to make an ironclad commitment to your physical safety, and make a commitment to your treatment, with a professional who is trained to treat BPD, it’s very, very likely you will see substantial improvement. I’ve had a high success rate with the borderline patients I’ve treated in the thirty five years I’ve been a practicing in Baltimore.

In 1987, I completed a two year post-doctoral fellowship at New York Hospital-Cornell Medical in treatment of BPD working under the renowned Otto Kernberg, whose work helped define the disorder. From him, I learned to make therapy a truly safe space with an inviolable safety contract and to confront and set limits around destructive behaviors. In addition, borderline patients can have rapid extreme shifts in their perceptions of self and others, swinging from excited idealization to enraged devaluation—a phenomenon Kernberg called “splitting,“ and which has since become one of the diagnostic criteria for BPD in the DSM. Bringing a patient’s attention to these shifting distortions allows them to achieve a stable and realistic view of themselves and the people in their lives, and thus achieve a stable life.

In addition, I’ve been strongly influenced by Marsha Linehan’s Dialectical Behavior Therapy (DBT), with its emphasis on mindfulness meditation and learning skills to manage emotional disregulation. Thirty years ago, while spending the day together at a conference on Buddhism and psychotherapy, Marsha Linehan told me meditation was the core skill that made all the other DBT skills possible, and in case after case I’ve seen her proven right. In my view, it does no good to teach the DBT skills without grounding the patient in a mediation practice gives them the capacity to employ those skills.

More meditation can mean less medication.

As I explained in this interview in Psychology Today, because borderline patients are “impulse-ridden,”training them to focus on their breath allows them to “let the thoughts pass without being compelled by them.’ That translates to “less damage to their lives, less drama, and fewer crises in interpersonal relationships.”

Borderline patients are often on a cocktail of psychiatric medications, sometimes accumulated over years in the mental health system. Since medications are blunt instruments that typically dull strengths as well as symptoms, less is often more. In particular, I usually discontinue atypical antipsychotics whose toxic side effects usually outweigh their therapeutic benefit.

As you learn to self-regulate with meditation, you may require less external chemical regulation.

“It’s now such a mainstay in Gartner’s practice—he specializes in treating people with bipolar disorder and borderline personality disorder—that no one exits a first session without 10 minutes of instruction in meditation and downloading on their cell phone a free app for guided meditation. “I work with people who are impulse-ridden,” Gartner explains. Training them to focus on their breath doesn’t stop their thoughts; it interposes distance and delay so they can pay less attention to them. “They can let the thoughts pass without being compelled by them.” For his patients that translates to less damage to their lives, less drama, and fewer crises in interpersonal relationships.

Hara Estroff Marano, “The Omnibus Cure,” Psychology Today, 6/10/16Psychology Today

Boderline Personality Disorder Treatment

John Gartner, PhD Borderline Psychologist

I offer my borderline patients an informed treatment approach which is both tough (when needed) and compassionate in the context of a committed long term relationship. Experience and research shows this kind of therapeutic relationship combined with meditation has a high rate of success.

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