Imagine your worst emotional moment. You feel frantic, hopeless and alone. You know your feelings are “too big” for the situation, but you can’t seem to reign them in no matter how hard you try. You reach out to a few people for some support, but they either don’t respond, or don’t understand your pain. You are agitated and restless, but also feel paralyzed to do anything to get relief — besides, what would you even do? Nothing seems to work, and for a time, it seems like your pain will never end.

Most people (especially when we are young) know what it’s like to have an emotional meltdown. If you have ever experienced anything like this, you know it’s miserable, but for most of us, fairly short lived. Big feelings tend to pass, and over time, we learn more effective ways of coping with, or even preventing these emotional storms.

Now imagine feeling this way all the time.

Experiencing constant emotional storms like the one described above is a reality of life for the millions of individuals who suffer from the symptoms associated with Borderline Personality Disorder (or BPD).

BPD is a debilitating condition that is typically diagnosed in young adulthood and is characterized by emotional instability, chaos in relationships, a sense of emptiness or or lack of identity, and difficulty communicating feelings and needs appropriately. Many individuals with BPD struggle with ongoing thoughts of suicide; they often self-injure or engage in destructive and impulsive behaviors.

My first real job as a mental health counselor took place in a hospital setting. I saw individuals and families for regular (usually weekly) therapy sessions, but my office was located in a behavioral health setting which was a part of our local hospital.

Over time I started to notice that many of my clients struggled with settling down, tolerating distress, regulating their emotions and communicating effectively. While many of us have these issues from time to time, I noticed that for some individuals, the inability to cope was their core issue. Their problems weren’t necessarily overly complex or unmanageable, but they did not possess the needed skills to deal with life stressors, and the strategies and insights that helped other clients did not seem to make any difference at all.

Prior to this job I worked in an inpatient crisis stabilization unit, so I was familiar with the more severe presentation of Borderline Personality Disorder. Many of those individuals struggled most of their lives with suicidal thoughts and self-injurious behavior. They could not hold jobs or maintain healthy relationships and their routines were interrupted by frequent hospitalizations.

I learned very quickly that the symptoms of BPD exist on a spectrum. The patients I worked with in inpatient were among those with more severe symptoms, often compulsively self-injuring or unable to cope with overwhelming thoughts of suicide. (It is believed that up to 20% of individuals who are hospitalized for psychiatric issues meet the criteria for BPD).

On the other hand, the individuals who presented for outpatient therapy tended to have some of the same traits, but were generally less intense in their moods, emotions and behaviors. They typically were able to hold jobs, and had at least a few supportive people in their lives.

But their lives were also characterized by chaos. It was difficult to get any real therapeutic work done, because each week would bring a new crisis. Each time these clients walked in the door, I felt like we were starting all over. They might exhibit great insight one week, but the next week tell me their lives had fallen apart.

I began to experience the same hopelessness my clients did. How on earth was I going to help them? I became even more discouraged when I discovered that individuals with Borderline Personality Disorder can be extremely marginalized — not only by their families and friends, but also by the mental health community. Many counselors simply refuse to work with clients who have BPD, referring them out as soon as they see the telltale signs and symptoms.

This did not feel right to me. As frustrated as I was at times with the behavior of these clients, I also found myself having a great deal of compassion for them. Their suffering was palpable and I truly wanted to do something to help them feel less miserable and function more effectively.

That’s when I found Dialectical Behavior Therapy (DBT).

In my next post I will discuss DBT in more detail and explain how this therapy has brought hope and relief to those who suffer from the symptoms of BPD. This framework also helps family members communicate with and support loved ones who have this condition.

An important note about suicide – Suicidal thoughts and feelings are never normal and require immediate intervention. If you have these thoughts, particularly if they persist, call 911, 988 or text 741741. You can also go directly to your local Emergency Department.

If you are in the Greenwood/Indianapolis, Indiana area and are interested in learning more about how the therapy process works, give us a call at 317-743-8202 or email [email protected]. Even if you’re not in the area and have questions, we would be glad to help if we can.