Relationships

I was diagnosed with a brain tumor in 2020 as an incidental finding after a routine MRI for migraines during the height of the pandemic. This was not my first diagnosis with a chronic or invisible illness, but proved to be an annoying diagnosis. I say this because it came with more questions than answers. Until you have the tumor removed or biopsied, there is no way to be 100% sure exactly what it is beyond the educated guesses of your amazing medical team. In what I thought would be unrelated, I had an IUD eject itself a month or so prior to finding the tumor, so I was in the market for a new form of protection and menstrual control. Because I also have POTS, birth control has been extremely helpful in controlling some related blood pressure and migraine symptoms. While updating my OBGYN provider to get a new IUD, I was refused until I received clearance from my neurologist. The reasoning was that the hormones from birth control may or may not worsen the status of the tumor. Now while I agree it is the provider’s job to inform the patient, the patient’s consent is the only consent that matters. As if I didn’t understand the repercussions when the duality of the hormones from an unwanted pregnancy wouldn’t be just as precarious, but obviously more so. My medical history is complex and nuanced and that IUD helps manage other conditions I must deal with on a daily basis. I did not have the luxury of just managing the tumor and leaving other conditions and their symptoms to be reactive. I wrote my neurologist a light, but snarky email about how I’d rather be afflicted by the hormones of birth control than those of an unwanted pregnancy. His office faxed a letter to my OBGYN to clear me for my IUD, but the fact I had to ask him for birth control sits oddly to this day. I share my story because we are now in a post-Roe climate where patient autonomy, needs, and consent are often secondary to blanketed thought. Thirty-eight percent of American women face one or more chronic illnesses. The symptomatic nuance chronic illness places on childbearing years will never see the inside of a courtroom because justices are not qualified physicians. These blanket bans by the states will never know how to regulate exceptions, acknowledge women as whole patients, or address their patient outcomes. Now that the Supreme Court has asserted that all uterus-bearing patients no longer have the right to privacy, there is no longer a threshold or standard for patient care independent of a state’s belief systems. Risk assessments are no longer the choice of just the patient, depending on your location. Where does this leave an already complicated relationship between physicians, their patients, and the conditions they’ve vowed to treat?

I have spent nearly 1,000 hours in therapy since I first received a borderline personality disorder (BPD) diagnosis nearly five years ago. Although it has by no means been a walk in the park every single week, I have reached a point in my life where I no longer meet the criteria for BPD and feel (mostly) satisfied with my day-to-day routines. Like many people who receive a borderline personality disorder diagnosis after a hospitalization, I was given the contact information for local dialectical behavior therapy (DBT) treatment facilities and therapists trained in this modality who may be able to help. What I didn’t realize at the time was that DBT isn’t the only option out there for people like me. In fact, there are a total of five different types of therapy that all have a proven success record with borderline patients. 1. Dialectical Behavior Therapy (DBT) Dialectical behavior therapy (DBT) is an evidence-based therapeutic modality designed specifically for individuals with borderline personality disorder. Psychologist Marsha Linehan designed DBT in the 1980s. Linehan, who spent years researching clients with extreme emotion dysregulation and suicidal urges, felt like cognitive behavioral therapy (CBT) caused these clients to experience burnout, lack of motivation, and invalidation. So, she combined some of the aspects of CBT with the ideas of acceptance and mindfulness practice to create a modality that was more fitting for this clientele. Fully-adherent DBT includes weekly individual therapy sessions, weekly skills group education sessions, and phone coaching between sessions. A full course of DBT takes around six months to complete, and clients are encouraged to complete two cycles to master the skills for mindfulness, emotion regulation, distress tolerance, and interpersonal communication. 2. Mentalization-Based Therapy (MBT) Mentalization-based therapy is another evidence-based practice created specifically for people with borderline personality disorder. It’s highly beneficial for people who experienced early childhood trauma that caused abandonment issues or people with insecure attachments to one or both of their parents. The modality borrows some techniques from other common types of therapy, including cognitive-behavioral, psychodynamic, social-ecological and systemic therapies. However, the main focus of this specific modality is to enhance each person’s ability to differentiate between their own emotional state and the emotional state of those around them. This concept is called mentalization, and it is something that many people with BPD struggle with. By learning how to separate your own emotions from others, you can regulate your emotions more effectively and spend less time trapped in a dysregulated state. Like DBT, people who enroll in MBT with a therapist typically attend weekly individual sessions as well as weekly group sessions. Unlike DBT, though, members in groups often interact with each other to offer advice and learn from one another. 3. Transference-Focused Psychotherapy (TFP) Transference-focused psychotherapy (TFP) is a specific type of psychoanalytic treatment in which the focus is on the relationship between the therapist and the individual client. The idea is that by focusing on the interpersonal dynamics that occur between the therapist and the client, the therapist can gain insight that will help the client improve. According to therapists who use TFP, most people develop BPD because of dysfunctional relationships with parents and other caregivers during early childhood. For people who live with borderline personality disorder, TFP is used to uncover the underlying causes of a person’s borderline symptoms so they can build new, healthier thought processes and behaviors. 4. Systems Training for Emotional Predictability and Problem Solving (STEPPS) Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a manual-based, 20-week group therapy program designed specifically for people with borderline personality disorder. Like dialectical behavior therapy, STEPPS combines cognitive behavioral elements and skills training in a group setting. The skills group programs meet once per week for two hours each session. The groups are typically led by a pair of therapists, and the groups are kept fairly small, with around six to 10 participants at a time. Within STEPPS, individuals learn how to identify automatic thoughts through schema work, monitor their symptoms, and how to problem solve situations in healthy manners. STEPPS also teaches the importance of self-care, and how to better manage overwhelming emotions. Although it has not gained as much recognition as other therapeutic modalities for people with BPD, it is still an evidence-based approach with studies that show its success. 5. Trauma Treatment Studies show that people with borderline personality disorder are 13 times more likely to have experienced early childhood trauma. Because of the strong links to trauma, many clinicians have started using trauma treatment with BPD clients to see if processing the trauma helps lower emotional intensity and other symptoms. In fact, some preliminary studies show trauma work as a viable option for people who have BPD and a trauma history. There are several notable types of trauma treatment that work well for people with borderline personality disorder who also have a history of trauma. Some trauma treatment methods that may work include eye movement desensitization and reprocessing therapy (EMDR), skills training in affective and interpersonal regulation (STAIR), and cognitive processing therapy (CPT). While each approach is a little different, they are all methods of processing trauma, which can help decrease symptoms over time. Like most other mental health conditions, treatment options for people with borderline personality disorder shouldn’t be a “one size fits all” approach. However, many people with BPD don’t realize just how many viable treatment options exist for them, and instead they give up when one recommended method doesn’t work. If you are looking for a path to recovery from borderline personality disorder, I hope this list gives you some options to pursue. Recovery from BPD is possible —  it’s just a matter of finding the treatment method and lifestyle that works for you.