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How to treat Borderline Personality Disorder: A Schema Therapy Approach (Part 1)

(Note: The terms modes, personas, parts-of-self, and sub-selves, are all used interchangeably in this article.)

 

Research has been conducted on the effectiveness of schema therapy for the treatment of borderline personality disorder (BPD); results indicate that this form of treatment is a very effective intervention for people struggling with the disorder.  (Giesen-Bloo, et al, 2006).

A schema is a deep seated, felt and internalized belief about the self in relation to others.  You know you are experiencing a maladaptive schema (no longer functional in current relationships) when you feel “triggered” to the point that your reaction is not in line with the preceding event.

All people have schemas. The purpose of this article series is to address and help people heal the maladaptive ones; maladaptive because they no longer serve the host, at least in terms of healthy interpersonal relating.

Early maladaptive schemas are the memories, emotions, bodily sensations, and cognitions associated with the destructive aspects of the individual’s childhood experiences, organized into patterns that repeat throughout life. 

Schemas of people with BPD

According to Jeffrey Young, the core schemas experienced by the person with borderline issues include abandonment, abuse, emotional deprivation, defectiveness, and subjugation.  These are defined below (Young, Klosko, Weishaar, 2003):

  • Abandonment: Involves the sense that significant others will not be able to continue providing emotional support, connection, strength, or protection.
  • Abuse: The expectations that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage.
  • Emotional Deprivation: The expectation that one’s desire for a normal degree of emotional support will not be adequately met by others.
  • Defectiveness: The feeling that one is defective, bad, unwanted, inferior, or invalid; to such a degree that one is unlovable to significant others.
  • Subjugation: Excessive surrendering to others because one feels coerced – for instance, submitting in order to avoid anger, retaliation, or abandonment.

Note: People with BPD are often misdiagnosed as having bipolar disorder.  The key marker for BPD is a deep and pervasive fear of abandonment. The main indicator for bipolar disorder is the symptom of manic episodes. Bipolar disorder is a commonly misdiagnosed mental illness.

Probably, the main reason people with BPD get diagnosed with bipolar disorder so often is because of their fluctuating mood swings. One thing to note that is particular about the “mood swings” of the person with BPD is that they happen rapidly, multiple times per day.

In order to diagnose someone with Bipolar disorder he must meet the following definition for a manic episode:  “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day” (American Psychiatric Publishing, 2013).  A person with bipolar disorder does not have rapid mood swings within the hour. The cycle is longer in duration than that experienced by someone struggling with a borderline diagnosis.

Underlying theory of schema therapy 

While schemas are deeply ingrained systems of belief that are activated when “triggered,” modes are the personification the person takes on as a self-defense mechanism.  In essence, a mode is a self-protective, dissociated state of personality that “comes to the rescue” in order to protect the fragile psyche (the vulnerable child) from facing the deep pain associated with the triggered schema.

A similar therapy approach similar to this idea is ego-state therapy. Ego-state therapy views the various modes listed below as protectors, created during the child’s developmental stages of growth in response to childhood stressors. In ego-state therapy, these protectors are called parts of self or reactive parts. There may be distinctions, but the basic idea is the same. (For further information on these theories, check out the website www.dnmsinstitute.com.)

List of common sub-selves displayed by a person with BPD in childhood (according to Jeffrey Young, 2003), include:

  • Abandoned child mode
  • Angry and impulsive child mode
  • Punitive parent mode
  • Detached protector mode

The descriptions of each of these personas will be discussed in part 2:  How to treat Borderline Personality Disorder:  A Schema Therapy Approach (Part 2)

 

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth  Edition:  DSM-V.  Arlington, VA: American Psychiatric Association.

Giesen-Bloo, J., van Dyck, R. Spinhoven P.; van Tilburg, W. Dirksen, C.; Thea van Asselt, T., Kremers, I., Nadort,& Arntz, A. (2006).  Outpatient Psychotherapy for Borderline Personality Disorder: a randomized trial of Schema focused therapy versus Transference focused therapy.  Archives of General Psychiatry (63)6.  pp. 649-658.

Schmidt, S.J. (n.d.) The Developmental Needs Meeting Strategy: What It Is and How It Works. Published by The DNMS Institute, LLC. Retrieved from: http://www.dnmsinstitute.com/therapy/wp-content/docs/aboutdnms.pdf

Young, J.E.; Klosko, J.S.; Weishaar, M.E. (2003). Schema Therapy: New York, NY. Guilford Press.

 

How to treat Borderline Personality Disorder: A Schema Therapy Approach (Part 1)

Sharie Stines, Psy.D

Sharie Stines, Psy.D. is a recovery expert specializing in personality disorders, complex trauma and helping people overcome damage caused to their lives by addictions, abuse, trauma and dysfunctional relationships. Sharie is a counselor at LIfeline Counseling & Education Inc., in Southern California (www.lifelinecounselingservices.org). Lifeline Counseling is a non-profit organization 501(c)(3) corporation. Sharie is also an abusive relationship recovery coach - therecoveryexpert.com

 


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APA Reference
Stines, S. (2018). How to treat Borderline Personality Disorder: A Schema Therapy Approach (Part 1). Psych Central. Retrieved on December 13, 2018, from https://pro.psychcentral.com/recovery-expert/2018/12/how-to-treat-borderline-personality-disorder-a-schema-therapy-approach-part-1/