Borderline Personality Disorder and Hypnotherapy

Borderline Personality Disorder is a mental illness that affects a person’s behaviour. BPD is considered by medical practitioners to be a severe psychiatric disorder. It is recognised as such by the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).

The term “Borderline” was first coined by Adolph Stern in 1938. This name was used to describe patients who were on a ‘borderline’ between neurosis and psychosis. However, the symptoms of BPD are not so simplistic as to be defined in terms of neurotic and psychotic. The diagnosis of BPD is based upon signs of emotional instability, feelings of depression and emptiness, identity and behavioural issues rather than signs of neurosis and psychosis.
The latest version of the DSM defines Borderline Personality Disorder (BPD) as: "a pervasive pattern of instability of interpersonal relationships, self image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts." According to the DSM, diagnosis of BPD requires five or more out of nine criteria to be present.

The criteria are
1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense intense interpersonal relationships characterized by alternating between extremes of idealisation and devaluation.
3. Identity Disturbance: markedly and persistently unstable self-image.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g substance abuse , sexual promiscuity, reckless driving, binge eating).
5. Recurrent suicidal behaviour, gestures, threats, or self-mutilating behaviour such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
6. Affective instability due to a marked reactivity of mood.
7. Chronic feelings of emptiness, worthlessness.
8. Inappropriate anger or difficulty controlling anger.
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.

If you search the internet for Borderline Personality Disorder websites, you will find that most sites focus on describing the kind of support one should offer a friend or relative with this disorder, how the world around a person feels to someone with BPD etc. There is very little information on treatments, most sites suggesting Cognitive Behaviour Therapy or Counselling.In 2007, I was presented (as a hypnotherapist) with a client who had been diagnosed with BPD at the age of fourteen years, some twenty years earlier. Prior to this, I had never come across this disorder either personally or professionally so when asked “can hypnotherapy help with BPD”, I had to admit to needing to carry out some research into the disorder and then get back to her.

On reading up on the disorder and in particular seeing the criterion (above) used to diagnose it, I was amazed that as far as I could find, there is nothing published on the use of hypnosis with BPD sufferers. The reason for this amazement was quite simply that each criterion, individually, can be treated with hypnotherapy. The assumption from this being that by starting with a “tick list” of each criterion present and working through each of them, one by one, would surely yield positive results?
The lady in question lived a fairly long way from my hypnotherapy practice so I actually treated her in two hour sessions to help keep down her travelling time and costs. She ticked seven of the nine criterion and we graded them from “present” to “overwhelming” and embarked upon treating each of them.
Now, this all sounds so incredibly simple, and I’m sure that any hypnotherapist reading this and looking at the above list is probably thinking “this is pretty easy, surely a disorder that has been identified for so long and has so little known about it can’t be this simple to treat”. It is also worth mentioning at this point that the lady in question had seen psychiatrists, psychologists, psychotherapists, counsellors, attended group therapy programmes, you name it, she had tried it – for twenty years with little or no success!
The sad thing is that, in this instance at least, it really was this simple. I spent a total of fourteen hours with the lady in question, seeing positive change after every session (double session). At the end of the seven weeks, this is what she had to say:

“I’d lived with an illness for over twenty years when I went to see Gary. After some tailored sessions, and a different CD to take home each time, I now experience life in a way neither I, nor the doctors thought was possible. I can only compare the result of what he did to being like stepping out of a cage for the first time in twenty years”.
Since then, she has moved home, found work and the last time I spoke to her (a few months ago) had become involved in a new relationship and was considering living overseas.
I refer to this as a sad thing because, if indeed the treatment can be this simple (unfortunately without treating another ninety nine or so BPD patients or at least tracking down this number of case studies, it is, as yet, far from proven), then it really is an outrage that so few medical professionals in the UK refer patients for hypnotherapy. The journalist and author Robert Temple felt the same indignation at the mainstream medical profession’s closed-mindedness towards hypnosis when he wrote (on the subject of hypnosis for pain relief):

“ Hypnosis has the wonderful advantage that when it can be used against pain, it carries no side effects. Unlike morphine, it does not cloud the mind. Terminal cancer patients are amongst the most urgent cases needing hypnosis. There is no need for the hypnotizable terminal cancer patient to be doped up and die in a haze of confusion……. With hypnosis, he or she can die in dignity with a clear head up to the last moments of life, free from agony and enjoying the company of loved ones. It is an outrage that this possibility has been denied to all but a fraction of those terminal cancer patients who have died in the past century or so”.

If you are reading this and have been diagnosed with Borderline Personality Disorder, then please seek help from a hypnotherapist. If you are a hypnotherapist who has further case studies on the treatment of BPD with hypnosis then please contact me. Hopefully with enough case studies, the hypnotherapy profession can set foot along the road to being seen as a serious alternative to the inadequate treatments that are currently available for this disorder.

© Gary Oke, January 2009

Gary Oke is a hypnotherapist and life coach based in Manchester, Glossop and Sheffield (UK). He is a member of the British Institute of Hypnotherapy and the General Hypnotherapy Register. For further information, please visit http://www.okehypnotherapy.co.uk