Summary: Borderline personality disorder ( BPD ) has a significant role in it and frequently persists even after the clinical symptoms subside. Recent treatments, such as dialectical behavior therapy, fail to fully solve social inclusion, which is essential for long-term treatment.
A better strategy may include general medical management ( GPM), which emphasizes self-reliance, neighborhood engagement, and expanding social network through low-stakes connections. Patients may develop lasting connections and lessen their dependence on special medical relationships through interventions like party therapy, occupational programs, and group activities.
Important Information:
- Despite receiving no symptoms, patients report higher levels of loneliness.
- Treatment Gaps: Recent treatments overlook fostering real-world social inclusion.
- Community Focus: GPM promotes self-reliance through group therapy, technical job, and shared actions.
Origin: Wolters Kluwer Health
According to Harvard researchers, loneliness is a key factor in the growth of borderline personality disorder ( BPD). Therefore, the majority of patients list increased social cohesion as their top care objective.
In the , Harvard Review of Psychiatry,  , part of the Lippincott portfolio from , Wolters Kluwer, Lois W. Choi-Kain, MD, MEd, DFAPA, of Harvard’s McLean Hospital, and associates call for BPD therapy to extend beyond special therapeutic associations to help people  , build durable relationships with others in the area.
” Any support in building little links can provide some relief from loneliness and work against phases of dominance, luxury, and uncertainty in social relationships”, the authors emphasize.
In a world where traditional psychosocial treatment demand significantly outweighs supply, benefits gained from community-based interventions are also important.
Loneliness is key to BPD, but present treatments do not handle it fully
In a review of scientific literature, Dr. Choi-Kain’s team found that, compared with good controls, individuals with BPD regularly report higher levels of loneliness, which is defined as a personal feeling of inadequate social connection different from the person’s goal degree of social isolation.
Moreover, social networks of people with BPD include more intense and exclusive relationships, such as romantic partners and therapists, and fewer acquaintances.
When clinical symptoms relapse, loneliness frequently persists, which indicates that it is a component of BPD. Loneliness has been linked to a number of chronic health conditions and premature mortality in the general population.
Therefore, loneliness should be a part of BPD’s general health intervention.
The team, however, found numerous studies that showed that dialectical behavior therapy, which concentrates on emotional dysregulation and skill deficiencies, does not produce sufficient functional improvements in roles that can give a sense of self.
Major psychodynamic approaches, such as mentalization-based treatment and transference-focused psychotherapy, focus on enhancing accurate and mature social cognition and insight, but do not always focus on social integration in the community.
General psychiatric management promotes self-reliance and community engagement
In addition to noting the shortfalls of current treatment approaches, Dr. Choi-Kain and her co-authors critique colleagues for , “advocating sequential migration of patients through multiple intensive specialist psychotherapies” . ,
They claim,” This practice of stringing together lengthy and inaccessible therapies continuously socializes patients into dyadic caregiving in treatment settings rather than focusing on self-reliance in the real world.”
The general psychiatric management ( GPM) model, which views hypersensitivity to interpersonal stressors as the main dysfunction in BPD, is a better option, according to the group.
GPM emphasizes developing self-esteem and identity through work and other forms of responsibility in addition to using psychoeducation to help patients understand their social interactions more realistically.
The idea is to expand patients ‘ social networks by helping them form low-stakes relationships through role-bound, scheduled, activity-directed interactions such as:
- In a supportive environment, group therapy allows patients to engage in social behavior, provides a forum for explicit instruction in rules and community values, and rebalances the intense and exclusive relationships that people with BPD typically form.
- Connection to nonclinical community resources, including organized activities in line with patients ‘ genuine interests, such as gardening, sports, and the arts, as well as engaging in individualized pursuits in a shared space
- vocational interventions to improve patients ‘ self-reliance by fostering structured relationships with others and daily activities.
- Peer support, which appears to benefit both patients and peer support specialists
Dr. Choi-Kain’s group urges more attention to the long-term recovery period for patients with BPD, beyond initial symptom reduction.  ,
Further study is needed to help patients work independently, among peers, and in relationships with others to solidify and stabilize their personality functioning.” This later treatment phase requires greater investment.
About this research on loneliness and borderline personality disorder.
Author: Josh DeStefano
Source: Wolters Kluwer Health
Contact: Josh DeStefano – Wolters Kluwer Health
Image: The image is credited to Neuroscience News
Original Research: Open access.
” Borderline Personality Disorder and Loneliness: Broadening the Scope of Treatment for Social Rehabilitation” by Lois W. Choi-Kain et al. Harvard Review of Psychiatry
Abstract
Borderline Personality Disorder and Loneliness: Broadening the Scope of Treatment for Social Rehabilitation
Borderline personality disorder ( BPD ) has been described as a form of isolation intolerance. This characteristic drives distinguishing criteria, such as frantic efforts to avoid abandonment.
BPD and loneliness are linked to a higher mortality risk and a number of undesirable health outcomes. Fundamental impairment in attachment and interpersonal functioning are stressed in psychodynamic theories of BPD.
Empirical research demonstrates that a BPD diagnosis is linked to a rise in loneliness.
Individuals with BPD experience higher levels of loneliness than the general population, and their social networks are systematically smaller, less diverse, and less satisfying.
When controlling for these relevant social network characteristics, there are still differences in the subjective experience of loneliness, which suggests that those with BPD experience more loneliness than others in the same objective social circumstances.
Increased social interaction is frequently a primary treatment objective and indicator of a successful recovery, according to BPD patients.
However, there are only a few empirically proven methods for addressing loneliness and creating life patterns that foster lasting bonds with others.
Therefore, loneliness persists as an intractable problem, often failing to remit alongside other symptoms, and few resources are routinely implemented to address this problem.
We make the argument in this article that loneliness is at the heart of many BPD patients ‘ symptomatic oscillations and subjective experiences.
To enhance patients ‘ social networks, we suggest that treatment go beyond the overemphasized therapeutic alliance relationship and also include socialization and group and vocational settings.
Building larger social networks that emphasize role-bound identity formation and community relationships rather than exclusive caregiving and/or romantic relationships would more directly target relational instability and long-term identity diffusion.
Such interventions can harness nonclinical community resources, such as group treatment, vocational supports, and peer supports.
