Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). The Guilford Press. https://survivingcptsd.files.wordpress.com/2018/01/dbt_skills_training_handouts_and_worksheets_-_linehan_marsha_srg_.pdf
- The manual has 3 modules: distress tolerance, emotion regulation, and interpersonal effectiveness. Each module has handouts, which are essentially the lesson plans with descriptions and teachings of the skill. 

University of Minnesota - Twin Cities

Eastern Michigan University

Borderline personality disorder (BPD) is a mental disorder characterized by unstable interpersonal relationships and extreme emotional reactions to affective stimuli. These emotional reactions include, but are not limited to, impulsivity, aggression, self-injurious behaviors, etc., and are usually at their peak during an episode brought about via a singular crisis, whether it is imagined or real.

Borderline Personality Disorder

"Borderline personality disorder. What are the signs and symptoms of Borderline Personality Disorder?" (n.d.). https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-conditions/borderline-personality-disorder/
- This article provides an overview of BPD, including its associated symptoms, the potential causes and current treatments, risks and complications people with BPD experience, as well as modes of self-care for emotional regulation.
- Also provides further reading, additional resources, and important information for relatives and/or friends that have a loved one suffering from BPD.

BPD Signs and Symptoms

DBT Skills Training Manual

- Genetic Predisposition
- Environmental Stress
- Epigenetic Influence
- Neurobiological Mechanisms

Development of BPD

In order to be diagnosed with BPD, an individual must exhibit at least 5 of the following 9 criteria:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Markedly and persistently unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, or recurrent physical fights)
- Transient, stress-related paranoid ideation or severe dissociative symptoms

BPD Diagnostic Criteria

Individuals with BPD often have intense reactions to stimuli, especially in stressful situations. Quarantine and social distancing practices promote the feeling of loneliness and detachment from reality felt by BPD patients and can negatively impact their mental health. 

Impact of COVID-19 on Individuals with BPD

In this study, researchers try to determine the prevalence of Borderline Personality Disorder and self-injurious behaviors among suicidal army soldiers as well as if BPD diagnosis is correlated with higher rates of suicidality.

BPD and Self-Directed Violence Among Suicidal Army Soldiers

1. Dialectical behavior therapy (DBT)
2. Mentalization-based therapy (MBT)
3. Transference-focused therapy (TFP)
4. System training for emotional predictability and problem-solving (STEPPS)
5. Schema-focused therapy 
6. Standard cognitive therapy 
7. Good psychiatric management
8. Rogerian supportive therapy 

Evidence-based Treatments for BPD

1. Attention-Deficit Hyperactivity Disorder (ADHD)
2. Anxiety
3. Depression
4. Post-traumatic stress disorder (PTSD) 
5. Eating disorders (particularly binge-eating)
6. Substance abuse 
7. Dream-reality confusion (DRC)
8. Mood disorder
9. Dissociated Identity Disorder (DID)
10. Heightened rejection sensitivity

Co-occurring Symptoms in BPD

1. high-functioning internalizing (quiet BPD)
2. depressive internalizing 
3. histrionic-impulsive
4. angry externalizing
5. schizotypal/paranoid
6. disturbed internalizing 

Subtypes of BPD 

It has been proposed that there are gender differences in BPD presentation - most notably, there are patterns of novelty seeking and explosive temperament in men with BPD that aren't in men.

BPD and Gender

The DSM-5 specifies nine symptoms of Borderline Personality Disorder:
1. Efforts to avoid real or perceived abandonment.
2. Intense, unstable personal relationships.
3. An unstable and shifting sense of identity.
4. Risky and potentially self-damaging impulsive behaviors.
5. Self-injurious or suicidal behaviors.
6. Unstable patterns of mood and affect.
7. Persistent feelings of emptiness.
8. Difficulty controlling anger.
9. Paranoid delusions.

Symptoms of BPD

Although contentious, one proposed classification of BPD highlights five different subcategories that vary by symptom presentation:

1. Affective: Mood-related symptoms such as depression and anxiety.
2. Impulsive: Characterized by impulsive and often self-injurious behavior.
3. Aggressive: Temperamental symptoms characterized by inappropriate levels of rage and irratibility.
4. Dependent: Characterized by an ntolerance of being alone and fear of abandonment.
5. Empty: Characterized by an instable self-identity and a sense of inner emptiness.

Subtypes of Borderline Personality Disorder

Over the years, many studies have been conducted to examine whether individuals with borderline personality disorder have an empathy deficit and have had conflicting results. However, a recent systematic review examined forty five different studies on the topic and found that thirty six of these studies found a deficit of empathy in their participants with borderline personality disorder. These findings suggest that it may be a characteristic of borderline personality disorder after all.

Borderline Personality Disorder and Empathy 

Reference for Stress Generation

Stress generation is a term given to the propensity of individuals with borderline personality disorder to generate stressful situations in their lives because of their interpersonal problems and instability. 

Stress Generation

References for Neuropsychological Effects of Childhood Trauma in Individuals with Borderline Personality Disorder

Borderline Personality Disorder is a mental illness that is indicated by instability within interpersonal relationships and drastic emotional reactions to stimuli. Some of these reactions include aggression and self-inflicting actions. Aggression can take the form of criminal behaviors, seeing as people with BPD are unable to regulate their actions and impulses. Connections have then been made between childhood trauma and criminal behaviors based on the different effects on a person’s mental state. This is due to the way trauma plays a role in altering functioning within brain areas and responses to situations.

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