Table of ContentsView AllTable of ContentsParanoid IdeationDichotomous ThinkingDissociationBPD Treatments

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Table of Contents

Paranoid Ideation

Dichotomous Thinking

Dissociation

BPD Treatments

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Borderline personality disorder(BPD) is associated with cognitive problems that often contribute to other symptoms, includingrelationship issues, emotional instability, andimpulsive behavior. Some treatments for BPD focus on addressing these problems in thinking.

This article discusses some of the thinking problems that characterize BPD, along with treatments that can help people manage them.

Many people with BPD experienceparanoia, erroneously believing that others want to harm them.This type of thinking typically does not happen all the time. Instead, it tends to occur when a person is experiencing stress. These paranoid thoughts are transient, usually lasting a few days or weeks.

Research suggests that 87% of people with borderline personality disorder experience paranoid ideation.

People with BPD may believe that others have hostile intent toward them. They may see signs of this that reinforce this belief all around them. For example, they might believe there are hidden meanings in people’s words, gestures, body language, and eye glances. Because of this, they may feel suspicious and distrustful of others.

Making Lifestyle Changes When You Have BPD

People with BPD also have a tendency to think in extremes, a phenomenon called “dichotomous” or “black-or-white” thinking.People with BPD often struggle to see the complexity in people and situations and are unable to recognize that things are often not either perfect or horrible, but are something in between.

Dichotomous thinking can lead to “splitting,” which refers to an inability to maintain a cohesive set of beliefs about oneself and others. Because of these extreme patterns of thinking, people with borderline personality disorder are prone to slip from one side to the opposite side in their thinking.

For example, they might one day believe their partner is the most wonderful, loving person in the world. The next day, they may think their partner is evil, hateful, and contemptuous. This can harm their potential to hold lastinginterpersonal relationshipsand how they can interact with others.

A History of Borderline Personality Disorder

Another problematic pattern of thinking that occurs in BPD is dissociation. This thinking problem has less to do with the content of thoughts and what people think about, but rather the process of perception.

Dissociationis a common symptom of BPD that involves feeling “unreal,” numb, or separate from one’s own body or psychological experiences.In most cases, people with BPD don’t experience this symptom all of the time. Instead, it tends to emerge during times of stress.

Historically, BPD was regarded as very challenging to treat. More recent evidence indicates that treatments can be effective and help people with the condition cope with thinking problems and other symptoms. Psychotherapy is the most commonly recommended treatment, but medications are also sometimes prescribed.

Psychotherapy

For example, indialectical behavior therapy(DBT), clients are taughtgrounding skills, which can help them end dissociative episodes when they occur.

Inschema-focused therapy, clients learn the origins of their ways of thinking (for example, many people with BPD come from childhood environments that may promote dichotomous thinking patterns), and work with their therapist and on their own to recognize maladaptive ways of thinking and to change those patterns.

Medications

Medications are typically prescribed to manage specific symptoms of BPD. They are often used alongside psychotherapy rather than as a stand-alone treatment.

Mood stabilizers, antidepressants, anti-anxiety medications, and antipsychotics are a few types that may be used. Specific medications that might be prescribed include:

These medications can help reduce symptom severity, improve functioning, and treat co-occurring conditions. That can also play a role in decreasing the risk of suicide, which is higher in people who have BPD.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

Types of Medication for BPD

The Takeaway

People with BPD often experience distorted thinking such as paranoid ideation and dissociation.  Psychotherapy and medication can help people with BPD address negative thought patterns and develop effective coping skills.

If you suspect that you’re experiencing this kind of BPD symptom, talk to your doctor. They can evaluate your symptoms and refer you to a mental health professional.

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Muñoz-negro J, Prudent C, Gutiérrez B, Cervilla J.Paranoia and risk of personality disorder in the general population.Personal Ment Health. 2019;13(2):107-116. doi:10.1002/pmh.1443

Arntz A, Ten haaf J.Social cognition in borderline personality disorder: evidence for dichotomous thinking but no evidence for less complex attributions.Behav Res Ther. 2012;50(11):707-18. doi:10.1016/j.brat.2012.07.002

Vermetten E, Spiegel D.Trauma and dissociation: implications for borderline personality disorder.Curr Psychiatry Rep. 2014;16(2):434. doi:10.1007/s11920-013-0434-8

Choi-kain L, Finch E, Masland S, Jenkins J, Unruh B.What Works in the Treatment of Borderline Personality Disorder.Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007%2Fs40473-017-0103-z

National Institute of Mental Health.Borderline personality disorder.

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th edition. American Psychiatric Association: 2013.Glaser J-P, Van Os J, Thewissen V, Myin-Germeys I. “Psychotic Reactivity in Borderline Personality Disorder.“Acta Psychiatrica Scandinavica, 121(2):125-134, 2010.

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