Summary: Loneliness plays a central role in borderline personality disorder (BPD) and often persists even when clinical symptoms subside. Current treatments, such as dialectical behavior therapy, fail to fully address social integration, which is crucial for long-term recovery.
A better approach may involve general psychiatric management (GPM), which emphasizes self-reliance, community engagement, and expanding social networks through low-stakes relationships. Interventions like group therapy, vocational programs, and community activities could help patients build lasting connections and reduce dependency on exclusive therapeutic relationships.
Key Facts:
- Loneliness in BPD: Patients report high loneliness levels despite symptom remission.
- Treatment Gaps: Current therapies overlook fostering real-world social integration.
- Community Focus: GPM promotes self-reliance through group therapy, vocational work, and shared activities.
Source: Wolters Kluwer Health
Loneliness is a key driver in the maintenance of borderline personality disorder (BPD), Harvard researchers argue. Thus, many patients cite increased social connection as a primary treatment goal.
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 colleagues call for BPD treatment to extend beyond exclusive therapeutic relationships to help patients build durable connections with others in the community.
“Any support in building small connections can provide some relief from loneliness and work against cycles of dependency, exclusivity, and volatility in social relations,” the authors emphasize.
“Additionally, benefits achieved through community resource-driven interventions are valuable in a landscape in which demand for traditional psychotherapeutic treatment drastically outweighs supply.”
Loneliness is core to BPD, but current interventions do not address it comprehensively
In a review of scientific literature, Dr. Choi-Kain’s team found that, compared with healthy controls, individuals with BPD consistently report higher levels of loneliness, which is defined as a subjective feeling of insufficient social connection distinct from the person’s objective 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.
Loneliness often persists when clinical symptoms remit, indicating that it is integral to BPD. In the general population, loneliness has been linked to numerous chronic health conditions and premature mortality.
Therefore, loneliness should be targeted as a general health intervention in BPD.
The team, however, identified multiple studies demonstrating that dialectical behavior therapy, which concentrates on emotional dysregulation and skill deficits, does not result in adequate functional improvements in roles that can provide a positive 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 point out, “this practice of stringing together lengthy and inaccessible therapies continuously socializes patients into dyadic caregiving in treatment settings rather than emphasizing self-reliance in the real world.”
A better option, the group says, is the general psychiatric management (GPM) model, which considers hypersensitivity to interpersonal stressors to be the core dysfunction in BPD.
In addition to harnessing psychoeducation to help patients more realistically understand their social interactions, GPM emphasizes developing self-esteem and identity through work and other forms of responsibility.
The idea is to expand patients’ social networks by helping them form low-stakes relationships through role-bound, scheduled, activity-directed interactions such as:
- Group therapy, which allows patients to practice social behavior in a supportive environment, provides a forum for explicit instruction on rules and community values, and balances the intense and exclusive relationships that people with BPD tend to 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 increase patients’ self-reliance by participating in daily activities and structured relationships with others
- 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.
“Greater investment in this later treatment phase is critical and requires further research to help patients work independently, among peers, and in relationship with others to solidify and stabilize their personality functioning.”
About this borderline personality disorder and loneliness research news
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 condition of intolerance of aloneness. This characteristic drives distinguishing criteria, such as frantic efforts to avoid abandonment.
Both BPD and loneliness are linked with elevated mortality risk and multiple negative health outcomes. Psychodynamic theories of BPD emphasize fundamental impairment in attachment and interpersonal functioning.
Empirical research demonstrates an association between BPD diagnosis and increased 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.
Differences in the subjective experience of loneliness persist when controlling for these relevant social network features, indicating that people with BPD experience more loneliness than others in the same objective social circumstances.
According to patients with BPD, increased social connection is often a primary treatment goal and marker of satisfying recovery.
There are, however, few evidence-based approaches that primarily target loneliness and building life structures that support durable connections 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.
In this article, we argue that loneliness is central to the symptomatic oscillations and subjective experiences of many patients with BPD.
We propose that treatment extend beyond the overemphasized therapeutic alliance relationship to also promote socialization and group and vocational settings to enhance patients’ social networks.
Building larger social networks that rely less on exclusive caregiving and/or romantic relationships and more on role-bound identity building and community relationships would more directly target long-term identity diffusion and relational instability.
Such interventions can harness nonclinical community resources, such as group treatment, vocational supports, and peer supports.
