What Are the Causes of Borderline Personality Disorder?

Borderline personality disorder (BPD), a basic feature of which is a universal pattern of interpersonal relationships, instability of self-image and emotion, and significant impulses, begins no later than early adulthood and exists in a variety of backgrounds.

Chinese name: Borderline personality disorder
Foreign name: Borderline personality disorder / BPD
Applied discipline: psychology

Application range: Perverted Psychology, Psychiatry
Also known as: Boundary personality disorder
Category: Pathological personality
Main features: Emotions, relationships, self-image, behavioral instability

Borderline personality disorder diagnostic criteria

As defined in the latest edition of the 5th Edition of the Manual of Diagnostic and Statistical Mental Illnesses ("DSM-5"), the following are the diagnostic criteria ^[1] :

A general psychological behavior pattern of interpersonal relationships, self-image and emotional instability, and significant conflict: Begins in early adulthood, exists in a variety of backgrounds, and exhibits the following five (or more) symptoms ^[1] :

1. Try to avoid real or imagined abandonment (Note: Excluding suicide or self-harm in the diagnostic criteria in item 5) ^[1] .

2. An unstable and tense interpersonal relationship model characterized by alternating changes between extreme idealization and extreme depreciation ^[1] .

3. Disorder of identity: Significant persistent and unstable self-image or self-perception ^[1] .

4. Impulsiveness of potential self-harm in at least 2 areas (eg, consumption, sexual behavior, substance abuse, reckless driving, binge eating) (Note: Excluding suicide or self-harm in diagnostic criteria item 5) ^] .

5. Repeated suicidal behavior, suicidal gestures or threats or self-harm ^[1] .

6. Emotional instability due to significant mood reactions (for example, intense episodic irritability, irritability, or anxiety, which usually lasts for several hours and rarely exceeds several days) ^[1]

7. Chronic emptiness ^[1] .

8. Inappropriate intense anger or difficulty in controlling anger (for example, frequent tantrums, persistent anger, repetitive fighting) ^[1] .

9. Transient stress-related paranoia or severe separation symptoms ^[1] .

Epidemiology of borderline personality disorder

Epidemiological studies in the United States in 2015 showed that the average prevalence of borderline personality disorder is estimated at 1.6%, but may be as high as 5.9%. In primary care settings, the prevalence of borderline personality disorder is about 6%, about 10% in mental health outpatients, and about 20% in psychiatric inpatients (United States, 2015). The prevalence of borderline personality disorder may be reduced in the elderly ^[1] .

Pathological mechanism of borderline personality disorder

The cause of borderline personality disorder is still under investigation. The etiology and pathological mechanism may include the following aspects ^[2] :

Biological factors of borderline personality disorder

The biological factors of BPD include genetic characteristics. Some scholars studying twins and families believe that personality disorders will be inherited, especially the emotional instability and impulsive behavior of borderline personality disorders. ^[2] The most commonly used research method for BPD hereditary behavioral genetic research is twin studies. Studies have shown that the probability of co-occurring BPD in identical twins is 35%, and the probability of co-occurring BPD in fraternal twins is 7%, which indicates that BPD has a strong genetic component and genetic basis ^[3] .

Family factors of borderline personality disorder

Unfavorable childhood environments, such as being criticized by parents, witnessing domestic violence, neglecting emotional and physical needs, and related sexual, emotional, and physical abuse, have long been considered important causes of BPD Disease factors. In addition, other trauma events caused by the caregiver, poor parent-child communication, family dysfunction, improper parenting styles, separation from parents or missing parents, and parental personality problems are also risk factors for BPD. ^[2] .

The etiological mechanism of marginal characteristics or disorders has both the effects of psychosocial factors, and the role of neurochemical transmitters and the structure and function of the nervous system. However, there is no evidence to prove which factor is the dominant factor, and it is not possible to determine Clear causality ^[2] .

Borderline personality disorder brain pathology

Neuroimaging studies of patients with borderline personality disorder show that: (brain) structural dysfunction. MRI studies have found that patients with borderline personality disorder have reduced hippocampus and amygdala volume, or only amygdala volume ^[4] .

Some researchers have researched the core characteristics of BPD from the perspective of neural mechanisms and summarized them from the following 4 aspects ^[4] :

Insecure attachment

The brain regions associated with BPD attachment may roughly include some of the brain structures of the frontal lobe, temporal lobe, and limbic system, such as the anterior cingulate gyrus, prefrontal lobe, superior temporal groove, and hippocampal structures. A hypothesis has been proposed that abnormal attachment in early childhood may lead to impaired function of the fronto-limbic control system, and this impaired function in childhood is closely related to the impaired fronto-limbic brain network in adult BPD patients. Relatedly, this hypothesis is currently supported by strong evidence in neurobiological research on parenting disorders ^[4] .

Traumatic experience

Overall, researchers generally believe that the decrease in hippocampal volume is directly related to BPD patients with early traumatic experience, and early traumatic experience plays an important role in hippocampal atrophy in BPD patients. In addition to the hippocampal structure, some researchers have found that the gray matter volume of the caudate nucleus and the right dorsal lateral prefrontal lobe of female patients with childhood trauma are significantly smaller than those of the normal population ^[4] .

3. impulse

Due to changes in the gray matter volume of the prefrontal cortex (especially the orbitofrontal cortex and the dorsal lateral prefrontal cortex), it can be speculated that neuronal activity in the prefrontal cortex (especially the orbitofrontal cortex and the dorsal lateral prefrontal cortex) will have a high effect on BPD patients. The impulsive response plays a role in compensating, but this change in compensation relative to the volume of gray matter is not enough. In addition to the prefrontal cortex, it has also been found that the impulse score of patients with BPD is also inversely related to the parietal lobe ^[4] .

4. Emotional regulation

BPD's emotional regulation dysfunction may be caused in part by the difficulty of BPD patients in calming negative emotions. In addition, the amygdala serves as the starting point for creating a model of the level of the brain system under alert and negative emotional states, and the starting point for identifying systemic abnormalities related to emotional disorders. The role of the amygdala in emotional abnormalities is the focus of research ^[4] .

Clinical manifestations of borderline personality disorder

The basic characteristics of borderline personality disorder are a general pattern of interpersonal relationships, instability of self-image and emotion, and significant impulses ^[1] .

Individuals with borderline personality disorder make crazy efforts to avoid real or imagined abandonment. The perception that separation or rejection is imminent or that external support is lost can lead to profound changes in self-image, emotions, cognition, and behavior. These individuals are very sensitive to environmental changes. They experience extreme abandonment fear and inappropriate anger even when faced with real-life, brief separations or unavoidable plan changes (e.g., sudden Despair response; when someone important to them shows up late or even has to cancel the appointment and shows panic or anger). They may believe that "abandonment" means they are "bad." These abandonment fears are related to the unbearability of being alone and the need to have others around them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-harm or suicide ^[1] .

Individuals with borderline personality disorder will have an unstable and tense interpersonal relationship model. They may idealize the caretaker or couple after the first and second meetings, request more time together, and share the most intimate early in the relationship. detail. However, they may soon switch between extreme idealization and extreme disparagement of others, feeling that the other party is not caring enough, giving enough, or not "on call." These individuals can be empathetic and caring for others, but only if they expect others to be on call to meet their own needs. These people's perceptions of others are prone to sudden and dramatic changes, and others may be alternately considered to be supportive or brutal in good faith. This change often reflects the disillusionment of caregivers of individuals with borderline personality disorder. The caring nature of these caregivers has been idealized, and individuals are expected to be rejected or abandoned by them ^[1] .

Individuals with borderline personality disorder may have problems with identity disorders, which are characterized by significant, persistent, and unstable self-image or self-awareness. Self-image can change suddenly and dramatically, and is characterized by changes in goals, values, and professional aspirations. They may have sudden changes in their perceptions and plans regarding occupations, gender identity, values and friend types. These individuals may suddenly change from a helping role to an avenger of bad treatment in the past. Although individuals with this disorder often have bad or evil based self-images, they may sometimes feel that they do not exist at all. These experiences often occur when individuals feel that they lack meaningful relationships, care and support. In an unstructured work or school environment, these individuals may perform worse ^[1] .

Individuals with borderline personality disorder have a potential for self-harm in at least two ways. They may gamble, spend money, overeat, abuse substances, engage in unsafe sex or drive recklessly ^[1] .

The disorder exhibits repeated suicidal behavior, suicidal gestures or natural threats, and self-harm. Among these individuals, 8% -10% will succeed in suicide; self-harm behaviors (such as cutting or burning) and suicide threats and attempts are very common. Repeated suicide is often the reason why these people come for help. These self-destructive behaviors are often triggered by threats of separation or rejection, or are expected to require more responsibility. Self-harm may occur in a dissociative experience and usually brings a sense of relief by reconfirming the individual's feelings or by atonement for the sense of evil felt by the individual ^[1] .

Individuals with borderline personality disorder may experience emotional instability due to a significant mood response (for example, intense paroxysmal irritability, irritability, or anxiety, which usually lasts for several hours and rarely exceeds several days). The basic irritability of individuals with borderline personality disorder is often interrupted by a period of anger, terror, and despair, and is rarely relieved by a period of comfort or contentment. These episodes may reflect an individual's extreme response to interpersonal stress. Individuals with borderline personality disorder may suffer from chronic emptiness. They are easily bored and may be constantly looking for things to do. Individuals with this disorder often express inappropriate, intense anger or have difficulty controlling anger. They may exhibit extreme irony, long-lasting causticity, or offensive language. Anger often arises when a caregiver or couple is considered to be neglected, reserved, indifferent, or abandoned. This expression of anger is followed by shame and guilt, which makes them feel evil. In extreme stress, individuals with the disorder may experience temporary paranoia or separation symptoms (for example, disintegration of personality), but the severity or duration of these symptoms often does not support giving additional diagnosis. These episodes are most common in reactions to abandonment, real or imagined. Symptoms tend to appear briefly, lasting minutes to hours. The return of real or perceived caregiver caring may lead to relief of symptoms ^[1] .

Individuals with borderline personality disorder may experience self-destructive patterns when goals are about to be achieved (eg, drop out of school when graduation is imminent; severe regression after discussing how well treatment is progressing; destroying relationships when they can be clearly continued) . Some individuals can develop psychotic symptoms under stress (for example, hallucinations, body distortions, implicated concepts, hallucinations before going to bed). Individuals with this disorder may feel more secure about transitional objects (for example, pets or some inanimate object) than interpersonal relationships. Individuals with this disorder, especially those co-morbid with depression or substance abuse disorders, may die prematurely from suicide. Suicide or attempted suicide may result in a physical disability in the individual with the disorder. Repeated unemployment, interrupted education, separation or divorce are common. Physical and sexual abuse, neglect, hostile conflict, early parental loss, are more common in the childhood of individuals with borderline personality disorder. Common comorbidities include depression and bipolar disorder, substance use disorders, eating disorders (especially bulimia nervosa), traumatic stress disorders, and attention deficit / hyperactivity disorder. Borderline personality disorders are often co-morbid with other personality disorders ^[1] .

Differential diagnosis of borderline personality disorder

Depression and Bipolar Disorder: Borderline personality disorder is often associated with depression or bipolar disorder. Both can be diagnosed if they meet the diagnostic criteria. Because borderline personality disorder may behave similarly to the onset of depression or bipolar disorder, if there is no documented early-onset, long-lasting behavioral pattern, clinicians should avoid solely based on cross-sectoral performance. Make additional diagnosis of borderline personality disorder ^[1] .

Borderline personality disorder

Other Personality Disorders: Due to some common characteristics, other personality disorders may be confused with borderline personality disorders. Therefore, it is important to distinguish these obstacles based on typical characteristics. However, if individuals meet the diagnostic criteria for one or more personality disorders in addition to the diagnostic criteria for borderline personality disorder, all disorders can be diagnosed. Although performing personality disorder also has emotions of seeking attention, manipulative behavior, and rapid change, borderline personality disorder can be distinguished by self-harm, anger-like rupture of close relationships, and chronic emptiness and loneliness. Individuals with borderline personality disorder and individuals with schizotypal personality disorder may have paranoid ideas or illusions, but in individuals with borderline personality disorder, these symptoms are more transient, more interpersonal, and more responsive to external environmental changes . Although paranoid personality disorder and narcissistic personality disorder can also respond to minor stimuli with anger, relatively stable self-image and relatively lack of self-damaging, impulsive and abandoned concerns can be used to overcome these disorders. Distinguish from borderline personality disorder. Although antisocial personality disorder and borderline personality disorder have the characteristics of manipulative behavior, individuals with antisocial personality disorder obtain benefits, power or other material satisfaction through manipulation; while the goal of individuals with borderline personality disorder is to obtain Care of the caregiver. Individuals with dependent personality disorder and individuals with borderline personality disorder are afraid of being abandoned; however, the response of individuals with borderline personality disorder to abandonment is emotional emptiness, anger, and strong demands; and responses with individuals with dependent personality disorder It is intensified courting, obedience, and eagerness to find alternative relationships for care and support. Borderline personality disorder can be further distinguished from dependent personality disorder through typical unstable and tense interpersonal relationship models ^[1] .

Personality changes due to other physical diseases: Borderline personality disorder must be distinguished from personality changes due to other physical diseases. Among personality changes due to other physical diseases, the appearance of personality traits is attributed to other physical diseases. Effects on the central nervous system ^[1] .

Substance use disorders : Borderline personality disorders must be distinguished from symptoms developed as a result of persistent substance use ^[1] .

Identity issues: Borderline personality disorders need to be distinguished from identity issues, which are only used to describe issues that are related to identity issues at developmental stages (for example, adolescents) but not mental disorders ^[1] .

Marginal differential diagnosis table ^[5]

Marginal personality is characterized by a universal interpersonal relationship, self-image and emotional instability and a pattern of obvious impulsivity, which must be distinguished from ...	Relative to borderline personality disorder ...
Performance personality disorder	Characteristic performance is good self-destruction, anger disturbs intimacy and chronic deep emptiness and loneliness.
Paranoid ideas or angry responses to minor stimuli in paranoid personality and performance personality disorders	It is characterized by a relatively stable self-image and a relative lack of self-destruction, impulse and fear of being abandoned.
Manipulation in antisocial personality disorder	The desire to receive rights, benefits or material benefits is driven by the desire to receive care instead.
Worries abandon in attachment personality disorder	Characterized by double courting and obedience to the threat of being abandoned, and eager to find alternative relationships for care and support
Paranoia or illusion in schizotypal personality disorder	It is characterized by paranoia, which is less interpersonal and more difficult to modify by external structure and support.
Personality disorders due to other physical diseases, unstable	Characteristic is that personality changes are related to the direct effects of general physical illness.

Course and Outcome of Borderline Personality Disorder

The course of borderline personality disorder has considerable variability. The most common patterns are chronic instability in early adulthood, severe episodes of out-of-control emotional and impulse control, and high use of health and mental health resources. The impairment and the risk of suicide are greatest in youth and gradually diminish with age. Although strong emotions, impulses, and strong tendencies to interpersonal relationships are usually life-long, individuals participating in therapeutic interventions usually begin to improve in the first year. In their 30s and 40s, most individuals with this disorder will gain greater stability in their relationships and professional functions. From mental health clinics about these

Borderline personality disorder Individual follow-up studies show that after about 10 years, half of these individuals no longer have behavioral patterns that meet the diagnostic criteria for borderline personality disorder ^[1] .

Although many studies have evaluated the long-term course of BPD, they are accompanied by a variety of methodological issues. Part of the reason why the actual course of the disease is difficult to determine is because it is difficult to find untreated marginal patients as study samples. Because of its characteristics, BPD patients will seek treatment. Therefore, studies designed to confirm its long-term course of disease are, in general, interfered with to some extent by hospitalization, partial hospitalization, and outpatient treatment experience ^[1] .

Studies show that patients' symptoms are spread across two broad categories. The first category includes near-psychiatric thinking, suicidal attempts, self-harm, and degenerative phenomena during treatment. These symptoms seem to resolve earlier in the course of the disease. Other symptoms persist after six years and may last forever: most of these are long-lasting and personality-based symptoms, including anger and emptiness, intolerable loneliness, and fear of being abandoned ^[1] .

Treatment and rehabilitation of borderline personality disorder

The treatment of borderline personality disorder includes the following:

Borderline personality disorder drug treatment

The preferred medication is a serotonin reuptake inhibitor (SSRI). This drug is particularly effective in reducing anger, impulsive-aggressive behavior (especially verbal aggression), as well as rapid emotional conversion or emotional change. Some patients need to receive fluoxetine (trade name Prozac) up to 80 mg per day to be effective, and some patients seem to receive general doses of depression (20 to 40 mg per day) to improve symptoms ^{[ 5]} .

Using SSRI can reduce "emotional noise", such as strong anger, high alert anxiety, or irritability (these conditions can prevent patients from reflecting on their inner world and the inner experiences of others), and can promote psychotherapy get on. There is also growing evidence that SSRI can stimulate neural regeneration (especially in the hippocampus) and improve declarative memory in language. In addition, SSRI can decrease the excessive activity of the HPA axis by reducing the excessive secretion of corticotropin-releasing factor (CRF) ^[5] .

Reducing the overreactivity of the HPA axis may directly affect the patient's ability to reflect. As mentioned above, the emotional state of excessive alertness and anxiety is related to the particular combination of object relationships in which patients perceive others as potentially malicious or persecutory individuals and perceive themselves as victims. In the case of intimidation, the individual can only react intuitively, but cannot think clearly. Using SSRI to reduce over-reactivity can stimulate thinking and reflection. In addition to the strong emotional state before SSR1 treatment, it is easier for patients to consider the other motivations of the therapist and to reflect on their inner state. As a result, patients are beginning to see the healer as someone who can help themselves, not as a persecutor. Similarly, when the patient's excessive alertness is reduced, the therapist's ability to think from a psychotherapy perspective is less likely to be lost. When the therapist is in a defensive state, he only wants to defend himself and ignores the progress of psychotherapy ^[5] .

Some BPD patients do not respond to SSRI, so Sorov has developed several possible procedures and advised clinicians to use other drugs to manage the situation. Sorov's process is determined based on the target symptom group: affective symptoms, impulsive-behavioral symptoms, and cognitive-perceptual symptoms. For emotional disorders, if a certain type of SSRI seems to be ineffective, you can consider switching to venlafaxine (brand name Yinuosi), or other SSRIs that act on multiple neurotransmitting substances simultaneously. If anger is a problem, consider adding a low dose of a single antipsychotic; if anxiety is the main barrier, then clonazepam may be effective. Alprazolam should be avoided because it has been found to cause de-inhibition in patients with BPD, which could lead to violent or self-harmful behavior. Monoamine oxidase inhibitors or lithium salts can be used as a last resort to treat symptoms of emotional disorders; however, both drugs have distressing side effects, so clinical work is known for patients known for poor medication compliance or drug abuse Patients need to carefully weigh the risks and the pros and cons when prescribing such drugs ^[5] .

When the main target symptoms of marginalized patients are in the impulsive-behavioral field, SSRI is still the first-line drug. In this category, in addition to low-dose antipsychotics, lithium salts, or monoamine oxidase inhibitors, clinicians may also consider using carbamazepine and divalproex sodium (debakin): both drugs have undergone Double-blind placebo-controlled trials have shown that impulse bursts can be reduced. For patients with self-harm and / or alcohol abuse, it is worth trying Naltresone treatment ^[5] .

If cognitive-perceptive symptoms, such as paranoid thoughts or loss of self-esteem, are particularly disturbing, the use of low-dose traditional antipsychotics has been proven to help deal with these near-psychotic thoughts. Although most randomized controlled trials in the literature have focused on the effects of traditional antipsychotics, there is increasing evidence that some atypical antipsychotics such as olanzapine (trade names repro Nazapine may also be effective. In fact, a recent study showed that combining olanzapine and fluoxetine is better than using fluoxetine alone. SSRI may also be effective for some cognitive problems ^[5] .

To provide appropriate treatment for marginal patients requires active use of drugs to treat first-axis disease. Most patients with BPD have concurrent first-axis disease. Emotional disorders are extremely common in BPD patients. After investigating many retrospective studies on comorbidities, Coderson estimates that 50% of patients diagnosed with BPD on the second axis have a diagnosis of depression on the first axis and 70% are diagnosed with mild emotion Illness. There are far fewer patients with comorbid bipolar disorder; however, because BPD's emotions are prone to change and are unstable, they can sometimes be misdiagnosed as a type 2 bipolar disorder, although patients with BPD are not typically Sustained periods of high or low emotions, and the inherent confusion often stems from reactions to interpersonal disappointment. About 25% to 85% of patients with BHD abuse alcohol or other substances, and about 30% can be diagnosed with post-traumatic stress disorder ^[5] .

Borderline personality disorder psychotherapy

Dialectical Behavior Therapy (DBT) is designed to treat disorders. This is the core treatment for borderline personality disorder. Personal, collective, and telephone consultations are usually conducted. Dialectical behavior therapy is based on teaching people how to regulate their emotions, endure pain, and improve relationships ^[6] .

Borderline personality disorder is a type of mental illness that is extremely difficult to treat. The American Psychological Association recommends psychotherapy as the preferred method of treating BPD. In recent years, a variety of BPD psychotherapy has been supported by empirical research. At present, more and more commonly used psychological therapies are dialectical behavior therapy (DBT), basic mentalization therapy (MBT), empathy focus therapy (TFP), schema therapy (ST), and interpersonal relationship therapy (IPT) ^{[ 6]} . Here are some common psychological therapies:

Dialectical behavior therapy

Dialectical Behavior Therapy (DBT), founded by Marsha Linehan in the 1990s, was originally used for the treatment of chronic suicide, and has since developed into one of the main methods of treating BPD. Psychotherapy. DBT is a new type of cognitive behavioral therapy based on biological theory and dialectics, and integrates multiple therapies such as cognitive behavior and mental motivation. It is generally believed that emotional disorders are the core characteristics of BPD, and some researchers have suggested that this may be caused by congenital biological defects and poor childhood experience. DBT aims to change behaviors and manage emotions through a "balance and integration of acceptance and change". There are four main types of DBT treatment models: individual psychotherapy, group skills training, telephone guidance, and therapist team consultation meetings. At present, DBT is not only used for outpatient treatment of borderline personality disorder, but can also be effectively used in hospitalization ^[6] .

2. Basic mental therapy

At present, basic mental therapy (MBT), founded and developed by Fonagy and Bateman, has become the mainstream of short-term psychotherapy for BPD in Europe and America. MBT originates from the psychoanalytic object relationship theory, and integrates Meins and Bowlby's attachment theory with many psychoanalytic concepts and principles. With the efforts of Fonag and others, MBT has a specific operation process and has become a popular treatment model for contemporary psychoanalysis. Bateman et al. Believe that the essential problem of borderline personality disorder is the impairment of mental functioning. They have not developed the ability to explain their own and other people's emotions by relying on internal and external clues. 2. The process of regulating behavior is affected. The core of MBT treatment is to improve the mental capacity of patients, that is, the ability to understand and identify the psychological state of self and others. Through the mentalized response to the thoughts, emotions, motivations and intentions of self and others, the purpose of regulating emotions and behaviors ^[6] .

3. Empathy Focus Therapy

Empathy focus therapy (TFP) is another currently popular psychodynamic therapy for BPD. This therapy was proposed by Otto F. Kernberg and others for the treatment of multiple personality disorders. In recent years, with the completion of a number of clinical experiments, TFP has become one of the main methods for treating BPD. TFP is based on the objective theory of psychoanalysis and integrates related concepts and technologies of psychoanalysis. Otto F. Kernberg et al. People with borderline personality disorder mainly lack the ability to integrate mental state, which is mainly manifested in diffuse identity, lack of a coherent and complete understanding of self and others, and primary defense under stress. Therefore, the TFP goal focuses on the diffusion of identity, solving the problem of the original defense mechanism, and distinguishing between the self and others, thereby helping patients to enhance their ability to cope with negative emotions and maintain social functions such as work and interpersonal communication. TFP has three key components: the framework of the treatment course, the integration of countertransference into the interpretation process, and the interpretation process (clarification, confrontation, interpretation). After TFP treatment, most patients can conduct behavioral regulation after half a year. The original defense mechanism will be significantly reduced after two years, and the system integration ability will be enhanced. The therapy has published a standardized operation manual ^[6] .

4. Graphic therapy

After more than 20 years of exploration, Jeffrey Young and others have created Schema Therapy (ST) on the basis of traditional cognitive behavior, combining object relationship theory, psychodynamic theory, Gestalt theory, and constructivism. This new cognitive behavioral therapy was initially used for complex personality disorders and has since become an effective treatment for BPD. ST has four main concepts: early maladaptive schema, coping style, schema scope, and schema mode. Among them, early maladaptive schema (EMS) is the core concept. The early maladaptive schema may be an important cause of personality disorders, including cognition, emotions, feelings, etc., formed by the unsatisfactory early core emotions and the experience of poor early life (being subjected to abuse, hostility, etc.), and the individual establishes himself The bad illustrations of frustration are used to react negatively to the environment at the time, and they are repeated in later life, which causes many psychological problems. The goal of the illustrated therapy is to help marginalized patients identify maladaptations in adulthood due to unmet childhood emotional needs. Schema therapy is divided into two stages: schema assessment and schema change. During the evaluation phase, the therapist identifies the patient's suitability for schema therapy, determines their schema, understands the early causes of the schema, and combines it with current issues. In the stage of change, the therapist flexibly combines anti-empathy, cognition, interpersonal, and behavioral strategies, and replaces maladaptive coping styles with positive and healthy behaviors to promote changes in patient schema ^[6] .

5. Interpersonal therapy

Interpersonal psychotherapy (IPT) is a concise, highly structured manual and diagnostic-oriented psychotherapy. In recent years, IPT has been used to treat patients with borderline personality disorder. The core symptom of emotional disorders and relationship problems shown by BPD patients is the main reason that IPT can treat BPD. Some researchers have made corresponding adjustments to this therapy in order to be more suitable for BPD. The adjusted features mainly include different understanding of the concept of obstacles, longer treatment time, and more flexible settings. ^[6]