DBT: An important treatment for borderline personality disorder

by Anne Chambers, LCSW, MOLAP director 

There aren’t many articles addressing borderline personality disorder in litigation. Borderline personality is complicated to treat and poorly understood. Individuals with this condition experience strong emotions; display emotional dysregulation; and may engage in self-harm, suicide attempts, or agitated behavior. Relationships can be intense, as people living with this condition can react strongly in an effort to avoid real or perceived abandonment.  

While individuals with antisocial personality are more likely to engage in behaviors that violate others' rights, individuals with borderline personality are emotionally sensitive. They may react strongly to real or perceived slights and shift from seeing people in their lives as the best to the worst. The work of Marsha Linehan contributed to better understanding of borderline personality, and an effective treatment called dialectical behavior therapy, or DBT, for this high need group. 

DBT provides a roadmap for therapists to work with clients facing multiple problems. It provides a hierarchy prioritizing what to address first, starting with suicidal and self-harming behaviors, therapy interfering behaviors, quality of life interfering behaviors, and then other goals. DBT teaches mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. DBT works with the clients to build and maintain lives worth living. This approach combines individual therapy, group skills training, and support for providers engaged in this challenging and rewarding work.   

Like antisocial personality disorder, borderline personality has been linked to some legal problems. People with antisocial personality are more likely to be defendants, and those with borderline personality disorders are more often plaintiffs. In research on litigation success of Cluster B personality disorder parties in 1,399 published court opinions, BPD clients were successful 40% of the time, while histrionic clients were successful 38% of the time, antisocial clients were successful 27% of the time, and narcissistic clients were successful 19% of the time. Borderline personality cases comprised 38% of the cases. Most were civil lawsuits. 

The most frequent concerns raised were criminal appeals, disability, and family matters. Individuals with borderline personality have been known to sue providers for malpractice related to sexual misconduct or suicide, and risk management practices have been emphasized in work with this population.   

The Missouri Lawyers’ Assistance Program provides free, confidential counseling to Missouri lawyers, judges, law students, and immediate family members who reside with them. To access services, call 1-800-688-7859. You are not alone. We’re here to help! 

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