For people with borderline personality disorder (BPD), life can become a series of mounting stresses. Not only does the disorder create inner turmoil, but it also leads to troubled relationships, the potential for self-harm, and occupational impairment. Within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), BPD remains its own diagnostic category, as it does in the International Classification of Diseases (ICD-11), but researchers in the field believe that it is more productive to view BPD not as a category but as a set of positions along several dimensions.

The Five-Factor Model (FFM) is one of the most widely accepted approaches to understanding personality from a so-called “trait” perspective. Among its five traits, those of neuroticism (high), agreeableness (low), and conscientiousness (low) stand out as the most relevant to BPD. The FFM, indeed, is a central component of what’s called the alternative model of personality disorders (AMPD), a beta approach described in the DSM-5-TR but not yet part of official diagnostic coding.

Although it’s easy to regard personality traits as immutable so that you’re stuck with the personality you’ve always had (a commonly held view), research on development and adaptation in adulthood shows that this doesn’t hold up to scientific scrutiny. If so, might there be reason to regard BPD with more optimism about its potential for improvement?

The Compass Approach to BPD

According to University of Kentucky’s Shannon Sauer-Zavala and colleagues (2023), all three of these personality traits should become part of psychological interventions for people with BPD. Yet, as she and her co-authors note, some of the most well-known, such as dialectical behavior therapy (DBT), only address the emotional difficulties (“negative affectivity”). However, as effective as DBT can be, it leaves relatively untouched the personality trait of low conscientiousness (i.e., disinhibition) that is so much a part of the trail of life problems left behind by people with BPD. Antagonism, the low end of agreeableness, is also part of the symptom picture and typically is not a focus of therapy. As the authors note, “Thus, a comprehensive BPD treatment must include strategies to address negative affectivity, antagonism, and disinhibition.”

Looking to the AMPD as a possible basis for treatment, the U. Kentucky researchers developed a method they named “BPD Compass,” or “cognitive-behavioral modules for personality symptoms.” BPD Compass focuses on change within the three personality trait domains, and within each, seeks to promote the learning of flexible and adaptive skills. As such, BPD Compass becomes part of the vanguard of newer, third-wave approaches to treatment of psychological disorders that take advantage of cognitive behavioral therapy’s strengths along with acceptance-based and mindfulness approaches that continue to gain support in randomized treatment trials. One final note is that the method is designed to be far shorter than other BPD treatment approaches, with a specified length of 18 sessions.

Looking specifically at the trait change components of BPD Compass, these are as follows:

• Negative affectivity: countering the ways that people with BPD run away from their aversive emotions, and as such, reducing the “rebound” emotions that follow.
• Agreeableness (antagonism): working on the individual’s insecure attachment style that can lead them to try to protect themselves from interpersonal relationships they perceive as threatening.
• Conscientiousness (impulsivity): changing the individual’s expectancies about being able to complete tasks and also helping to reduce the tendency to pursue rewards that have negative consequences.

It Sounds Great, But Does It Work?

Of course, the big question in any intervention study is whether it can produce the type of change it seeks to promote. As their test, Sauer-Zavala and her fellow researchers recruited 81 adults with diagnosed BPD, which, after exclusion based on the study criteria, produced a final sample of 50 individuals (average age 28 and 83 percent who identified as female), divided between treatment and waiting-list control. Like many other individuals with BPD, the sample participants had other diagnoses as well, including depressive and anxiety disorders as well as posttraumatic stress disorder. Unfortunately, as is so often the case in treatment studies that cover a span of months, only 13 of the treatment and 19 of the waiting-list group completed the final assessments.

The treatment sessions group in these four stages: (1) understanding and living in accordance with one’s values, (2) developing cognitive skills such as rethinking emotion-provoking situations, (3) identifying problematic behaviors and then practicing how to bring them into accordance with their values, and (4) mindfulness training such as noticing one’s reactions to emotion-provoking situations in a nonjudgmental and accepting way. A final session focuses on relapse prevention or being able to accept the idea that they may revert back to some of their prior emotions and behaviors. All interventions were conducted on Zoom.

You can think of BPD Compass, then, as a true “compass” with the three dimensions of personality traits as they intersect with the four components of values clarification, cognitive skill development, behavior change, and self-acceptance.

The findings provided strong support for BPD Compass as an intervention method, with improvements along a number of outcome measures in the treatment versus waiting-list groups. Perhaps just as impressively, the patients in the treatment groups reported high degrees of satisfaction. Of course, with dropouts after treatment, there could be a self-selection effect operating. However, given the serious nature of their disorder, plus the other diagnoses they had, this is significant. Looking at some of their comments, which the authors provided in supplemental information, the treatment made a strong impression on them. When asked the most important thing they learned in treatment, these included “Mindfulness, hands down,” “…I no longer feel that I am ‘crazy’ and not in control of my emotions,” and “I learned to live with my impulses and emotions instead of struggling against them.”

In terms of improvements along the three personality dimensions, it was only in neuroticism that significant differences were observed between the two groups. Nevertheless, the therapy participants themselves believed that they had gained in conscientiousness, signifying greater ability to self-regulate. Focusing on values might have helped to promote this growth, as individuals in treatment could begin to see the importance of working toward their own aims.

The Future of BPD Compass

There will undoubtedly continue to be new treatments for BPD that researchers develop and test in systematic ways. However, the Compass approach seems to have considerable potential, both as a treatment in and of itself and for what it adds to the understanding of personality and personality change.

If people with severe personality disturbance can learn, over the course of 18 weeks, to modulate these very basic traits by gaining insight, skills, and self-acceptance, it suggests that even individuals living with personality functioning that they consider less than optimal should be able to steer themselves in a more favorable direction.

Just by considering such aspects of your own approach to life as what is important to you and how can you accept yourself and your flaws can become an important step in your own process of growth. Which parts of your personality cause you the most grief, and are there practical steps you can take to recalibrate them? On top of this, is there a way to reframe your own reactions to these pieces of yourself so that you stop fighting them? Maybe you’re not low on conscientiousness, but overly high. You are always early for meetings and then become annoyed when others are merely “on time.” You could try to become more like them, or just accept the fact that you tend to pop in early to things and not feel irritated if they do not.

To sum up, borderline personality disorder is a condition that is extremely challenging for those people who live with it or who live with people who have this condition. For them, and you, it is heartening to know that there’s another possibility available for promoting positive life changes.