Borderline Personality Disorder (BPD)

Definition
Borderline personality disorder (BPD) is a complex and confusing illness. It is characterized by instability in moods, interpersonal relationships, self-image, and behavior. People with BPD often act impulsively. This behavior disrupts family and work life, long-term planning, and the individual’s sense of self. Individuals with BPS also have difficulty controlling their moods (called affect regulation).
Most BPD sufferers have a very hard time coping with separations from loved ones, and desperately try to avoid being alone. In severe cases, individuals with BPD may seek relief from inner pain by cutting, burning, or scratching themselves.
As the understanding of the causes and symptoms of BPD has increased, treatment options have improved. Many BPD suffers are helped significantly by psychotherapy and medications.
Causes
The causes of BPD are not fully understood although brain chemistry, genetics, and environmental factors are thought to play a role. People who develop BPD are probably born with an underlying vulnerability to the illness. When they are exposed to certain experiences and types of stress, their chances of developing the illness increase. BPD sufferers are often found to have experienced childhood abuse, neglect, separation, sexual abuse, or violence.
Risk Factors
The following factors increase your chances of developing BPD:
• Sex: female
• A history of abuse, neglect, or abandonment as a child
• A history of sexual abuse or violence
• Inborn sensitivity to stress
• Poor self-image; not having a clear sense of who you are
• Mother, father, or sibling with BPD
Symptoms
The symptoms of BPD vary from person-to-person. People with BPD tend to be extremely sensitive to rejection, reacting with anger and upset at even mild separations from friends or family members. Symptoms often become more acute when people with BPD feel isolated and lonely, or during times of particular stress.
Traits that are common to people with BPD include:
• Fears of abandonment, resulting in frantic behaviors aimed at avoiding abandonment
• Extreme mood swings and difficulty managing emotions
• Difficulty in relationships, characterized by dramatic swings between idealizing the relationship and devaluing the relationship (views people as all-good or all-bad)
• Unstable self-image
• Impulsive behavior
o Excessive spending
o Promiscuity, risky sexual behavior
o Gambling
o Drug and alcohol abuse
o Self-injury, suicide threats
o Binge eating
• Repetitively injuring the self through cutting, scratching, or burning
• Feeling misunderstood, bored, and empty
• Having deep-seated feelings of being flawed or bad in some way
• Using ‘defense’ mechanisms to avoid taking responsibility for behavior, or to blame others
• Unpredictable mood and difficulty regulating mood
• Problems with anger management, manifested as periods of intense, uncontrollable and often unreasonable anger
• Episodes (usually precipitated by stress) of intense paranoia, dissociation, or thought patterns bordering on psychosis (hence the term “borderline”)
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam to rule out other possible causes for mood and behavior problems. If BPD is suspected, you should get a thorough evaluation by a psychiatrist who specializes in personality disorders.
BPD can affect anyone, but is usually diagnosed in adolescents and young adults. BPD seems to occur much more frequently among women than men. A diagnosis of BPD may be made if a person has a history of having unstable interpersonal relationships, poor self-image, and marked impulsivity along with some of the specific symptoms of BPD listed above. In addition, BPD patients almost always have coexisting mental health problems, including:
• Depression
• Substance abuse
• Eating disorders
• Anxiety disorders
• Bipolar disorder
• Compulsive spending, gambling, or risky sexual behavior
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Psychotherapy
Individual, group, and family therapy form the basis of BPD treatment. Individual psychotherapy usually consists of 2-3 sessions a week for a period of years. Dialectical behavior therapy (DBT) is a type of cognitive behavior therapy that has shown particular success with individuals with BPD. It may be delivered as group therapy. The goal of therapy is to help the person with BPD:
• Understand his or her behavior
• Improve his or her ability to tolerate frustration, anxiety, loneliness, and anger
• Control impulsive behavior
• Improve social skills
Family therapy may help family members deal with the effects of BPD and provide support to the BPD sufferer.
Medication
Antidepressant drugs and mood stabilizers may be used to treat coexisting depression and mood swings. Antipsychotic drugs may be used in low doses to control distorted thinking or anxiety.
Prevention
There are no guidelines for preventing BPD. Research is underway to identify which treatment methods work most effectively to control and reverse the course of the illness.