What is Borderline Personality Disorder?
Borderline Personality Disorder (also known as Emotionally Unstable Personality Disorder) is a personality disorder that is typified by deeply pervasive patterns of unstable self-image and interpersonal relationships. It presents itself through the sufferer’s manipulation of others to obtain, continue, and/or further being nurtured; unusual variability and depth of moods; fear of abandonment; extreme “black and white” thinking; exceedingly impulsive actions and feelings; and self-harm.
People who are afflicted with Borderline Personality Disorder (BPD) feel their emotions more deeply, more easily, and for longer periods of time than those who do not suffer from this disorder. For example, they are instantly in love, instantly in hate, instantly in fear, instantly in comfort, instantly in grief, instantly in bliss in a matter of a few minutes or hours. Their mood is dictated by their perceived situation. This type of disorder lends itself to black and white thinking. For example, the object of their emotion is either all good or all bad. There is no middle ground or recognition that everyone has both good and bad attributes. The incredible intensity and rate of change of these emotions can be staggering. Additionally, persons with BPD tend to be very sensitive to the emotions related to perceived failure, isolation and rejection. They can feel these extreme emotions under normal circumstances, as when a friend or loved one suggests a change in plans or cannot make an appointment. Their world can come crashing down around them over things that non-BPD affected people would find trivial or explainable.
The World Health Organization describes two subtypes of Emotionally Unstable Personality Disorder. They are:
- Impulsive Type – Includes showing behavior tendencies to act unexpectedly, to engage in arguing, angry outbursts or violence, and unstable moods.
- Borderline Type – Includes indecisiveness regarding their self-image, intense and unstable relationships, fear of abandonment, threats and acts of self-harm, and feeling empty.
Because Borderline Personality Disorder shares many symptoms with other disorders and because of its high rate of co-occurring conditions, it can be difficult to diagnose. For a correct diagnosis, you must consult with a mental health care professional or a treatment center that focuses on Borderline Personality Disorder. A key point to remember is that manipulative behavior to obtain or further being nurtured, fear of isolation and abandonment, and unpredictable behavior are considered to be the hallmark symptoms of BPD. Once the signs of Borderline Personality Disorder have been identified, and a diagnosis has been made, then healing can begin and a healthier and more stable life becomes possible. A person who is afflicted with Borderline Personality Disorder can live a stable and happy life.
Co-occurring conditions are very common with persons afflicted with Borderline Personality Disorder. For persons living with BPD, 75 percent of them meet the criteria for Major Depression, Bipolar Disorder, and Anxiety Disorders, 73 percent meet the criteria for Substance Abuse, and 38 percent meet the criteria for Attention Deficit and Hyperactivity Disorder .
50.4 percent of people with BPD will have a co-occurring paranoid, schizoid or schizotypal condition. 49.2 percent of those with BPD will have a co-occurring antisocial, histrionic or narcissistic condition. Only 29.9 percent of persons with BPD will have a co-occurring obsessive-compulsive or avoidant dependent condition .
The suicide rate of persons coping with Borderline Personality Disorder is around 10 percent .
While these statistics may sound scary, there is also hope. The prognosis for the majority of people suffering from BPD is hopeful. In order to be considered in remission, a person must have 2 years of consistent relief from the symptoms of Borderline Personality Disorder. A study that tracked the symptoms of BPD showed remission in 34.5 percent of the participants within 2 years, 49.4 percent of participants within 4 years, and 68.6 percent of participants within 6 years. 73.5 percent of the participants reached remission by the end of the study. Additionally, only 5.9 percent of the participants had recurrences during the study period .
Causes of BPD
The causes of BPD are complex, diverse, and not completely understood. Post-traumatic Stress Disorder is closely related to Borderline Personality Disorder. Whether the relationship is causal or coincidental is a matter of great debate. The primary difference between Borderline Personality Disorder and Post-traumatic Stress Disorder are the symptoms reflected by PTSD are not situationally based while the symptoms for BPD are. Additionally, the rate of mood changes are much higher in a person with BPD than PTSD. Research shows several possible causes for BPD. Brain abnormalities show that persons with BPD usually have a smaller, yet more active amygdala (responsible for processing memory and emotional reactions), the prefrontal cortex tends to be less active, and cortisol production is elevated compared to the general population. A woman’s estrogen levels can exacerbate a female patient’s symptoms. Childhood trauma and childhood abuse are also quite common in the backgrounds of persons coping with BPD.
Signs and Symptoms of Borderline Personality Disorder
Because Borderline Personality Disorder so often occurs with other disorders, it can be difficult to recognize. However, there are signs and symptoms that a professional therapist or mental health worker can recognize. Should these warning signs be exhibited, professional aid should be acquired. They are:
- Extreme efforts of avoid being abandoned (Real or Imagined)
- Intense and unstable relationships especially when they are marked with extreme idealization and extreme devaluation
- Unstable sense of self
- Potentially self-damaging impulsivity (Reckless driving, binge eating or drinking, etc.)
- Self-mutilation, suicidal threats or behaviors
- Marked reactivity of mood (Extreme ups and downs lasting for a few minutes or hours)
- Feelings of emptiness
- Difficulty in controlling anger and inappropriate intensity of the feeling
- Transient paranoid ideation or severe dissociative symptoms
Of all these symptoms, manipulation is considered to be the most common feature of persons with BPD.
Borderline Personality Disorder Treatment
The treatment of choice for Borderline Personality Disorder is psychotherapy. It is important that the needs of the individual is the deciding factor in determining what type of therapy to pursue. The general diagnosis of “BPD” is too broad to be the determining factor. However, evidence shows that long-term psychotherapies to be the most beneficial. Currently, there are no medications to treat the core issue of BPD. However, there are medications to relieve certain aspects of particular symptoms and to treat the co-occurring disorders. Some medications being used are:
- Haloperidol to reduce anger
- Flupenthixol to reduce suicidal behaviors
- Aripiprazole to reduce impulsivity, anger, depression, and anxiety
- Olanzapine to reduce instability, anger, psychotic paranoid symptoms
- Valproate Semisodium to reduce depression and anger
- Lamotrigine to reduce impulsivity and anger
- Topiramate to reduce impulsivity, anxiety, anger and interpersonal issues
Only a trained professional or Borderline Personality Disorder treatment center can accurately diagnose this condition, and create the best plan for remission.
Remission from the symptoms of Borderline Personality Disorder is not only possible, but also probable. Counseling, understanding from loved ones and friends, desire and hard work by the patient and medications to ameliorate some of the symptoms can significantly help the person afflicted with BPD. Once your emotions become more stable, your life will become more stable. Once your life becomes more stable, you will see the people around you for who they are. They are neither all good nor all bad. Humans make mistakes, but that does not mean that they are out to harm you. In addition, manipulation is not the way to find love and acceptance. There is hope. You just have to reach out and grab it.
: Grant, Bridget F; S. Patricia Chou, Risë B. Goldstein, Boji Huang, Frederick S. Stinson, Tulshi D. Saha, Sharon M. Smith, Deborah A. Dawson, Attila J. Pulay, Roger P. Pickering, W. June Ruan (April 2008). “Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions”. Journal of Clinical Psychiatry 69 (4): 533–545. PMC 2676679. PMID 18426259.
: Gunderson J, “Borderline Personality Disorder”, “The New England Journal of Medicine”, 26 May 2011
: Zanarini, Mary C.; Frances R. Frankenburg; John Hennen; Kenneth R. Silk (February 2003). “The Longitudinal Course of Borderline Psychopathology: 6-Year Prospective Follow-Up of the Phenomenology of Borderline Personality Disorder”. The American Journal of Psychiatry 160: 274–283
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 15th, 2013
Published on AddictionHope.com, Substance Abuse Resource Online