Borderline Personality Disorder

BPDWhat is Borderline Personality Disorder (BPD)?

The main feature of borderline personality disorder (BPD) is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. People with BPD experience episodic highs and lows, as well as inconsistent behavior and mood swings, which are troubling and disconcerting to themselves and to others.

The result to the BPD sufferer is a lack of friendship and other enduring connections to others. The constant relational roller coaster creates great upheaval and instability in many aspects of life. Eventually, the BPD sufferer may tend to withdraw and become isolated. He/she may also withhold their personal information in situations where it is normally shared. Trust of others and oneself can be fleeting.

Individuals with borderline personality disorder are very sensitive to environmental circumstances. The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. They experience intense abandonment fears and inappropriate anger, even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g., sudden despair in reaction to a clinician’s announcing the end of the hour; panic or fury when someone important to them is just a few minutes late or must cancel an appointment).

They may believe that this “abandonment” implies they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them. Relationships and the person’s emotions may sometimes be seen by others or characterized as being shallow.

Additional Common Symptoms of BPD:

  • Few long-lasting relationships
  • Anxious/avoidance attachment styles
  • Difficulty making decisions
  • Over-reacting
  • Self-loathing
  • Easily offended
  • Misinterpretation of others due to trust issues

Co-morbidities

Borderline personality disorder often occurs with other illnesses. This can make it hard to diagnose, especially if symptoms of other illnesses overlap with the BPD symptoms

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, substance abuse or eating disorders. In men, BPD is more likely to accompany disorders such as substance abuse or antisocial personality disorder.

According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also suffer from another mental illness.

Most of these are listed below, followed by the estimated percent of people with BPD who have them:

  • Major Depressive Disorder – 60%
  • Dysthymia (a chronic type of depression) – 70%
  • Substance abuse – 35%
  • Eating disorders (such as anorexia, bulimia, binge eating) – 25%
  • Bipolar disorder – 15%
  • Antisocial Personality Disorder – 25%
  • Narcissistic Personality Disorder – 25%
  • Self-Injury – 55%-85%

What is the treatment for Borderline Personality Disorder?

Psychotherapy—also called talk therapy—is the preferred method for treating borderline personality disorder. While medications may effectively treat certain symptoms, they cannot teach a person with borderline personality disorder to cope with the illness or change thought patterns and behavior.

The most successful and effective psychotherapeutic approach to date has been Marsha Linehan’s Dialectical Behavior Therapy (DBT). Research conducted on DBT has shown it to be more effective than most other psychotherapeutic and medical approaches in helping a person to better cope with this disorder. DBT focuses on the concept of mindfulness, or paying attention to the present emotion and teaches skills to control intense emotions, reduce self-destructive behavior, manage distress, and improve relationships.  It seeks a balance between accepting and changing behaviors, and is a proactive, problem-solving approach designed specifically to treat BPD.

Prognosis

Research has shown that outcomes can be quite good for people with BPD, particularly if they are engaged in treatment. With specialized therapy, most people with borderline personality disorder find their symptoms are reduced and their lives are improved. Although not all the symptoms may ease, there is often a major decrease in problem behaviors and suffering. Under stress, some symptoms may come back.  When this happens, people with BPD should  return to therapy and other kinds of support.

Many individuals with BPD experience a decrease in their impulsive behavior in their 40’s.

Diagnosis

To meet a diagnosis of Borderline Personality Disorder under the DSM-V, you must show “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following”:

  1. Frantic efforts to avoid real or imagined abandonment
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, binge eating, and reckless driving)
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms