Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental illness that manifests as ongoing patters of difficulty with self-regulation. People with BPD often feel that everything is unstable in their lives, from their moods to relationships, thinking, behaviour and self-image.

What is Borderline Personality Disorder?

Borderline Personality Disorder (BPD) is a mental illness that manifests as ongoing patters of difficulty with self-regulation. People with BPD often feel that everything is unstable in their lives, from their moods to relationships, thinking, behaviour and self-image.

BPD usually begins in adolescence or early adulthood and affects relationships due to an inabilityto manage emotions. The lack of internal stability can make it a frightening way to live.

BPD was listed as a diagnosable illness for the first time in 1980 in the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III). The name came stemmed from a perception of BPD as on the ‘borderline’ between psychosis and neurosis, and although it doesn’t describe the condition very accurately, it has stuck.

BPD is often misdiagnosed or connected to other mental illnesses such as bipolar disorder or depression and can sometimes get lost in the treatment of these illnesses.

People who have BPD tend to suffer from:

Problems with regulating, thoughts, feelings and actions

Difficulty maintaining relationships

Explosive anger

Impulsive and sometimes reckless behaviour

There is hope - BPD is treatable with consistent therapy, self-awareness, and support. Specialised treatments and coping skills can help break dysfunctional patterns of thinking, feeling and behaving and restore emotional balance.

Causes

It appears that no one single cause or risk factor is responsible for causing the disorder. Although research into BDP is still at a very early stage, most researchers agree that BPD is commonly caused by an interaction of a combination factors:

Biological factors such as a genetic predisposition to developing the disorder. Studies of twins with BPD suggest that the illness is strongly inherited. Genetic abnormalities appear to affect the proper functioning of brain pathways that regulate the behavioural functions of information processing and impulse control and cognitive activity such as perception and reasoning

Environmental factors: For example, difficult or traumatic experiences while growing up, such as death of a parent, chronic fear or distress, family instability, abuse or neglect. Environmental factors increase the risk, but the disorder can develop without them in some cases.

Signs & Symptoms

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ((Referred to as DSM-V), defines nine specific diagnostic criteria for BPD. To be diagnosed with BPD, patients must have five of the following criteria:

Impulsive, self-destructive behaviours. This includes engaging in harmful or sensation-seeking behaviours, for example driving recklessly, binge eating, impulsive spending, reckless driving, risky sex or overdoing drugs and alcohol.

A pattern of unstable relationships: Tending to have relationships that are intense and quickly over. Relationships tend to veer from idealisation to intense dislike, with nothing in-between.

Fear of abandonment: People with BPD are often terrified of being abandoned or left alone. This leads to jealousy and clinginess in relationships.

Unclear or unstable sense of self. People with BPD have a self-image that is unstable. Sometimes they feel good about themselves, but at other times hate themselves. They often don’t have a clear idea of who they are and what they want, which can lead to changes in religion, jobs, values, opinions, feelings and goals.

Self-harm: Attempts to hurt oneself, such as cutting or burning and suicidal behaviour is common in people with BPD.
Intense emotional swings: Changeable emotions or moods are common with BPD. Emotions can fluctuate between happiness and despair in minutes. The mood swings are intense, but are short and tend to pass quickly.

Severe and long-term feelings of emptiness or boredom: Feeling like there is a void inside that is uncomfortable and needs to be filled. People with BPD often fill this ‘hole’ with drugs, food or sex.

Explosive anger: People with BPD often struggle with intense anger, lose their tempers quickly and have trouble controlling themselves once they are in a temper. This anger may be directed inwards and they may feel angry with themselves.

Suspicious thoughts and feeling out of touch with reality. People with BPD often struggle with paranoia and doubts about other people’s motives. They may experience dissociation (feeling spaced out or outside your own body) when they are stressed.

Who Is At Risk?

According to recent statistics, over 4 million people in the United States alone have BPD. Far more women are likely to be diagnosed with BPD with men, but this may be due to the fact that it is underdiagnosed in men. People may be at greater risk of developing BPD if they had a family member with BPD, felt emotionally vulnerable as a child or were emotionally abused or if they were raised in an impulsive household.

Diagnosis

Cases of BPD are often missed or misdiagnosed, which can delay or prevent recovery. It is frequently misdiagnosed as bipolar disorder because of mood instability, but there are fundamental differences between the two conditions. In the case of bipolar disorder, mood changes exist for weeks, but with BPD, mood changes are short-lived.

Only a qualified mental health professional such as a psychiatrist, psychologist, clinical social worker or psychiatric nurse can diagnose BPD. Diagnosis is usually only made after a medical exam to rule out other causes of symptoms, as well as a comprehensive assessment of symptoms and presentation, often based on the DSM classification system. The professional may also consult family, friends and caregivers to increase understanding of symptoms. The mental health practitioner will decide on the best course of treatment for the patient.

The diagnosis will normally only be made in adults as signs and symptoms of BPD may go away as children get older and more mature.

BPD often co-occurs with other disorders such as substance abuse, depression, bipolar disorder, eating disorder and anxiety disorders.

Treatments

People with BPD can recover. Research increasingly shows that some treatments for BPD are effective and many people with BPD experience a lessening of symptoms and substantially improved quality of life after treatment.

Treatments typically involve a combination of psychotherapy, medication and social support. At Papillon, BPD is treated primarily with psychotherapy. In some cases, medication may be prescribed in conjunction with other treatments to manage specific symptoms, such as anxiety. In cases where a person is under the care of more than one professional it is imperative for the professionals to work as a team on the treatment plan. As the treatment plan may take time, it is also important for friends and family to be patient and supportive during treatment.

Some of the treatments options available to a person with BPD are covered in more detail below.

Psychotherapy

Psychotherapy is the central treatment for BPD. Several different psychotherapy approaches appear be successful. Ongoing studies into BPD treatments are providing increasing insight into which psychotherapy approaches are optimal.

The primary therapies used to treat BPD are;Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT) and Schema-Focused therapy and a skilled therapist will be familiar with them. Many psychotherapists will also adapt therapy to suit the patients’ needs, or mix techniques from different therapies.

Therapy can either be in a group or one-on-one session. Group sessions may teach people with BPD how to improve interaction with other people and how to express themselves constructively. Families of people with BPD can also benefit from therapy to develop skills and better support a person with BPD.

A breakdown of common therapy treatments follows:

Cognitive Behavioural Therapy (CBT): CBT can help people with BPD reduce symptoms by helping them change the way they think about or interpret situations and change the actions they take in response. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviours.

Dialectical Behaviour Therapy (DBT): DBT integrates CBT with the concept of mindfulness, which is learning to be focus and be aware of what is happening moment-to-moment. DBT also teaches techniques to control intense emotions, tolerate stress, reduce self-destructive behaviours, and improve relationships.

Schema-Focused Therapy: Schemas are self-defeating, core themes or patterns that people keep repeating throughout their lives. This therapy combines elements of CBT with other types of psychotherapy to ‘reframe’ the way people see themselves.

It is important for a person with BPD to find a therapist they feel safe with and commit to therapy. Recovery is a slow process, the core symptoms of mood swings, anger and impulsiveness tend to be the ones that require the most attention. Additionally, people whose symptoms improve may still face issues with co-occurring disorders such as anxiety and depression. However, every time a person with BPD practices a new coping response or self-soothing technique it helps to create new neural pathways in the brain and will with time and regular practice change the way the person with BPD thinks, feels and acts. Research shows that once a level of functioning is reached, only a small minority fall back, while the majority of people tend to maintain the level they have reached, unless faced with considerable stressors.

Medications

There are no drugs specifically licenced to treat BPD. The use of medications in BPD is primarily to treat a co-occurring disorder such as depression or anxiety and manage the symptoms of that disorder. Health providers may use anti-depressants, anti-psychotics and mood stabilizers, to treat these co-occurring disorders. People diagnosed with BPD should be aware of all the facts and talk to the prescribing doctor about possible side-effects, to make an informed decision.

Other Treatments

Omega-3 fatty acids have been used to some extent and have been the subject of some research which primarily found that Omega-3 fatty acids may have moderating effects on aggression and impulsivity.

Some lifestyle modifications can be useful in recovering from BPD such as maintaining a regular sleeping and eating schedule, regular exercise, avoiding alcohol and drugs and enlisting the support of friends and family.

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