Borderline Personality Disorder

Borderline personality disorder (BPD) is a type of personality disorder in which a person has difficulty processing or managing their emotions. It is a mental health condition marked by extreme mood fluctuations, instability in interpersonal relationships and impulsivity.
People with BPD have an intense fear of abandonment and have trouble regulating their emotions, especially anger. They also tend to show impulsive and dangerous behaviors, such as reckless driving and threatening self-harm. All of these behaviors make it difficult for them to maintain relationships.
Many people who live with borderline personality disorder don’t know they have it and may not realize there’s a healthier way to behave and relate to others.

Most personality disorders begin in the teen years when your personality further develops and matures. As a result, almost all people diagnosed with borderline personality disorder are above the age of 18.
Living with BPD can look slightly different for everyone. However, there are certain signs and symptoms that can indicate borderline personality disorder may be present.

Symptoms –
Symptoms can range from manageable to very severe and can include any combination of the following –

• Fear of abandonment: It’s common for people with BPD to feel uncomfortable being alone. When people with BPD feel that they’re being abandoned or neglected, they feel intense fear or anger. They might track their loved ones’ whereabouts or stop them from leaving. Or they might push people away before getting too close to avoid rejection.

• Unstable, intense relationships: People with BPD find it challenging to keep healthy personal relationships because they tend to change their views of others abruptly and dramatically. They can go from idealizing others to devaluing them quickly and vice versa. Their friendships, marriages and relationships with family members are often chaotic and unstable.

• Unstable self-image or sense of self: People with BPD often have a distorted or unclear self-image and often feel guilty or ashamed and see themselves as “bad.” They may also abruptly and dramatically change their self-image, shown by suddenly changing their goals, opinions, careers or friends. They also tend to sabotage their own progress. For instance, they may fail a test on purpose, ruin relationships or get fired from a job.

• Rapid mood changes: People with BPD may experience sudden changes in how they feel about others, themselves and the world around them. Irrational emotions — including uncontrollable anger, fear, anxiety, hatred, sadness and love — change frequently and suddenly. These swings usually only last a few hours and rarely more than a few days.

• Impulsive and dangerous behavior: Episodes of reckless driving, fighting, gambling, substance use, binge eating and/or unsafe sexual activity are common among people with BPD.

• Repeated self-harm or suicidal behavior: People with BPD may cut, burn or injure themselves (self-injury) or threaten to do so. They may also have suicidal thoughts. These self-destructive acts are usually triggered by rejection, possible abandonment or disappointment in a caregiver or lover.

• Persistent feelings of emptiness: Many people with BPD feel sad, bored, unfulfilled or “empty.” Feelings of worthlessness and self-loathing are common, too.

• Anger management issues: People with BPD have difficulty controlling their anger and often become intensely angry. They may express their anger with biting sarcasm, bitterness or angry tirades. These episodes are often followed by shame and guilt.

• Temporary paranoid thoughts: Dissociative episodes, paranoid thoughts and sometimes hallucinations may be triggered by extreme stress, usually fear of abandonment. These symptoms are temporary and usually not severe enough to be considered a separate disorder.

You may experience all, some, or only a few of the signs and symptoms if you’re living with BPD. Certain events or people may trigger some of the symptoms.

Causes –
As with other mental health disorders, the causes of borderline personality disorder aren’t fully understood. In addition to environmental factors — such as a history of child abuse or neglect — borderline personality disorder may be linked to –
•  Genetics.
 Some studies of twins and families suggest that personality disorders may be inherited or strongly associated with other mental health disorders among family members.
•  Brain abnormalities.
Some research has shown changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. In addition, certain brain chemicals that help regulate mood, such as serotonin, may not function properly.

Risk Factors –
Some factors related to personality development can increase the risk of developing borderline personality disorder. These include –
•  Hereditary predisposition.
You may be at a higher risk if a close relative — your mother, father, brother or sister — has the same or a similar disorder.
•  Stressful childhood.
Many people with the disorder report being sexually or physically abused or neglected during childhood. Some people have lost or were separated from a parent or close caregiver when they were young or had parents or caregivers with substance misuse or other mental health issues. Others have been exposed to hostile conflict and unstable family relationships.

Complications –
BPD may raise your risk of developing other conditions, such as –
•  depression
•  anxiety disorders
•  eating disorders
•  bipolar disorder

•  substance abuse

Your BPD symptoms can also increase your risk of:
•  work issues
•  relationship issues
•  being in an abusive relationship, as the abused or the abuser
•  sexually transmitted infections
•  self-injury
•  suicidal ideation
•  getting in a motor vehicle accident
•  getting in physical fights
•  becoming the victim of violent crimes

Diagnosis –
Personality disorders, including borderline personality disorder, are diagnosed based on a –
•  Detailed interview with your doctor or mental health provider
•  Psychological evaluation that may include completing questionnaires
•  Medical history and exam
•  Discussion of your signs and symptoms

A diagnosis of borderline personality disorder is usually made in adults, not in children or teenagers. That’s because what appear to be signs and symptoms of borderline personality disorder may go away as children get older and become more mature.

Treatment –
BPD historically has been challenging to treat. But effective treatment takes time, patience and commitment. Treatment may include psychotherapy (talk therapy), medications or both.

▪︎  Psychotherapy
Types of therapy that can help treat BPD include:

•  Dialectical behavior therapy (DBT)
This type of therapy was developed specifically for people with BPD. DBT focuses on helping you accept the reality of your life and your behaviors, as well as helping you learn to change your life, including unhelpful behaviors. It teaches skills to help you control intense emotions, reduce self-destructive behaviors and improve relationships.
•  Cognitive behavioral therapy (CBT)
This is a structured, goal-oriented type of therapy. Your therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.
•  Group therapy
This is a type of psychotherapy in which a group of people meets to describe and discuss their problems together under the supervision of a therapist or psychologist. Group therapy may help people with BPD to interact with others more positively and express themselves effectively.

▪︎  Medications
Because the benefits of prescription medication for borderline personality disorder are unclear, healthcare providers typically don’t prescribe medications as the main treatment for BPD.

But in some cases, a psychiatrist may recommend medications to treat specific symptoms or co-occurring mental health conditions. Medications can treat anxiety and depression, regulate mood swings or help control impulsive behavior. Antipsychotic (neuroleptic) drugs help some people with BPD.

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