What is Borderline Personality Disorder (BPD)?

Editor's Choice
Main Category: Mental Health
Also Included In: Psychology / Psychiatry
Article Date: 24 Feb 2012 - 0:00 PST


Borderline Personality Disorder (BPD) is a serious emotional condition, typically with a tendency towards unstable and turbulent emotions, heightened anger, feelings of emptiness, and fears of being left alone.

An individual with borderline personality disorder finds it hard to cope with limiting demands of the world around them. They will often take impulsive actions, and as a result, have relationships which become chaotic and unstable. The sufferer's sense of identity may be affected, and relationships with work colleagues, friends and household members may turbulent.

A BPD patient may seem calm and serene one moment, and then suddenly explode in outbursts of anger or rage at what they may perceive as disapproval or rejection.

BPD is often misunderstood. It is more common than other recognized mental illnesses, such as schizophrenia and bipolar disorder. BPD is a serious condition because many people with the condition are prone to self-harm and attempt suicide.

According to Medilexicon's medical dictionary:

Borderline Personality Disorder is "an enduring and pervasive pattern that begins by early adulthood and is characterized by impulsivity and unpredictability, unstable interpersonal relationships, inappropriate or uncontrolled affect, especially anger, identity disturbances, rapid shifts of mood, suicidal acts, self-mutilations, job and marital instability, chronic feelings of emptiness or boredom, and intolerance of being alone."

The term "borderline" comes from the assessment in the 1940s that the disorder was on the border between psychosis and neurosis. But that analysis is no longer relevant. BPD is best understood as a disorder of mood and how a person interacts with others.

Although the causes of BPD are unclear, it appears to be the result of a combination of genetic and environmental factors. Traumatic events that occur during childhood (parental neglect, abandonment, physical, sexual or emotional abuse) are a major risk factor for developing BPD. It is most common in young women. Treatment consists of psychotherapy and medications.

What are the signs and symptoms of Borderline Personality Disorder?

People affected with BPD are terrified of being alone. However, they push others away with their mood swings and erratic behavior. Their identity is blurry and as a result their interests, goals and opinions may shift quickly. They have a tendency to view things and people in terms of extremes alternating between idealization and devaluation. Ordinary details can set off impulsive reactions of anger or despair. Outbursts of verbal abuse and sarcasm may be followed by feelings of guilt.

Other signs and symptoms of BPD may include:

• Chronic feelings of emptiness and boredom
• Frequent displays of inappropriate anger (temper, physical fights)
• Unpredictable mood swings (emotional ups and downs)
• Impulsive and reckless actions (related to money, substance abuse, sexual relationships, gambling spree, binge eating, reckless driving or shoplifting)
• Intense negative emotions (anger, rage, panic, shame, terror, loneliness)
• Thoughts are distorted leading to judging others in terms of "all good" or "all bad"
• Fear of being abandoned leading to frenetic behavior to prevent being left alone (hysterical texting, franticly calling a person and threatening them...)
• Fear of being alone
• Stormy relationships (emotional and professional)
• Uncontrolled emotions or impulses
• Acts of self-injury, such as wrist cutting, cigarette burning, hair pulling, overdosing
• Brief episodes of strange thoughts and hallucinations
• In severe cases of sadness and depression, the impulse can lead to feeling suicidal

Unlike the mood changes in other disorders which may last for weeks or months, the mood swings in BPD generally last just hours. It is common for people with BPD to feel hopeless and suicidal and then feel fairly positive a few hours later.

What are the causes of Borderline Personality Disorder?

The exact cause of BPD is unclear, but most experts agree that it is likely that the condition is caused by a combination of different factors:

• Genetics. The genes inherited from parents may make a person more likely to develop BPD.
• Neurotransmitters. Changes in the levels of certain neurotransmitters can have a powerful effect on mood and behavior.
• Neurobiology. It appears that some people with BPD have a number of regions in the brain with abnormal structure and function. This can affect the nervous system.
• Environmental factors (family and social) . Events that happened in childhood and adolescence such as abandonment, neglect, emotional, physical or sexual abuse, growing up with another family member with a serious mental health condition (such as bipolar disorder or drug problem) seem to be common among people with BPD.
• Neurologic injury in early childhood. There appears to be a high incidence of childhood head injuries in people with BPD.

Family relationships have a strong impact on a person´s outlook on the world and how they perceive other people. Unsolved childhood fears, anger and suffering can have a lasting effect in adult life. They can influence a person´s thinking patterns, emotional expectations and behavior. Diagnosis of BPD is based on a psychological evaluation and the history and severity of the symptoms. A checklist of internationally recognized criteria is used for the diagnosis.

What are the treatment options for Borderline Personality Disorder?

Several types of individual talk therapy can successfully treat BPD. In addition, group therapy can help change self-destructive behaviors. In some cases, medications can help level mood swings and treat depression or other disorders that may occur with this condition.

Medication

The doctor may prescribe an antidepressant to stabilize emotional reactions, resulting in less impulsivity. Most experts say this type of medication should be a short-term treatment. Psychotherapy Psychotherapy helps the patient come to terms with and understand their own thoughts and feeling. It also suggests how the patient might effectively change and alter behavior and attitudes.

• Dialectical behavior therapy (DBT):This type of therapy has been specifically designed to treat people with BPD. It aims at breaking the circle of intense emotions and the feelings of guilt and worthlessness for having these emotions. The therapy brings the patient to accept their emotions and be open to hear other ideas and opinions.
  
  Dialectical behavior therapy is based on weekly individual sessions and weekly group sessions in order to interact with other people with BPD and different therapists.
• Mentalisation-based therapy (MBT): Mentalisation is the capacity to examine one´s thoughts and beliefs, and to assess whether they are practical and realistic. People with BPD have a poor capacity to analyze their thoughts. The goal of MBT is to improve the patient´s ability to recognize their own and others' mental states. The patient learns to understand that other people have their own thoughts, emotions, beliefs, wishes and needs.

A good therapist will give the patient a telephone contact in case of crises moments. Hospitalization, although uncommon, may be considered if there is a risk of self-harm.

Family members (parents, spouses and children) should be educated about the BPD diagnosis. They should have reasonable expectations from treatment and should be explained how they can contribute. Family involvement is also very important for effective treatment.

With proper treatment and support, prognosis is usually good. The outlook depends on the severity of the condition and whether the patient is willing to accept help and commit to long-term treatment.

Written by Christian Nordqvist
Original article date: 18 June 2004. Article updated: 24 February 2012.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations