What is Borderline Personality Disorder?
Borderline Personality Disorder is a mental illness affecting how individuals perceive themselves and others. The illness may affect an individual’s ability to manage their emotions and behavior. As a result, it can cause serious problems in their everyday lives.
Signs and Symptoms
Borderline Personality Disorder may affect an individual’s ability to manage their emotions and behavior. Common signs and symptoms of the condition may include:
- Constant worry about being abandoned and will go to any lengths to prevent it from happening
- Finding it hard to make and keep stable relationships. When individuals do connect to people, these relationships are intense but can end abruptly because of perceived anger or aggression.
- A distorted sense of self that is often changing
- Very intense emotions that can change quickly
- A feeling of emptiness
- Trouble controlling anger
- When stressed, individuals may feel paranoid, imagine seeing or hearing things that others do not, or cannot remember things that have recently happened.
- Impulsive behavior and engagement in hazardous activities such as using drugs, having risky sex, or driving fast.
- Suicidal thoughts and/or engagement in self-harm.
Causes
Like many mental health illnesses, the exact cause of borderline personality disorder is not fully understood. Doctors believe it may be a mixture of:
- Genetics
- Environmental factors, such as abuse or trauma
- Biological brain differences affecting how individuals control their emotions or make decisions.
Risk Factors
Doctors believe that BPD stems from a combination of genetic and environmental factors. Research studies have shown that a person is five times more likely to have the disorder if a close family member, such as a parent or sibling, also has the disorder. Currently, investigators are studying genes that help regulate emotions and control of impulses to find possible links to BPD. Other factors that may cause BPD include:
- Social or cultural influences. Being part of a community or culture in which unstable familial relationships are common may increase one’s risk of having borderline personality disorder.
- Brain abnormalities. Neurologic studies have shown that there are biological differences between the brains of people with and without BPD. The amygdala — the brain’s “fear-sensing” center — is more active in individuals with BPD, while the prefrontal cortex, which is associated with reasoning, may be less developed. Also, several hormones (such as oxytocin) and molecules in the brain (neurotransmitters such as serotonin) may play a role in BPD.
Scientists continue to study the biology of BPD. The results of their research could lead to new, more effective therapies for the disorder.
Diagnosis
Personality disorders, such as borderline personality disorder, are usually diagnosed by a licensed mental health professional, such as a psychiatrist, psychologist or clinical social worker.
The health professional may ask for a patient’s medical history and family medical history. They will also take note of patients’ symptoms, especially concerning their impulse control.
Criteria for diagnosing Borderline Personality Disorder
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a reference book published by the American Psychiatric Association and the standard diagnostic classification tool used by mental health professionals, a borderline personality disorder is “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts.”
To receive a diagnosis of borderline personality disorder, one must meet five or more of the following criteria:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
- Identity disturbance markedly and persistently unstable self-image or sense of self.
- Impulsive behavior in at least two area that are potentially self-damaging, such as spending, sex, substance abuse, reckless driving, or binge eating.
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood, such as intense episodic dysphoria, irritability or anxiety usually lasting a few hours or, in rare cases, a few days.
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger, e.g. frequent displays of temper, constant anger, or recurrent physical fights.
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
People with borderline personality disorder may experience these feelings in response to certain triggers. For example, they may perceive anger in someone’s facial expressions even though that person does not feel angry. Some individuals with BPD may have strong reaction to words with negative meaning. Identifying and learning to respond to these triggers is a major step toward recovering from the illness.
Difference between BPD and Bipolar Disorder
BPD is often confused with bipolar disorder. The two conditions share many similarities, but there are significant differences in how the disorders present in people and the treatment options.
Bipolar disorder is a depressive syndrome characterized by extreme episodes of mania preceded or followed by periods of depression. This can last for days or months. At times, symptoms of depression and mania co-occur. Bipolar disorder is treated with mood stabilizers and antipsychotic medication. While medication is sometimes used in the treatment of BPD, psychotherapy is considered the most efficient treatment method.
Also, people living with borderline personality disorder experience emotional instability almost daily, while those with bipolar disorder may have a consistent mood for long periods. It’s important to note that it is possible to experience borderline personality disorder in addition to bipolar disorder.
Treatments for Borderline Personality Disorder
Psychotherapy is the treatment of choice for Borderline Personality Disorder. Psychiatric medications, used in conjunction with therapy, may help alleviate symptoms of depression and anxiety.
Dr. Frank Yeomans, an expert in the field, refers to the “Big Five” evidence-based treatments:
- Dialectical Behavior Therapy (DBT)- the core idea is about dysregulation and helping individuals to better regulate emotions so they do not express themselves in very exaggerated forms.
- Transference Focused Psychotherapy (TFP)- How does the person perceive an interaction that leads to dysregulation?
- Mentalization - Overlapping with transference focused psychotherapy, mentalization helps individuals understand the contents of their mind.
- Schema therapy - Combination of cognitive behavior therapy and psychodynamic therapy, how the patient experiences themselves in relation to another person, how to correct cognitive misperceptions.
- Good psychiatric management - take what is valuable from all of the methods, teaching the most essential elements of the methods. If this is not effective, an individual can be referred for more intensive treatment.
Treatment and services for Borderline Personality Disorder can be provided in a variety of settings, including:
- Residential care
- Inpatient Care (short-term, focused on crisis stabilization)
- Partial Hospitalization Programs
- Intensive Outpatient Programs
- Outpatient clinics or private practitioners
- Support groups, such as family support groups, peer support groups, and skill-based groups
Suicide and BPD
Suicide is a risk factor for people living with borderline personality disorder (BPD). If you or someone you know is exhibiting signs of suicide, please call 911 for assistance in having the individual evaluated for safety at a local hospital ER, contact a mental health professional, or call the National Suicide and Crisis Lifeline at 988 for immediate assistance.
Signs to look out for include:
- Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself
- Looking for ways to kill oneself by seeking access to firearms, available pills, or other means
- Talking or writing about death, dying, or suicide when these actions are out of the ordinary for the person
- Feeling hopeless
- Feeling rage or uncontrolled anger or seeking revenge
- Acting reckless or engaging in risky activities—seemingly without thinking
- Feeling trapped - like there's no way out
- Increasing alcohol or drug use
- Withdrawing from friends, family, and society
- Feeling anxious, agitated, or unable to sleep or sleeping all the time
- Experiencing dramatic mood changes
- Seeing no reason for living or having no sense of purpose in life
Research has shown approximately 70 percent of people with borderline personality disorder will attempt suicide at least once in their lifetimes. About 10 percent complete the act. This suicide rate is higher than any other psychiatric disorder and the general population.
Finding Help for BPD
Because borderline personality disorder traits are similar to those of other mental illnesses, the disorder is commonly misdiagnosed. If you believe you are struggling with any of the criteria for BPD, you should contact a mental health provider. If you notice these symptoms in a friend or family member, you should speak to that person about contacting a mental health professional. The Borderline Personality Disorder Resource Center can provide guidance in locating treatment resources.