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Borderline Personality Disorder

Borderline Personality Disorder (BPD) is best defined by its symptoms of emotional instability. Patients demonstrate wildly erratic emotions with no external stimulation, and their thinking will become erratic and unstable. This state can alternate with a state of calm rational thinking, and with symptoms of psychosis. BPD affects self-image, behavior and moods, and it can be very disruptive to close personal relationships. Patients with this disorder are often intelligent, warm, friendly and very competent in life.

They can maintain this appearance for years, only showing symptoms of BPD when a very stressful life event occurs. Doctors believe that both environmental (nurture) and genetic (nature) factors play a role in this disorder. BPD remains one of the most controversial diagnoses in mental health. Since the introduction of the BPD diagnosis, doctors have tried to give this disorder a more solid definition. Some research indicates that BPD is a form of Post Traumatic Stress Disorder (PTSD) that is characterized by severe disruption of identity and relationships. Other research indicates that BPD is simply a misused diagnosis, and cannot be considered a defined disorder; noting instead that the symptoms can be attributed to other illness or disease. Whatever the cause or name, BPD is a serious disorder that creates instability in one’s sense of self, and in mood, function, and relationships. With treatment, patients can improve and lead productive lives.

What are the symptoms?

Patients with depression, bipolar and other disorders will often go through ‘phases’ with the same symptoms and mood for several weeks, whereas patients with BPD often exhibit extreme anger or rage, depression, or anxiety for at most, a day, and most often for mere hours. Symptoms can include:

• Extreme Rage, Aggression or Anger
• Attempts at self-injury or talk or attempts of suicide
• Abuse or overindulgence in drugs, alcohol and sex
• Distorted thinking and rapid changes in behavior (including decisions about jobs, relationships, values and even gender identity)
• Not wanting to be alone, needing constant reassurance and affirmation
• Identity disturbances, including uncertainty of self identity, sexuality, goals, life choices
• Overvaluing or undervaluing a friend or family member, overly dependent or demanding with others
• Feeling misunderstood or mistreated
• Feelings of unworthiness, guilt or being a bad person
• Feeling bored, hopeless, depressed, lonely or empty
• Extreme sensitivity to rejection, criticism, and the absence of loved ones, fear of abandonment even for brief separations
• Feelings of isolation and disconnection from social network
• Overspending, overeating, risky sexual activity or other impulsive behavior
• Unusually swift attachment to a new friend or person, alternating with abrupt distancing behavior, trying to push people away
• Great capacity for sensitivity to others, empathy and insight into the behavior and problems of others
• Difficulty in trusting others and themselves

How is it diagnosed and treated?

The assessment for BPD typically includes a physical, and the doctor will take a medical history, to ensure that other health conditions are not causing the symptoms. Since the symptoms of BPD can masquerade as other mental health conditions the doctor will also do a complete mental health exam. It is not unusual for BPD to coincide with other mental health disorders like bipolar disorder or bulimia nervosa, so the resulting diagnosis may include more than one condition. Treatment for BPD has drastically improved in the past few years, as doctors have learned more about the symptoms and patterns of the disorder.

Treatment can include one or more of the following:

• Avoids jobs or school activities that involve a lot of interpersonal contact.
• Shows lack of intimacy and fear of ridicule and embarrassment
• Poor peer relationships
• Apprehensive and anxious in social situations
• Does not get involved with others unless patient is certain they will be liked
• Reluctant to take personal risk or engage in new activities
• Conduct problems in school or at work
• Feels inadequate, incompetent and unappealing

Treatment(s) can include:

• Social Rehabilitation
• Hospitalization in extreme cases
• Psychotherapy
• Group therapy and self-help groups
• Dialectical Behavioral Therapy (DBT)
• Medications – antidepressant and/or mood stabilizing medication

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