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    Borderline Personality Disorder

    Borderline Personality Disorder (BPD) is a type of mood disorder where your mood, behavior, thinking, interpersonal relationships – everything feels unstable. It is a serious kind of mental disorder where you feel like you are on a rollercoaster. There are also intense episodes of anger, anxiety, and depression for a few hours to days. You become extremely sensitive. Even small issues tend to trigger intense reactions with high rates of suicide attempts. Compared to an individual with bipolar disorder or depression, an individual with BPD experiences bouts of anger, depression, and anxiety that will last for a few hours to days.

    In 1980, borderline personality disorder was listed as a diagnosable illness for the first time by the Diagnostic and Statistical Manual for Mental Disorders, third edition (DSM-III). The DSM manual is used by many psychiatrists and mental health professionals to diagnose mental illnesses.

    Why Is Borderline Personality Disorder Important?

    About 1.4% of adults in the U.S. have BPD. Recently, researches have shown that males and females are equally affected. The condition is more likely to be diagnosed in your 20s. Many people find that their symptoms become more manageable as they get older, and many people recover by the age of 50 years.

    Causes Of Borderline Personality Disorder?

    It is not clearly known why people experience symptoms of BPD. However, some factors have been shown to be linked with BPD:

    • Stressful life events
    • Traumatic events such as:

    a. losing a parent

    b. family instabilities like a parent with an addiction

    c.  physical, emotional, or sexual abuse

    d. feeling neglected, upset, or afraid

    • Genetic factors

    There is some evidence that genetic factors could be a cause of BPD. If someone in your family has BPD, you are then most likely to be given this diagnosis. But it is not certain whether BPD is inherited or other factors are responsible for it like the family environment you grow up with, the ways of coping, behaving, or thinking that you learn from people surrounding you. However, twin studies have shown strong inheritance.

    • Difference in brain structure and function

    Some research has shown changes in certain brain areas that are involved in regulating emotions and aggression. Certain brain chemicals that help to regulate mood, such as serotonin, may not function properly.

    The 4 Types of Borderline Personality Disorder

    a.  Discouraged borderline personality disorder

    b.   Impulsive Borderline personality disorder

    c.   Petulant Borderline

    d.   Self-destructive

    A discouraged borderline individual shows clingy and codependent behavior and tends to follow a group although seeming dejected. They usually are filled with anger and disappointment towards those around them. They are engaged in self-mutilation and even suicide.

    An impulsive borderline person is highly energetic, charismatic, flirtatious, and engaging. They seek thrills and are easily bored. They usually act first and then think later so they often get into trouble. This leads to substance abuse and self-harm.

    Petulant borderline behavior is characterized by irritability, unpredictability, defiance, and impatience. They are stubborn and pessimistic. These people can’t resist relying on others and also fear being disappointed.

    A self-destructive borderline person is usually terrified of being abandoned. They are likely to engage in reckless driving and other unacceptable acts that are self-destructive whether conscious or unconscious.

    Symptoms and Signs of Borderline Personality Disorder 

    The main characteristics of Borderline Personality Disorder are instability and impulsivity. Not everyone with Borderline Personality Disorder experiences every symptom. Some people experience only a few symptoms while others may experience multiple symptoms. According to The Diagnostic and Statistical Manual of Mental Disorders to be diagnosed as a Borderline Personality Disorder a person must have at least 5 of the following symptoms.

    9 Borderline Personality Disorder Symptoms

    1. Fear of abandonment – even if the fear of abandonment is minor or imagined there are frantic efforts to avoid being alone. Even something as small as a loved one arriving home late from work or going away for the weekend may trigger intense fear
    2. Intense and unstable relationships with others which frequently alternates between admiration and depreciation. Relationships are often intense and short-lived. You may fall in love quickly, thinking that the person is the one, only to be quickly disappointed
    3. Identity issues with an unstable sense of self-esteem. Sometimes you feel good about yourself but other times you hate yourself or even view yourself as an evil person. In the end, there are chances of losing your jobs, friends, lovers, religion, values, or sexual identity
    4. Impulsivity – self-damaging acts, inability to control impulsivity like shoplifting, drug abuse, and appending sprees, or binge eating, etc.
    5. Suicidal behavior, gestures, or threats – suicide notes are frequently written and left in areas where they can be easily found
    6. Self-mutilating behavior – resulting in self-inflicted physical injury to oneself.
    7. Persistent feelings of emptiness: you may feel as if you are completely unworthy. The feeling is uncomfortable, so you may try to indulge in things like drugs, food, or sex. But nothing feels truly satisfying.
    8. Inappropriate or hard to control anger – acts of violence. There is trouble controlling yourself like yelling, throwing things, or becoming completely consumed by rage. There often are times where you feel angry at yourself
    9. Short-lasting or stress-evoked paranoia, suspicious thoughts, or severe dissociation. You may feel spaced-out, foggy, or as if you are not in your own body.

    Sufferers tend to have an extreme reaction to things like a vacation, business trips, and sudden change in plans or being a few minutes late to an appointment. There can be suicidal tendencies as well. They are usually extremely sensitive to their environment. Feelings can quickly shift from the feeling of intense love to a feeling of not being loved or being there for them.

    Self-harming behaviors like eating disorders, substance abuse, reckless driving, self-mutilation, inappropriately extravagant, or risky sexual behavior. They have a feeling of separateness or “out-of-body” experiences. The frequency, duration, and severity of symptoms depend on the individual and their illness.

    Tools for Assessment of Borderline Personality Disorder

    Borderline Personality Disorder cannot be diagnosed at home. It is better to seek help from a health professional. A Borderline Personality Disorder is often misdiagnosed or under-diagnosed. There is no test specific for BPD.

    • Self-reported experiences of the sufferer
    • comprehensive personal and family history
    • physical examination
    • blood test to exclude HIV or Syphilis
    • electroencephalogram (EEG), CT Scan to exclude epilepsy and brain lesions
    • examination of mental state

    Research & Treatment of Borderline Personality Disorder

    Luckily, Borderline Personality Disorder is a treatable condition even though it was difficult to treat in the past. The long-term prognosis for BPD is better than for bipolar disorder or depression.

    Evidence has shown:

    • 40% remission in 2 years
    • 68% remission in 6 years
    • 85% remission in 10 years

    Remission is defined as no longer meeting the 5 out of 9 symptoms criteria. However, remission does not mean “recovery” or having a good quality of life. The following are the treatment options available.

    1. Psychotherapy, Psychodynamic therapy, or “talk” therapies

    It is usually the first treatment for people with a borderline personality disorder.

    2. Dialectical Behavior Therapy (DBT)

    It focuses on the concept of mindfulness or being aware of and attentive to the current situation. This type of therapy teaches the skills to control intense emotions, decreases self-destructive behaviors, and helps improve relationships. It differs from Cognitive Behavioral Therapy in that it seeks a balance between changing and accepting beliefs and behaviors. Individual, family, and marital counseling may be required according to the needs.

    3) Cognitive Behavioral Therapy (CBT)

    Cognitive Behavioral Therapy (CBT) can help people with a Borderline Personality Disorder to identify and change their beliefs and/or behaviors that cause inaccurate perceptions of themselves and others and ultimately causing problems interacting with others. It may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

    4) Schema-focused therapy

    This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas or the ways people view themselves. This approach is based on the fact that BPD occurs from a dysfunctional self-image that is brought about by negative childhood experiences. It affects how people react to their environment, interact with others, and cope with problems or stress.

    5) Group therapies

    Interpersonal, family, and problem-focused therapies. Therapy can be provided either between the therapist and the patient or it can be done in a group setting. Sessions led by therapists can assist in helping people with BPD on how to self-express better. Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a type of group therapy. It is led by an experienced social worker and is designed as a relatively brief treatment that consists of twenty 2-hour sessions. This training when used with other types of treatment (medications or individual psychotherapy), can help decrease symptoms and problem behaviors of borderline personality disorder, relieve symptoms of depression and improve the quality of life.

    Therapy may also be beneficial to families of people with a borderline personality disorder. It carries a lot of challenges and is very stressful to deal with a relative who is ill daily and family members may unknowingly act in ways that worsen their relative’s symptoms. DBT-family skills training (DBT-FST) is a training program that includes family members in treatment sessions. They help family members in developing skills to better understand and support a relative with a borderline personality disorder. Other therapies like Family Connections, focus on the needs of family members.

    6) Counselling

    Healthy habits like getting enough sleep, eating healthy foods, getting regular exercise, and avoiding alcohol and/or drugs. These habits can reduce stress and anxiety, and can help to make the symptoms less severe and less frequent.

    7) Medications

    No medications have been approved by the U.S. Food and Drug Administration for treatment of BPD. However, the role of medications is to manage symptoms, though the benefit is often uncertain due to ‘symptom chasing’ (which means that the sufferer addresses only the symptoms but does not think about the bigger picture as to why it happened or how to prevent it.

    Treatment of other associated illnesses should be done side-by-side.

    Many people experience fewer or less severe symptoms if proper treatment is provided to them. However, many factors affect the amount of time it takes for symptoms of BPD to improve, so the sufferers need to be patient and receive appropriate support during the treatment. Some people experience severe symptoms and require intensive, inpatient care.

    What Are The Complications Of Borderline Personality Disorder?

    Borderline Personality Disorder can damage many areas of day-to-day life with negative effects on intimate relationships, school, social activities, jobs, and self-image. Many sufferers struggle silently due to the fear of burdening their close ones. This complicates the situation leading to:

    • repeated job losses
    • inability to complete education
    • stressful lifestyle, marital stress, or divorce
    • self-injury like cutting or burning with frequent hospitalizations
    • legal issues like imprisonment
    • unplanned pregnancies, road-traffic accidents, sexually transmitted infections, physical fights due to impulsive behavior
    • suicidal attempts
    • involvements in an abusive relationship

    Conditions That Mimic Borderline Personality Disorder 

    The following conditions often mimic and sometimes co-occur with Borderline Personality Disorder.

    References:
    1. https://www.nimh.nih.gov/health/statistics/personality-disorders.shtml
    2. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
    3. https://www.helpguide.org/articles/mental-disorders/borderline-personality-disorder.htm
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